超声二维斑点追踪技术评价严重心收缩功能不全患者左室扭转及解旋研究

摘要

目的：采用二维斑点追踪技术（2DS）评价严重心收缩功能不全患者心肌扭转和解旋运动发生的变化，以及这些改变与左室舒缩功能的关系。方法：采用心尖双平面Simpson＇s法测量左心室射血分数（LVEF），对10例LVEF＜35％的严重心收缩功能不全患者和10例正常对照组使用EchoPAC工作站的2D Strain软件进行脱机分析。测算左室基底段和心尖段心肌旋转率、解旋率、旋转达峰时间、解旋达峰时间以及两者的达峰时间间期，测量收缩末左室整体扭转角度。结果：严重心收缩功能不全组左室旋转率、解旋率及左室整体扭转均显著低于正常组（P＜0．01），尤以左室心尖部旋转率的差异最为显著（P＜0．001）。两组时间参数的比较显示严重心收缩功能不全组左室旋转及解旋达峰时间提前，旋转及解旋时间间期的差异有显著性意义（P＜0．01）。两组左室旋转参数与 LVEF 相关性良好（r＞0．60，P＜0．01），尤以左室心尖部旋转率与LVEF的相关性最为显著（r＝0．73，P＜0．01）。结论：超声二维斑点追踪技术通过分析左室心肌扭转和解旋的相关参数，可准确评价严重心收缩功能不全患者左室收缩和舒张功能，为临床正确认识心功能障碍程度和性质提供一种可信赖的新方法。%Objective:This study was performed to evaluate the changes of left ventricular twist and untwist in pa-tients with serious cardiac systolic insufficiency,as well as the relationship between the changes and systolic or diastolic function of left ventricle using two dimensional speckle tracking imaging (2DS).Methods:Left ventricular ejection fraction (LVEF)was measured using apical two-plane Simpson′s method.A total of 10 patients with severs cardiac systolic insuffi-ciency (LVEF<35%)and 10 healthy control subjects were included in this study.Two-dimensional images were stored and transferred to EchoPAC workstation for offline strain analysis using three consecutive cardiac cycles of acquired loops.The peak apical rotation rate (PtwR apex),peak basal rotation rate (PtwR base),peak basal untwisting rate (UntwR base), peak apical untwisting rate (UntwR apex),peak left ventricular twist (Ptw),and time to peak left ventricular twist and un-twist (TPtw,TPUtw),and difference between apical and basal time to peak left ventricular twist and untwist (Tabtw, Tabuntw)were measured.Results:Compared with control subjects,PtwR apex,PtwR base,UntwR base,UntwR apex,and Ptw significantly decreased in patients with severe cardiac systolic insufficiency (P<0.01),especially in PtwR apex (P<0.001).Moreover,TPtw and TPUtw were earlier in patients with severe cardiac systolic insufficiency than control subjects, and the differences of Tabtw and Tabuntw in two groups were significant (P<0.01).A high correlation was found between left ventricular rotational parameters and LVEF (r>0.60,P<0.01),especially in PtwR apex (r= 0.73,P<0.01).Conclu-sion:2DS could be accurately used to evaluate the left ventricular systolic and diastolic function in patients with severe cardi-ac systolic insufficiency by measuring the left ventricular twist and untwist parameters.It provides a new convincing method to identify the degree and nature of cardiac systolic insufficiency clinically.