组织同步显像对不同病因心力衰竭患者心脏再同步化治疗的评价

摘要

目的：探讨应用组织同步显像（TSI）技术评价心脏再同步化治疗（CRT）慢性心力衰竭患者的临床应用价值。方法选择拟行CRT的慢性心力衰竭患者34例，根据病因不同分为缺血性心肌病（ICM）组12例和非缺血性心肌病（NICM）组22例。应用常规超声心动图及TSI技术观察两组患者术前及术后6个月左室收缩功能指标和心脏同步性参数的变化，并对其进行比较分析。结果术前两组患者均存在明显的心脏失同步；术后6个月两组患者心脏失同步均得到不同程度改善，表现为延迟节段数及左室收缩后收缩发生率（PSS％）减少，左室12节段达峰时间标准差（Ts－SD）、左室12个节段达峰时间的最大值与最小值之差（Ts max－min）、室间隔及左室侧壁基底段达峰时间差（TS－L delay）明显缩小，与术前比较差异均有统计学意义（P＜0．05）；术后6个月NICM组同步性改善更佳，Ts max－min、PSS％及重度延迟节段数与ICM组比较差异均有统计学意义（均P＜0．05）。术后6个月两组患者左室收缩末容积（LVESV）、左房容积（LAV）及左室射血分数（LVEF）均较术前明显改善，差异均有统计学意义（均P＜0．05）；术后6个月NICM组LVEF、LVESV改善情况优于ICM组，差异均有统计学意义（均P＜0．05）。结论 TSI技术可以快捷有效地评价心力衰竭患者的机械不同步，CRT术后ICM和NICM患者的左室同步性及心脏功能均得到改善，NICM患者疗效更佳。%Objective To explore the value of tissue synchronization imaging(TSI) in cardiac resynchronization therapy (CRT) for patients with chronic heart failure. Methods Three-forty patients with chronic heart failure were divided into ischemic cardiomyopathy(ICM) group(n=12) and non-ischemic cardiomyopathy(NICM) group(n=22) by heart failure etiology. Left ventricular systolic function parameters and cardiac synchrony parameters before and 6 months after CRT were observed by conventional echocardiography and TSI,and CRT effect was assessed. Results The assessment of preoperative TSI in all patients indicated the presence of ventricular dyssynchrony. Compared with those of pre-CRT,the figures of the delay segments,post systolic shortening(PSS)%,Ts-SD,Ts max-min and TS-L delay of the two groups had decreased. The differences of Ts max-min, PSS%and the number of the severe delay segments were statistically significant between the two groups after CRT(all P<0.05). Compared with pre-CRT , left ventricular end-systolic volume(LVESV), left atrium volume(LAV) and left ventricular ejection(LVEF) were significantly improved after CRT in two groups(all P<0.05). LVEF and LVESV were significant improved in NICM group than those in ICM group after CRT(all P<0.05). Conclusion Mechanical dyssynchrony can be evaluated by TSI effectively. There are improvements in the left ventricular synchronization and cardiac function in patients of both groups,but NICM patients have better curative effects.