CAJ | 학술논문

目的应用实时三维超声心动图(RT-3DE)和斑点追踪显像(STI)评价左心室同步性，以探索检测心脏再同步化治疗(cardiac resynchronization therapy，CRT)疗效的有效方法。方法动物实验对象为21条比格犬，随机分为A组(CRT组,10条),B组（心衰组，7条）和C组（对照组,4条）三组，临床研究对象为70例完成CRT术前及术后6个月随访的患者。以左室收缩末容积(LVESV)缩小15％为CRT治疗有效。评价同步性的超声参数包括RT-3DE评价左室16节段达最小收缩容积时间的标准差及其与心动周期的比值(Tmsv-16SD，SDI),STI评价犬左室乳头肌水平6节段QRS波起点至径向应变和圆周应变达峰时间的标准差与心动周期的比值(Trs-6SD、Tcs-6SD)。结果动物实验的Tmsv-16SD、Trs-6SD、Tcs-6SD与左室射血分数(LVEF)呈负相关（r分别为-0.86、-0.75、-0.83，P均＜0.01），Trs-6SD对CRT疗效最有预测价值，当Trs-6SD≥12.2％时，预测CRT有效的敏感性和特异性分别为83.3％和100％。临床研究显示，SDI最有预测价值，当其临界值为6.55％时，预测CRT有效的敏感性为80.0％，特异性为81.8％。结论 RT-3DE和STI能有效评价左室内不同步，有望成为预测CRT疗效的有效方法。
목적 응용실시삼유초성심동도(RT-3DE)화반점추종현상(STI)평개좌심실동보성，이탐색검측심장재동보화치료(cardiac resynchronization therapy，CRT)료효적유효방법。방법 동물실험대상위21조비격견，수궤분위A조(CRT조,10조),B조（심쇠조，7조）화C조（대조조,4조）삼조，림상연구대상위70례완성CRT술전급술후6개월수방적환자。이좌실수축말용적(LVESV)축소15％위CRT치료유효。평개동보성적초성삼수포괄RT-3DE평개좌실16절단체최소수축용적시간적표준차급기여심동주기적비치(Tmsv-16SD，SDI),STI평개견좌실유두기수평6절단QRS파기점지경향응변화원주응변체봉시간적표준차여심동주기적비치(Trs-6SD、Tcs-6SD)。결과 동물실험적Tmsv-16SD、Trs-6SD、Tcs-6SD여좌실사혈분수(LVEF)정부상관（r분별위-0.86、-0.75、-0.83，P균＜0.01），Trs-6SD대CRT료효최유예측개치，당Trs-6SD≥12.2％시，예측CRT유효적민감성화특이성분별위83.3％화100％。림상연구현시，SDI최유예측개치，당기림계치위6.55％시，예측CRT유효적민감성위80.0％，특이성위81.8％。결론 RT-3DE화STI능유효평개좌실내불동보，유망성위예측CRT료효적유효방법。
Objective To investigate new parameters to predict the response to cardiac resynchronization therapy (CRT) by using real-time three-dimensional echocardiography (RT3DE) and speckle tracking imaging(STI). Methods Twenty-one adult beagle dogs were divided into three groups:group A (CRT group, n =10) ,group B (heart failure group, n =7) and group C (control group, n =4).Seventy patients who accepted CRT and were followed up 6 months after CRT were enrolled. Response to CRT was defined as a ≥15％ decrease in left ventricular end-systolic volume. RT-3DE parameters were the dispersion of time to minimum regional volume for 16 segments (Tmsv16-SD) ,and the ratio of Tmsv16-SD to R-R interval (SDI). STI parameters were the ratios of standard deviation of the time to peak radial and circumferential strain at midventricular level to R-R interval (Trs-6SD,Tcs-6SD). Results In experimental study,Tmsv-16SD, Trs-6SD, Tcs-6SD had negative relationship with left veutricular ejection fraction (r were - 0. 86, - 0.75, - 0.83 respectively, all P ＜0.01 ). Trs-6SD was the strongest predictor to CRT. A cut-off value of Trs-6SD≥12.2％ was able to predict response to CRT with a sensitivity of 83.3％ and a specificity of 100％. Clinical studies found SDI was the strongest predictor to CRT. A cut-off value of SDI≥6.55％ was able to predict response to CRT with a sensitivity of 80. 0％ and a specificity of 81.8％.Conclusions RT-3DE and STI can assess left ventricular dyssynchrony, and are promising methods to predict the response to CRT.