三维斑点追踪超声心动图用于评估左心室功能和机械性不同步。
Three-dimensional speckle tracking echocardiography for the assessment of left ventricular function and mechanical dyssynchrony.
作者信息
Kang Yu, Sun Min-Min, Cui Jie, Chen Hai-Yan, Su Yan-Gang, Pan Cui-Zhen, Shu Xian-Hong
机构信息
Dept. of Echocardiography, Zhongshan Hospital of Fudan University; Shanghai Institute of Cardiovascular Disease, Shanghai, China.
出版信息
Acta Cardiol. 2012 Aug;67(4):423-30. doi: 10.1080/ac.67.4.2170683.
OBJECTIVE
Evaluation of left ventricular (LV) function and dyssynchrony is of vital importance. A newly-developed three-dimensional (3D) speckle tracking echocardiography (STE) has the potential to circumvent limitations of two-dimensional STE. Our study was to evaluate LV function and dyssynchrony by 3D-STE.
METHODS AND RESULTS
Fifty-two non-ischaemic dilated cardiomyopathy patients (DCM) with complete left bundle-branch block and 55 healthy subjects were enrolled. Of these patients, 24 underwent cardiac resynchronization therapy (CRT). 3D-STE was performed before and 1 month after CRT. We measured 3D (3DS), longitudinal (LS), circumferential (CS) and radial (RS) strain of the LV. LV dyssynchrony was evaluated by the standard deviation of time to peak negative value of 3D strain (3DS-SD) and time to reach the minimum regional volume of 16 segments (SDI) related to the heart cycle. DCM patients had significantly lower global 3DS (-17.12 +/- 6.70% vs -38.38 +/- 4.28%, P < 0.01), significantly greater 3DS-SD (11.11 +/- 5.14% vs 4.04 +/- 1.43%, P < 0.01) and SDI (9.69 +/- 4.82% vs 4.23 +/- 1.33%, P < 0.01) than normal volunteers. 3DS, LS, CS, RS had an excellent correlation with LV ejection fraction (LVEF) (r2 = -0.94, -0.91, -0.93, 0.89, respectively, P < 0.01 for all). 3DS-SD correlated well with SDI (ICC = 0.85). For mild, moderate and severe systolic dysfunction, 3DS-SDs were 4.56 +/- 1.53%, 9.87 +/- 2.58%, and 14.55 +/- 4.71%, respectively (P < 0.01) and SDIs were 4.46 +/- 1.27%, 8.19 +/- 2.35%, and 12.83 +/- 4.87%, respectively (P < 0.01), but independently of QRS width. After CRT therapy, global 3DS (-13.12 +/- 2.63% to -14.06 +/- 2.53%, P = 0.025), 3DS-SDs (12.99 +/- 3.92% to 11.53 +/- 4.53%, P = 0.015) and SDIs (10.85 +/- 3.74% to 9.50 +/- 4.63%, P = 0.013) were markedly improved.
CONCLUSION
When image quality is optimal, 3D STE seems to be a promising approach assessing LV function and dyssynchrony.
目的
评估左心室（LV）功能及不同步性至关重要。新开发的三维（3D）斑点追踪超声心动图（STE）有可能克服二维STE的局限性。我们的研究旨在通过3D-STE评估LV功能及不同步性。
方法与结果
纳入52例患有完全性左束支传导阻滞的非缺血性扩张型心肌病（DCM）患者及55名健康受试者。其中24例患者接受了心脏再同步治疗（CRT）。在CRT前及CRT后1个月进行3D-STE检查。我们测量了LV的三维（3DS）、纵向（LS）、圆周（CS）及径向（RS）应变。通过与心动周期相关的3D应变峰值负值时间标准差（3DS-SD）及16节段最小区域容积到达时间（SDI）评估LV不同步性。DCM患者的整体3DS显著更低（-17.12±6.70%对-38.38±4.28%，P<0.01），3DS-SD（11.11±5.14%对4.04±1.43%，P<0.01）及SDI（9.69±4.82%对4.23±1.33%，P<0.01）显著高于正常志愿者。3DS、LS、CS、RS与左心室射血分数（LVEF）具有良好相关性（r2分别为-0.94、-0.91、-0.93、0.89，均P<0.01）。3DS-SD与SDI相关性良好（ICC = 0.85）。对于轻度、中度及重度收缩功能障碍，3DS-SD分别为4.56±1.53%、9.87±2.58%及14.55±4.71%（P<0.01），SDI分别为4.46±1.27%、8.19±2.35%及12.83±4.87%（P<0.01），且与QRS波宽度无关。CRT治疗后，整体3DS（从-13.12±2.63%至-14.06±2.53%，P = 0.025）、3DS-SD（从12.99±3.92%至11.53±4.53%，P = 0.015）及SDI（从10.85±3.74%至9.50±4.63%，P = 0.013）均显著改善。
结论
当图像质量最佳时，3D STE似乎是评估LV功能及不同步性的一种有前景的方法。
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