摘要
目的应用普通超声心动图及组织多普勒成像技术探讨慢性心力衰竭患者QRS波群时限与心室收缩的不同步性关系。方法96例慢性心力衰竭患者根据QRS波群时限分三组,组ⅠQRS波群时限<120 ms,组ⅡQRS波群时限≥120 ms,<150 ms,组ⅢQRS波群时限≥150 ms。应用多普勒超声心动图分别测量QRS波群起点至主动脉、肺动脉前向血流频谱开始的时间间期,二者的差值为左右心室间电机械延迟(IVMD),应用组织多普勒测量左房室环各部位左室收缩期电机械运动时间的离散度。结果三组受试者不论QRS波群宽度均存在心室间(分别为13.9%、53.8%、68.1%,P<0.05)或心室内(分别为30.6%、61.5%、72.3%,P<0.05)不同步现象。一部分QRS波群正常或轻度增宽的慢性心力衰竭患者也表现出心室间或心室内的不同步性(13.9%、30.6%)。QRS时限越长,存在不同步的比例越高。QRS波群时限与IVMD呈正相关(r=0.66,P<0.01)。结论部分QRS波群正常或轻度延长慢性心力衰竭患者也存在心室间或心室内的不同步性。联合应用普通超声心动图和组织多普勒技术可以用来评价心肌运动的不同步性。
Objective To assess the prevalence of interventricular and intraventricular contractile dyssynchrony in chronic heart failure patients with either normal or prolonged QRS duration. Methods Ninety - six patients with chronic congestive heart failure were divided into three groups according to QRS duration. The aortic pre - ejection time was measured from the beginning of QRS complex to the beginning of aortic flow velocity curve recorded by pulsed- wave（PW） Doppler detection at apical 5 -chamber view, The pulmonary pre -ejection time was measured from the beginning of QRS complex to the beginning of the pulmonary flow at left parasternal view, The difference between these two values determined the interventricular mechanical delay（IVMD）. Pulse Tissue Doppler Imaging was performed to record the time dispersity of electromechanical motion of mitral annulus at four positions （ septal, lateral, anterior and inferior wall） at the level of basal and medium segments. Results Interventricular and intraventricular dyssynchrony were commonly seen in patients with chronic congestive heart failure regardless of QRS duration. Interventricular dyssynchrony was found in 13, 9% ,53.8% and 68.1% of patients in Group Ⅰ , Ⅱ and Ⅲ respectively（ P 〈 0.05 ）, Intraventricular dyssynchrony was observed in 30.6% ,61.5% and 72.3% of patients in Group Ⅰ , Ⅱ and Ⅲ respectively（ P 〈0.05 ）. There was a substantial proportion of chronic heart failure patients with normal QRS duration exhibiting dyssynchrony. The inerventricular delay was significantly related to QRS duration. Conclusion A substantial proportion of chronic heart failure patients with normal QRS or slightly prolonged QRS may exhibit ventricular dyssynchrony, Both standard echocardiography and TDI can be applied for evaluation of mechanical abnormalities due to ventricular dyssynchrony.
出处
《临床和实验医学杂志》
2008年第3期25-27,共3页
Journal of Clinical and Experimental Medicine
