斑点追踪显像技术评价心力衰竭患者左室扭转不同步运动

摘要

目的 应用二维超声斑点追踪显像技术观察慢性心力衰竭患者左室运动情况.方法 选取我院心血管内科住院部确诊的收缩性心力衰竭患者35例(心衰组),依据患者心电图QRS时限,可将其分为A组(QRS时限≥120 ms)与B组(<120 ms) 两亚组,另选同期健康体检者35例为正常组.应用斑点追踪显像技术对心衰组和正常组左室心肌扭转运动进行分析,比较两组扭转达峰时间(T-Peaktw)、6节段达峰时间标准差(Rot-SD)、6节段达峰最大时间差(Rot-diff)及两亚组间的Rot-SD、Rot-diff及左室旋转达峰时间.结果 正常组与心衰组心尖部Rot-diff分别为(28±52)ms、(133±86)ms,基底部Rot-diff分别为(51±70)ms、(144±101)ms,两组比较差异有统计学意义(P <0.05);心衰组心尖部和基底部Rot-SD均明显大于正常组[ 心尖部:(58±39)ms vs.(14±27)ms,基底部:(60±40)ms vs.(22±29)ms],差异有统计学意义(P <0.05).心衰组中A组与B组Rot-SD、Rot-diff及左室旋转达峰时间比较差异均无统计学意义.结论 心力衰竭患者的心尖部与基底部心肌旋转方向多变,各节段旋转不同步,扭转效率下降;心室扭转不同步参数,即Rot-diff与Rot-SD可反映左室心肌运动同步性,有望用于指导心脏再同步化治疗;心电图QRS时限不能作为评价左室不同步运动的可靠指标.%Objective To observe left ventricular (LV) torsion mechanics in patients with heart failure by two dimensional speckle tracking imaging (STI). Methods Thirty-five healthy subjects (control group) and 35 patients with chronic heart failure (heart failure group) were enrolled in this study .The patients in heart failure group were divided into two subgroups according to the duration of the QRS wave( ≥ 120 ms or<120 ms). Then the parameters of LV torsion(Rot-diff,Ret-SD and LV torsion peak time) were analyzed by STI technique.Results The apical Rot- diff in control group and heart failure group were (28± 52) ms and (133± 86) msahe basic Rot-diff were (51 ± 70) ms and (144 ± 101) ms, there was significant difference between the two groups (P <0.05). The apical and basic Rot- diff in heart iailure group were higher than that in control group [apical: (58± 39)ms vs. (14± 27)ms, basic: (60± 40)ms vs. (22± 29)ms] . There was no significant differnce in Rot- SD, Rot- diff and LV torsion peak time between two subgroups in heart failure group . Conclusion The rotating direction of the apical or basic level is varying, and the rotation of segments is out of synchrony, leading to the decreas of LV torsion efficiency. Rot-diff and Rot-SD can reflcets the dyssynchrony of LV wall, and it can be used in cardiac resynchronization therapy.The duration of QRS wave is not a reliable index to evaluate the left ventricular dyssynchrony.