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目的应用三维斑点追踪技术(3D-STI)检测慢性心力衰竭患者心脏再同步化治疗(CRT)前后左心室心肌力学参数变化,评价并预测CRT疗效。方法接受CRT治疗的心力衰竭患者24例,于起搏器植入术前及术后3个月进行常规超声测量左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)和射血分数(LVEF);采用3D-STI测量左心室整体面积应变(AS)和左心室整体扭转角度峰值(Twist)。比较术前和术后3个月各参数之间的差异,并将术后3个月LVEDV、LVESV、AS和Twist的改变量(△LVEDV、△LVESV、△AS和△Twist)与LVEF的改变量(△LVEF)进行相关性分析。将术后LVESV缩小≥15%定义为CRT治疗有效。结果 15例(62.5%)患者为CRT治疗有效组,9例(37.5%)为CRT治疗无效组。CRT术后,有效组的LVEDV、LVESV减小,LVEF增高,AS和Twist增强(P<0.05),而无效组各参数比较差异均未见统计学意义(P均>0.05);有效组术前AS和Twist大于无效组(P<0.05),其余参数比较差异未见统计学意义(P均>0.05);有效组术后LVEDV和LVESV较无效组减小,LVEF增高,AS和Twist增强(P<0.05)。相关分析结果显示△AS和△Twist与△LVEF均有良好相关性(r=-0.493、0.521,P<0.05)。结论三维斑点追踪技术检测的左心室心肌力学参数AS和Twist可准确评价和预测CRT疗效,为临床筛选合适患者提供重要的超声依据。
Objective To evaluate the change of left ventricular myocardial mechanics parameters before and after cardiac resynchronization therapy (CRT) in patients with chronic heart failure by 3D-STI and to evaluate and predict the efficacy of CRT. Methods Twenty-four patients with heart failure undergoing CRT were enrolled in this study. Left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were measured before and 3 months after implantation of pacemaker ); Left ventricular total area strain (AS) and left ventricular total torsion angle (Twist) were measured by 3D-STI. The changes of parameters of LVEDV, LVESV, AS and Twist (△ LVEDV, △ LVESV, △ AS and △ Twist) and changes of LVEF at 3 months after operation were compared between preoperative and postoperative 3 months. (△ LVEF) for correlation analysis. A reduction of ≥15% in LVESV after surgery was defined as effective CRT therapy. Results 15 (62.5%) patients were treated with CRT and 9 (37.5%) patients were treated with CRT ineffectively. After CRT, LVEDV, LVESV, LVEF, AS and Twist in the effective group were significantly increased (P <0.05), but no significant difference was found in the parameters of the invalid group (all P> 0.05) AS and Twist were significantly higher than those in the ineffective group (P <0.05), and there was no significant difference in other parameters between the two groups (P> 0.05). LVEDV and LVESV in the effective group were significantly lower than those in the ineffective group, <0.05). Correlation analysis showed that △ AS and △ Twist had good correlation with △ LVEF (r = -0.493, 0.521, P <0.05). Conclusions AS and Twist parameters of left ventricular myocardial parameters detected by three-dimensional speckle tracking technique can accurately evaluate and predict CRT efficacy and provide an important ultrasound basis for clinical screening of suitable patients.