单心动周期实时三维超声心动图评价扩张型心肌病左右心室收缩功能及左心室同步性

doi:10.16150/j.1671-2870.2017.03.012

摘要/Abstract

摘要： 目的: 应用单心动周期实时三维超声心动图(single beat real-time three-dimensional echocardiography, sRT-3DE)评价扩张型心肌病(dilated cardiomyopathy, DCM)患者左、右心室的收缩功能及左心室收缩同步性。方法: 对17例DCM患者和17 名年龄性别相匹配的健康对照者行sRT-3DE检查,通过专有软件分析获得以下参数。①左心室常规容积参数,包括左心室舒张末期和收缩末期的容积、左心室每搏输出量和射血分数(ejection fraction,EF);②左心室几何形态学参数,包括收缩末和舒张末的球形指数;③左心室收缩期节段容积变化同步性参数,包括收缩期失同步指数(systolic dyssynchrony index,SDI)、收缩末离散差、收缩后和收缩前的时间容积及平均收缩时间;④右心室容积参数,包括右心室舒张末期和收缩末期容积、右心室每搏输出量和EF。各项容积参数按照体表面积进行标化。结果: 与对照组相比,DCM组标化的左、右心室舒张末期和收缩末期容积均增大,左、右心室EF均减小(P均<0.01);左心室舒张末和收缩末的球形指数均增大(P均<0.01);SDI、收缩末离散差、收缩前及收缩后时间容积均增大(P均<0.01)。采用sRT-3DE检查评价左、右心室收缩功能和左心室同步性平均费时仅需5 min。结论: sRT-3DE能够揭示DCM患者左、右心室的收缩功能及左心室同步性异常,且检查费时少,或可常规应用于DCM患者的心功能评估及随访。

关键词: 单心动周期, 三维超声心动图, 扩张型心肌病, 心室收缩功能, 左心室同步性

Abstract: Objective: To assess the ventricular systolic function and left ventricular synchrony in patients with dila-ted cardiomyopathy using single beat real-time three-dimensional echocardiography (sRT-3DE). Methods: Seventeen patients with dilated cardiomyopathy (DCM group) and seventeen healthy subjects (control group, age and sex matched) undergone sRT-3DE examination were enrolled in this study.Full-volume imaging was performed and the data were analyzed by left ventricular analysis software and right ventricular analysis software. Results: ① The parameters of left ventricular volume: In DCM group, the end systolic volume and diastolic volume were larger and the ejection fraction was lower than that of the control group (P<0.01). ②The parameters of left ventricular geometry: In DCM group, the end systolic sphericity index and end diastolic sphericity index were larger than that of the control group (P<0.01). ③ The systolic synchrony parameters were significantly larger in DCM group (P<0.01). ④ The parameters of right ventricular volume: In DCM group, the systolic volume and diastolic volume were larger and the ejection fraction was lower than that of the control group (P<0.01). Conclusions: sRT-3DE can accurately and rapidly assess the ventricular systolic function and left ventricular synchrony in patients with dilated cardiomyopathy. Thus, it's a useful and feasible routine quantification technique in patients with DCM in clinical practice.

Key words: Single beat, Three-dimensional echocardiography, Dilated cardiomyopathy, Ventricular systolic function, Left ventricular synchrony

中图分类号:

R540.4⁺5

陈晔芬, 施仲伟. 单心动周期实时三维超声心动图评价扩张型心肌病左右心室收缩功能及左心室同步性[J]. 诊断学理论与实践, 2017, 16(03): 292-296.

CHEN Yefen, SHI Zhongwei. Evaluation of ventricular systolic function and left ventricular synchrony in patients with dilated cardiomyopathy using single beat real-time three-dimensional echocardiography[J]. Journal of Diagnostics Concepts & Practice, 2017, 16(03): 292-296.

参考文献

[1] Pinto YM, Elliott PM, Arbustini E, et al.Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clini-cal practice: a position statement of the ESC working group on myocardial and pericardial diseases[J]. Eur Heart J,2016,37(23):1850-1858.
[2] Bozkurt B, Colvin M, Cook J, et al.Current diagnostic and treatment strategies for specific dilated cardiomyo-pathies: a scientific statement from the american heart association[J]. Circulation,2016,134(23):e579-e646.
[3] Japp AG, Gulati A, Cook SA, et al.The diagnosis and evaluation of dilated cardiomyopathy[J]. J Am Coll Cardiol,2016,67(25):2996-3010.
[4] Velasco O, Beckett MQ, James AW, et al.Real-time three-dimensional echocardiography: characterization of cardiac anatomy and function-current clinical applications and literature review update[J]. Biores Open Access,2017,6(1):15-18.
[5] Otani K, Nakazono A, Salgo IS, et al.Three-dimensional echocardiographic assessment of left heart chamber size and function with fully automated quantification software in patients with atrial fibrillation[J]. J Am Soc Echocardiogr,2016,29(10):955-965.
[6] Gulati A, Ismail TF, Jabbour A, et al.The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy[J]. Circulation,2013,128(15):1623-1633.
[7] Lang RM, Badano LP, Mor-Avi V, et al.Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J]. J Am Soc Echocardiogr,2015,28(1):1-39.
[8] Wu VC, Takeuchi M.Three-Dimensional Echocardiography: Current Status and Real-Life Applications[J]. Acta Cardiol Sin,2017,33(2):107-118.
[9] Park JB, Lee SP, Lee JH, et al.Quantification of right ventricular volume and function using single-beat three-dimensional echocardiography: A validation study with cardiac magnetic resonance[J]. J Am Soc Echocardiogr,2016,29(5):392-401.
[10] Kim J, Cohen SB, Atalay MK, et al.Quantitative assessment of right ventricular volumes and ejection fraction in patients with left ventricular systolic dysfunction by real time three-dimensional echocardiography versus cardiac magnetic resonance imaging[J]. Echocardiography,2015, 32(5):805-812.
[11] Dickstein K, Vardas PE, Auricchio A, et al.2010 focused update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association[J]. Eur J Heart Fail,2010,12(11):1143-1153.
[12] Dai HL, Guang XF, Xiao ZC, et al.Application of echocardiography in resynchronization treatment of heart failure patients[J]. Chin Med J (Engl),2012,125(19):3548-3555.
[13] Padeletti L, Paoletti Perini A, Gronda E. Cardiac resynchronization therapy: the issue of non-response[J]. Heart Fail Rev.2012 Jan;17(1):97-105.
[14] Kleijn SA, Aly MF, Knol DL, et al.A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography[J]. Eur Heart J Cardiovasc Imaging,2012,13(9):763-775.
[15] D'Andrea A, Gravino R, Riegler L, et al. Right ventricular ejection fraction and left ventricular dyssynchrony by 3D echo correlate with functional impairment in patients with dilated cardiomyopathy[J]. J Card Fail,2011,17(4):309-317.
[16] Buccheri S, Costanzo L, Tamburino C, et al.Reference values for real time three-dimensional echocardiography-derived left ventricular volumes and ejection fraction: review and meta-analysis of currently availa-ble studies[J]. Echocardiography,2015,32(12):1841-1850.
[17] Maffessanti F, Muraru D, Esposito R, et al.Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography: a multicenter echocardiographic study in 507 healthy volunteers[J]. Circ Cardiovasc Imaging,2013,6(5):700-710.
[18] Mu Y, Chen L, Tang Q, et al.Real time three-dimensional echocardiographic assessment of left ventricular regional systolic function and dyssynchrony in patients with dilated cardiomyopathy[J]. Echocardiography,2010, 27(4):415-420.
[19] Tong K, Zhang J, Wang J, et al.Quantification of left and right ventricular systolic function in patients with dilated cardiomyopathy using real-time three-dimensional echo-cardiography[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban,2012,37(6):561-566.