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目的应用三维斑点追踪技术(3D-STI)评价左心室心肌力学变化,探讨3D-STI在评价心脏再同步化治疗(CRT)患者左心室收缩功能中的应用价值。方法选择接受CRT且成功植入三腔起搏器的心力衰竭患者20例,其中男性14例,女性6例;年龄18~69岁,平均年龄47岁。于起搏器植入术前及术后6个月进行常规超声测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)和左心室射血分数(LVEF);应用3D-STI测量左心室整体3D应变(D3S)、纵向应变(LS)、环向应变(CS)、径向应变(RS);左心室整体旋转角度峰值(LVrot)和左心室整体扭转角度峰值(LVtw)、左心室整体最大径向位移(Dr)、纵向位移(Dl)、三维位移(D3d)等指标。比较术前和术后上述指标之间的差异,并将以上指标进行相关性分析。结果 CRT术后D3S、LS、CS、RS较术前显著提高,LVrot、LVtw、Dr、Dl和D3d均较术前明显增加,差异均有统计学意义(P<0.05)。相关分析显示D3S、LS、CS、RS、LVrot、Dr、Dl和D3d与LVEF均相关(r=-0.63、-0.56、-0.51、0.60、0.38、0.80、0.49及0.45,P<0.01),LVtw与D3S、LS、CS、RS、Dr、D3d间均有良好相关性(r=-0.45、-0.35、-0.39、0.37、0.37、0.45,P<0.01)。结论 3D-STI能有效观察左心室心肌力学改变,准确评价左心室收缩功能,对评价CRT术后疗效有重要意义。
Objective To evaluate the value of 3D-STI in assessing the left ventricular systolic function in patients with cardiac resynchronization therapy (CRT) by using 3D speckle tracking (3D-STI) technique. Methods Twenty patients with heart failure undergoing CRT implantation and three-chamber pacemaker implantation were selected, including 14 males and 6 females, aged 18-69 years old with a mean age of 47 years. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by conventional ultrasound before and after 6 months of pacemaker implantation. 3D-STI Left ventricular total 3D strain (D3S), longitudinal strain (LS), circumferential strain (CS), radial strain (RS); left ventricular peak LVrot and left ventricular LVtw, Ventricular maximum radial displacement (Dr), longitudinal displacement (Dl), three-dimensional displacement (D3d) and other indicators. The differences between the above indexes before and after surgery were compared, and the above indexes were analyzed. Results The postoperative T3S, LS, CS and RS of CRT were significantly higher than those before operation. LVrot, LVtw, Dr, D1 and D3d were significantly increased compared with that before operation (P <0.05). Correlation analysis showed that D3S, LS, CS, RS, LVrot, Dr, D1 and D3d were all correlated with LVEF (r = -0.63, -0.56, -0.51,0.60,0.38,0.80,0.49and0.45, P <0.01) There was a good correlation between D3S, LS, CS, RS, Dr and D3d (r = -0.45, -0.35, -0.39,0.37,0.37,0.45, P <0.01). Conclusion 3D-STI can effectively observe left ventricular myocardial mechanic changes and accurately evaluate left ventricular systolic function, which is of great significance for evaluating the curative effect of CRT.