摘要
目的 探讨斑点追踪成像评估心脏再同步化治疗（CRT）对扩张型心肌病患者左心室（左室）舒张功能的影响.方法 21例行CRT的扩张型心肌病患者,男15例,女6例,平均年龄62.5±11.2（49 ～82）岁.所有患者术前及术后6个月均采用常规超声心动图、组织多普勒成像和斑点追踪成像测定左室同步性、左室收缩和舒张功能,并根据临床表现评估术前及术后6个月患者心功能分级.CRT临床有反应定义为术后6个月NYHA心功能分级改善l级以上;CRT超声心动图有反应定义为术后6个月左室收缩末期容积减少15％.结果 CRT临床有反应者16例,无反应者5例.采用常规超声评估有反应者和无反应者左室舒张功能,除舒张早期二尖瓣血流速度减速时间差异有统计学意义外,其余舒张功能各参数组间差异均无统计学意义.而采用斑点追踪成像评估有反应者和无反应者舒张功能,结果显示二者左室等容舒张期应变率分别为（0.18±0.11）/s和（0.14±0.09）/s（P＜0.001）,舒张早期二尖瓣口血流速度/左室等容舒张期应变率比值分别为680±600和787±690（P＜0.05）,且左室等容舒张期应变率与反映左室功能的血液B型利钠肽有较好的相关性（r=-0.68,P＜0.05）.结论 对CRT有反应的扩张型心肌病患者,CRT在改善其左室收缩功能和减少二尖瓣反流同时也可明显改善其左室舒张功能.斑点追踪成像可准确有效地评估CRT术后患者左室舒张功能的变化.
Objective To investigate the effects of cardiac resynchronization therapy （CRT） on left ventrieular （LV） diastolic function measured by speckle tracking imaging （STI） in patients with dilated eardiomyopathy （DCM）. Methods CRT was performed in 21 DCM patients [ 15 male,mean age： 61.2 ± 11.2 （49 - 82 ） years ~. LV synchronization, LV systolic function and LV diastolic function were evaluated with conventional echocardiography, tissue Doppler imaging and STI before and 6 months after CRT. NYHA heart function was also assessed. Clinic Response to CRT was defined as improvement of more than 1 NYHA class. Response to CRT in eehocardiography was defined as ≥ 15% reduction in LV end systolic volume at 6 months post CRT. Results There were 16 responders and 5 non-responders at 6 months post CRT. In terms of diastolic function, conventional eehocardiography derived deceleration time was both prolonged in non- responders and responders. At 6 months post CRT, STI derived LV isovolumetric diastolic strain rate [ （0. 19 -± 0. 11 ） /s vs. （ 0. 14 ± 0. 09 ） /s, P 〈 0. 001 I was significantly increased while early diastolic mitral valve blood flow velocity/left ventricular isovolumetric diastolic strain rate （680 ± 600 vs. 787 ± 690, P 〈0. 04） was significantly reduced in responder group while remained unchanged in non-responder group. Furthermore,left ventricular isovolumetric diastolic strain rate negatively correlated with plasma brain natriuretic peptide level （ r = - 0. 68, P 〈 0. 05 ）. Conclusion In CRT responders of DCM patients, LV diastolic function is significantly improved and this change could be detected more effectively by STI derived LV diastolic function parameters.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第11期940-944,共5页
Chinese Journal of Cardiology
关键词
心肌病
扩张型
超声心动描记术
心室功能
左
心脏再同步化治疗
Cardiomyopathy, dilated
Echocardiography
Ventricular function, left
Cardiacsynchronization therapy
