CAJ | 학술논문

目的应用实时三维超声心动图技术探讨慢性心肌缺血左心室收缩同步性的改变,以及小剂量多巴酚丁胺负荷对左室收缩同步性的影响.方法应用Philips iE33对10只猪于建模前及建模后4～6周每周行负荷前后心脏实时三维超声检查.建模前正常猪归为对照组;建模后依照冠脉狭窄程度分为轻度狭窄组、中度狭窄组和重度狭窄组.用3DQA软件分析左室多节段间达最小容积时间(Tmsv)的最大差值(Tmsv-Dif)、标准差(Tmsv-SD)及其标化值.结果中重度狭窄组负荷后12节段间、6节段间、基底段侧壁与下壁及后间隔间Tmsv最大差值之标化值较负荷前升高;静息及负荷后重度狭窄组各同步化参数较对照组、轻度狭窄组增大,中度狭窄组对照组增大,差异均有统计学意义(P＜0.05).轻度狭窄组负荷后6节段、基底段侧壁与下壁和后间隔间Tmsv最大差值较对照组升高,其标化值静息及负荷后均较对照组升高,差异有统计学意义(P＜0.05).结论实时三维超声心动图结合负荷试验能较敏感地显示慢性缺血导致的左室收缩同步性异常,左旋支供血区的侧壁比正常供血的室壁改变更明显.
목적 응용실시삼유초성심동도기술탐토만성심기결혈좌심실수축동보성적개변,이급소제량다파분정알부하대좌실수축동보성적영향.방법 응용Philips iE33대10지저우건모전급건모후4～6주매주행부하전후심장실시삼유초성검사.건모전정상저귀위대조조;건모후의조관맥협착정도분위경도협착조、중도협착조화중도협착조.용3DQA연건분석좌실다절단간체최소용적시간(Tmsv)적최대차치(Tmsv-Dif)、표준차(Tmsv-SD)급기표화치.결과 중중도협착조부하후12절단간、6절단간、기저단측벽여하벽급후간격간Tmsv최대차치지표화치교부하전승고;정식급부하후중도협착조각동보화삼수교대조조、경도협착조증대,중도협착조대조조증대,차이균유통계학의의(P＜0.05).경도협착조부하후6절단、기저단측벽여하벽화후간격간Tmsv최대차치교대조조승고,기표화치정식급부하후균교대조조승고,차이유통계학의의(P＜0.05).결론 실시삼유초성심동도결합부하시험능교민감지현시만성결혈도치적좌실수축동보성이상,좌선지공혈구적측벽비정상공혈적실벽개변경명현.
Objective To assess the left ventricular systolic asynchronicity in chronic ischemic model with real-time three-dimensional echocardiography (RT-3DE), and to explore the affection of low-dose dobutamine to it. Methods A chronic ischemic model was induced by placing an Ameroid constrictor in the left circumflex(LCX) in swines,then full volume RT-3DE was performed by Philips iE33 with X3-1 probe combining rest and stress(dobutamine stress echocardiography, DSE) every week after LCX constriction.Ten normal pigs before operation served as controls (group A). Examination of all the models post operation were grouped into group B (mild stenosis, LCX stenosis＜50% ), group C (moderate stenosis, LCX stenosis 50%～75%) and group D (severe stenosis, LCX stenosis≥75%) according to the results of coronary angiography. Images were copied to QLAB 5.2 postprocess workstation,and 3DQA software was used to analyze the full volume data sets. The time to the point with minimal systolic volume (Tmsv) in each segment was taken to derive the following indexes of systolic synchrony: the maximum difference of Tmsv (Tmsv-dif) and standard deviation(Tmsv-SD) among various segments and standard index (Tmsv-dif% and Tmsv-SD%), to evaluate left ventricular dyssynchrony. Tmsv3-6 represented the maximum difference of Tmsv between lateral segment and posterior septum (Tmsv3-5: between lateral segment and inferior) in basal level. Results Tmsvl2-Dif%, Tmsv6-Dif%, Tmsv3-6% and Tmsv3-5% under stress condition in group C and D were significantly higher than those at rest;all the data in group D were significantly higher than in group A and B, and in group C higher than group A ( P ＜0.05,0.01 ). Compared with group A,Tmsv6-Dif,Tmsv3-6 and Tmsv3-5 in group B were significantly increased under stress condition,and so did their standardize data under both rest and stress conditions ( P ＜ 0.05, 0. 01 ). Conclusions RT-3DEcombined with DSE could display sensitively the left ventricular asynchrony caused by chronic ischemia,and that will be more significant in lateral wall in LCX stenosis than in normal segments.