【摘要】 目的探讨实时三维超声心动图及其定量技术在评价心脏再同步化治疗(cardiac resynchronization therapy,CRT)短期疗效中的临床应用价值。方法对组织多普勒提示有左心室非同步的慢性充血性心力衰竭患者18例进行心脏再同步化治疗,起搏前和起搏后1个月行实时三维经胸超声心动图检查,获取左心室的全容积图像,应用Qlab分析软件,得到左室整体与17阶段时间-容积曲线(VTCs),记录左室舒张末容积(EDV)、左室收缩末容积(ESV)、左室射血分数(LVEF)、左室16、12、6节段达最小容积点时间(Tmsv)的标准差(即Tmsv16-SD,Tmsv12-SD和Tmsv6-SD)和最大时间差(即Tmsv16-Dif,Tmsv12-Dif和Tmsv6-Dif)。结果利用三维全容积法测量,与起搏前相比,起搏后所有患者的心率无明显变化,但左室舒张末容积和收缩末容积均有明显的减少(P<0.001),而LVEF值明显升高(P<0.001),Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif、Tmsv16-SD、Tmsv12-SD和Tmsv6-SD均显著减少(P均<0.001)。结论CRT可明显改善心力衰竭患者的心功能。实时三维超声心动图的左室容积-时间曲线形态及参数能为CRT治疗的短期疗效评估提供较完整的定量信息。更多还原

【Abstract】 Objective To assess the short-term effects of cardiac resynchronization therapy using real-time three-dimensional echocardiogrphy.Methods Eighteen congestive heart failure patients with mechanical dyssyn-chrony determined by tissue Doppler imaging were enrolled.Philips IE33 with X3-1 probe was used to perform full volume real-time three-dimensional echocardiography(RT-3DE)before and one month after CRT.The global and 17-segmental volume curves(VTCs) were obtained by the on-line Qlab software.The end diastolic volume(EDV),end systolic volume(ESV),left ventricular ejection fraction(LVEF),the dispersion of time to minimum regional volume for 16、12 and 6 left ventricular segment(Tmsv16-SD、Tmsv12-SD and Tmsv6-SD),and the maximum difference of time to minimum regional volume for16、12 and 6 left ventricular segment(Tmsv16-Dif 、Tmsv12-Dif and Tmsv6-Dif).The short-time changes of these parameters were investigated.Results There were no difference in heart rate before and one month after CRT.CRT increased SV 、LVEF(P<0.01),decreased EDV、ESV(P<0.01),and shortened Tmsv16-SD,Tmsv16-Dif,Tmsv12-SD,Tmsv12-Dif,Tmsv6-SD and Tmsv6-Dif.Conclusions CRT could significantly improve the cardiac function in patients with heart failure.The shape and parameters of VTCs by RT-3DE can provide unique quantitative information for assessing the short-term outcome of CRT.更多还原