| 摘要: |
| 目的研究实时三平面组织同步性成像（RT3P-TSI）对慢性心力衰竭（CHF）伴宽QRS波群患者左心室同步性的评估意义。方法选择CHF伴宽QRS波群患者75例，对照组75例，分别以RT3P-TSI技术和传统二维组织同步性成像（2D-TSI）技术测量同一心动周期下各个节段收缩达峰时间（Ts）并进行定量分析。比较RT3P-TSI和2D-TSI测量CHF患者及对照组左心室失同步情况，同时比较两种技术操作时间。15d后复测比较操作者间变异及操作者本人变异。结果与对照组相比，CHF组左心室各节段Ts及各节段收缩达峰时间最大差值（Ts-diff）明显延长（P＜0.01），CHF组后壁基底段Ts最大，侧壁基底部次之，对照组后壁基底段Ts最大，其次为下壁基底部。以收缩达峰时间标准差（Ts-SD）≥33ms判断为左心室失同步，QRS时间≥130ms患者中，2D-TSI法测量CHF组与对照组左心室失同步率分别为81.34%、65.21%（P＜0.05），RT3P-TSI法测量CHF组与对照组左心室失同步率分别为80.0%、71.7%（P＞0.05）。Pearson相关性分析提示2D-TSI与RT3P-TSI测量Ts及Ts-SD值相关性良好（r=0.85、0.57，均P＜0.01）。RT3P-TSI检查花费时间（59.8±11.8）s，低于2D-TSI（155.6±13.4）s。RT3P-TSI法操作者内变异率及操作者间变异率均低于2D-TSI法。结论CHF伴宽QRS波群患者左心室失同步率高于宽QRS波群但无CHF患者,CHF组左心室各节段收缩延迟，后壁基底段收缩最缓慢。采用RT3P-TSI可以得到与二维方法相近的左心室运动同步信息,其优势是切面规范，人为干扰减少，操作简便快捷。 |
| 关键词: 实时三平面组织同步性成像 左心室失同步 慢性心力衰竭 宽 QRS 波群 |
| DOI：10.12056/j.issn.1006-2785.2017.39.5.2016-1243 |
| 分类号: |
| 基金项目:浙江省重大科技专项计划项目（2012C13018-1） |
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| Assessment of left ventricular dyssynchrony in chronic heart failure patients with wide |
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MAO Ping, ZHOU Litao, XU Chenkai, TANG Lijiang, SUN Yanguang
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Zhejiang Hospital
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| Abstract: |
| Objective To investigate the application of real-time triplane tissue synchronization imaging (RT3P-TSI) in
assessment of left ventricular synchrony for chronic heart failure (CHF) patients. Methods Seventy five CHF patients with wide QRS complex and 75 controls were enrolled in the study. The subjects underwent RT3P-TSI and conventional two dimensional TSI (2D-TSI) examinations. The dyssynchrony indices in six basal and six middle segments of left ventricle were compared between the two methods. Time consuming during examination was recorded; interobserver and intraboserver variability were
calculated 15 days later. Results In the CHF group, the values of Ts and Ts-diff were significantly larger than those in control group (P ＜0.01). The biggest value of Ts in CHF group was observed in posterior basal segment, followed by lateral basal segment. When using Ts-SD≥33ms as definition for systolic dyssynchrony, the rate of dyssynchrony in CHF group was higher than that in control group (81.34% vs 65.21%, P＜0.05 as measured by 2D-TSI, 80.00% vs 72.57%, P ＞0.05, as measured by
RT3P-TSI). Pearson correlation analysis showed that the correlations between Ts and Ts-SD value calculated by two methods were moderate to high (r=0.85, 0.57). The examination time of RT3P-TSI was lower than that of 2D-TSI (59.8± 11.8 vs 155.6±
13.4 sec). Interobserver and intraboserver variability in evaluation of Ts by RT3P-TSI were lower than that by 2D-TSI. Conclusion The prevalence of left ventricle dyssynchrony was much higher in CHF patients with wide QRS complex than that in non-CHF patients with wide QRS complex. In CHF patients the left ventricle contracts are delayed in most segments, particularly in posterior wall. The RT3P-TSI method demonstrates excellent agreement with conventional 2D-TSI in evaluation of left ventricular synchronization with less time consuming and less variability. |
| Key words: Real-time triplane tissue synchronization imaging Left ventricle dyssynchrony Chronic heart failure
Wide QRS complex |
