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实时三维超声心动图评价儿童左室心肌收缩同步性的研究

徐兆峰,齐悦,贡欣,常亚彬,张宏艳   

  1. 天津市儿童医院
  • 收稿日期:2011-01-05 修回日期:2011-07-21 出版日期:2011-11-15 发布日期:2011-11-15
  • 通讯作者: 徐兆峰

Real-Time Three-Dimensional Echocardiographic Assessment of Left Ventricular Asynchrony in Pediatrics

  • Received:2011-01-05 Revised:2011-07-21 Published:2011-11-15 Online:2011-11-15
  • Contact: feng zhao xu

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摘要： 摘要 目的：研究实时三维超声心动图在评价儿童左室心肌收缩同步性中的应用价值。方法：应用实时三维超声心动图检测55例正常儿童（对照组）、10例扩张型心肌病（DCM）儿童及22例川崎病（KD）儿童，测量左室16节段心肌达最低收缩末期容量时间的最大差异（Tmsv16-Dif）及其标准差（Tmsv16-SD），为排除心率的影响，将上述2项指标与心率比值的百分数（Tmsv16-Dif%，Tmsv16-SD%）做为其标准化值进行比较研究。结果：对照组中Tmsv16-Dif、Tmsv16-SD、Tmsv16-Dif%及Tmsv16-SD%接近正态分布，且不同性别间差异无统计学意义；不同年龄组间Tmsv16-Dif、Tmsv16-SD差异有统计学意义；而Tmsv16-Dif%、Tmsv16-SD%差异无统计学意义。KD与DCM组Tmsv16-Dif、Tmsv16-SD、Tmsv16-Dif%及Tmsv16-SD%均高于对照组。Tmsv16-Dif、Tmsv16-SD、Tmsv16-Dif%及Tmsv16-SD%均与LVEF存在负相关（r分别为：–0.583、–0.565、–0.487、–0.567，均P<0.01）。对照组左室16段心肌容量—时间曲线排列有序，呈抛物线状，起伏较为一致，各节段心肌收缩达峰时间几乎一致；KD及DCM患儿左室16节段心肌容量—时间曲线排列紊乱，达峰时间点分散。结论：可利用Tmsv16-Dif%及Tmsv16-SD%作为评价不同年龄儿童左室收缩同步性的指标。

关键词: 超声心动图描记术, 实时三维, 不同步, 左心室

Abstract: Abstract Objective: To investigate the clinical value of real-time three-dimensional echocardiography (RT3DE) in assessment of left ventricular systolic asynchrony in children. Methods: RT3DE was used to detect 55 normal children (control group), 10 patients with dilated cardiomyopathy (DCM group) and 22 patients with Kawasaki disease (KD group). The 16-segment myocardial systolic volume reached the lowest maximal difference (Tmsv16-Dif) and the standard deviation (Tmsv16-SD) were measured. To Values of Tmsv16-Dif and Tmsv16-SD were expressed as a percentage of the duration of the cardiac cycle (Tmsv16-Dif %, Tmsv16-SD %) to allow comparisons between patients with significantly different heart rate. Results: In control group, there was no significant difference in Tmsv16-Dif, Tmsv16-SD, Tmsv16-Dif % and Tmsv16-SD % between male and female patients. There was a significant difference in Tmsv16-Dif and Tmsv16-SD between different age groups, but no significant difference in Tmsv16-Dif % and Tmsv16-SD % between different age groups. The values of Tmsv16-Dif, Tmsv16-SD, Tmsv16-Dif % and Tmsv16-SD % were significantly higher in KD and DCM groups than those of control. The values of Tmsv16-Dif, Tmsv16-SD, Tmsv16-Dif % and Tmsv16-SD% were negatively correlated with left ventricular ejection fraction (LVEF) (r= –0.583, –0.565, –0.487 and –0.567, P<0.01). In control group, the RT3DE segmental time-volume curves showed in order, but they were disorder and the peak time-point spread in KD and DCM groups. Conclusion: Tmsv16-Dif% and Tmsv16-SD% of RT3DE can quantify global left ventricular mechanical dyssynchrony. RT3DE is a feasible and accurate method for analysis of left ventricular function.

Key words: Echocardiography, Real-time three-dimensional, Asynchrony, Left ventricle