实时三维超声心动图容积-时间曲线评价心脏再同步化术后左心功能及舒张早期同步性

发布时间：2018-07-21 20:59

【摘要】：目的: 应用实时三维超声心动图(RT-3DE)容积-时间曲线(VTC)评价扩张型心肌病(DCM)患者心脏同步化（CRT）术后左心室舒张功能及舒张早期同步性变化以及二者间的关系；比较LBBB及NLBBB的CRT疗效。方法: 对39例DCM患者均于术前及术后1周、6个月、12个月行RT-3DE检查,分析其VTC,得出左心室6节段、12节段、16节段舒张早期容积的时间标准差(Tedv-SD),用R-R间期标准化后,作为舒张早期不同步化指数(DDI)；得出左室收缩末容积（LVESV）、左室舒张末容积（LVEDV）、左室射血分数（LVEF）；并计算出舒张期峰值充盈率（PFR）、舒张期早期容积与舒张末期容积之比(EDV早/EDV）；39例患者分为两个亚组LBBB组（25例）和NLBBB组（14例），比较其CRT术后12个月的LVEF、LVEDV、DDI，及术前术后的差值ΔLVEF、ΔLVEDV、ΔDDI。结果: ①与CRT术前比较，术后1周LVEDV、LVESV无明显改善，而于术后6个月及12个月较术前改善有统计学意义(P＜0.05， P＜0.01)；LVEF术后1周、6个月及12个月与术前相比均有统计学意义（P＜0.05）。 ②各节段(T edv-SD)/R-R术后一周均较术前显著缩短（P＜0.01），而术后1周、6个月及12个月之间差异均无统计学意义；PFR术后6个月增加有统计学意义（P0.05)，EDV早/EDV于术后12个月减少具有显著统计学意义（P0.01)。 ③相关分析：CRT术前后ΔDDI与ΔEDV早/EDV减少呈显著正相关（r=0.52，，P＜0.01），与ΔPFR呈负相关（r=-0.40，P＜0.05），ΔEDV早/EDV与ΔPFR之间也有良好的相关性（r=-0.56，P＜0.01）。 ④LBBB组较NLBBB组CRT术后LVEF增加有统计意义（P0.0001)；LVEDV明显缩小（P=0.020)；DDI明显改善（P=0.036）；ΔLVEF、ΔLVEDV、ΔDDI两组比较均有显著统计学意义（P0.01）。结论: ①DCM患者CRT术后左室同步性及心功能均得到改善，PFR、EDV早/EDV可作为评价左室舒张功能的有效指标 ②舒张早期的同步性改善会不断的提高左室舒张功能。 ③DCM伴有LBBB患者行CRT术后获益优于伴NLBBB者。 ④RT-3DE VTC能直观地显示同步性及心肌运动幅度，可用于评价DCM患者CRT术前及术后的疗效。
[Abstract]:Objective: to evaluate the left ventricular diastolic function and early diastolic synchronism after cardiac synchronization (CRT) in patients with dilated cardiomyopathy (DCM) by real-time three-dimensional echocardiography (RT-3DE) volume-time curve (VTC). To compare the effect of CRT between LBBB and NLBBB. Methods: RT-3DE was performed in 39 patients with DCM before operation, 1 week, 6 months and 12 months after DCM. VTCDE was analyzed. The time standard deviation (Tedv-SD) of left ventricular early diastolic volume (Tedv-SD) was obtained in 6 segments of left ventricle and 12 segments of left ventricle. After R-R interval standardization, the mean time standard deviation (Tedv-SD) of left ventricular early diastolic volume was obtained. The left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), peak diastolic filling ratio (PFR) and the ratio of early diastolic volume to end-diastolic volume (EDV) were calculated as early diastolic index (DDI), left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF). 39 patients were divided into two subgroups: LBBB group (n = 25) and NLBBB group (n = 14). The differences of LVEF, 螖 LVEDVV, 螖 DDI were compared 12 months after CRT. Results: 1Compared with CRT before operation, LVEDVV / LVESV did not improve significantly at 1 week after operation, but it was significantly improved at 6 and 12 months after operation (P < 0.05, P < 0.01). At 1 week, 6 months and 12 months after LVEF, there was statistical significance (P < 0.05). 2 the postoperative week of each segment (T edv-SD) / R R was significantly shorter than that before operation (P < 0.01), but there was no significant difference between 1 week, 6 months and 12 months after LVEF (P < 0.05). The increase of PFR 6 months after operation was statistically significant (P0.05) that EDV decreased significantly at 12 months after operation (P0.01). 3 correlation analysis showed that there was a significant positive correlation between 螖 DDI and 螖 EDV early / EDV decrease before and after the operation (r = 0.52, P < 0.01), and a negative correlation with 螖 PFR (P < 0.01). There was also a good correlation between 螖 EDV and 螖 PFR (r-0.56, P < 0.01). 4 the LVEF in LBBB group was significantly higher than that in NLBBB group (P 0.0001). The decrease of LVEDV (P0. 020) and the improvement of DDI (P0. 036), and the difference of 螖 LVEF, 螖 LVEDVand 螖 DDI were statistically significant (P0.01). Conclusion: 1 left ventricular synchrony and cardiac function were improved after CRT in patients with DCM. Early EDV / EDV could be used as an effective index to evaluate left ventricular diastolic function. The benefits of CRT in 3DCM with LBBB were better than those with NLBBB. 4RT-3DE VTC could show the synchronism and the amplitude of myocardial movement directly. It can be used to evaluate the preoperative and postoperative effects of CRT in DCM patients.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45;R654.2

【参考文献】