CAJ | 학술논문

目的应用二维斑点追踪(2D-STI)技术评价充血性心力衰竭(CHF)患者再同步化治疗(CRT)前后右室功能的变化,探讨CRT治疗对CHF患者右室功能的影响.方法 CHF组患者46例,根据CRT术后6个月左室收缩末容积降低≥10％的标准将CRT患者分为CRT有反应组(26例)和CRT无反应组(16例).所有患者均于CRT术前1～3 d、术后6个月接受超声检查.组织多普勒显像(TDI)测量左室12节段心肌收缩期达峰时间标准差(Ts-SD);心尖四腔观测量右室基底部横径(D1)、右室中部横径(D2)、右室长径(D3);2D-STI技术测量右心室游离壁基底段、中间段2个节段的收缩期峰值应变及应变率.结果与CRT术前比较,CRT有反应组CRT术后6个月LVEDd、LVEDV、LVESV显著减小,LVEF显著增加,左室12节段Ts-SD显著减小,而CRT无反应组CRT术后6个月上述参数差异均无明显统计学意义;与CRT无反应组比较,CRT有反应组CRT术前右室径线D1、D2、D3无显著差别,而右室游离壁基底段、中段收缩期应变及应变率则显著较高;CRT有反应组术后6个月与CRT术前比较,右室径线D1、D2、D3显著减小,右室游离壁基底段、中间段收缩期应变及应变率显著增高,而CRT无反应组CRT术前后上述参数差异无统计学意义.CRT有反应组CRT术前后右室游离壁基底段、中间段收缩期应变及应变率均与左室12节段Ts-SD呈显著负相关.结论 CRT治疗能有效改善CHF患者右室重构及收缩功能,CRT术前将CHF患者右室功能指标纳入遴选标准可能有助于提高CRT治疗的有效性.
목적 응용이유반점추종(2D-STI)기술평개충혈성심력쇠갈(CHF)환자재동보화치료(CRT)전후우실공능적변화,탐토CRT치료대CHF환자우실공능적영향.방법 CHF조환자46례,근거CRT술후6개월좌실수축말용적강저≥10％적표준장CRT환자분위CRT유반응조(26례)화CRT무반응조(16례).소유환자균우CRT술전1～3 d、술후6개월접수초성검사.조직다보륵현상(TDI)측량좌실12절단심기수축기체봉시간표준차(Ts-SD);심첨사강관측량우실기저부횡경(D1)、우실중부횡경(D2)、우실장경(D3);2D-STI기술측량우심실유리벽기저단、중간단2개절단적수축기봉치응변급응변솔.결과 여CRT술전비교,CRT유반응조CRT술후6개월LVEDd、LVEDV、LVESV현저감소,LVEF현저증가,좌실12절단Ts-SD현저감소,이CRT무반응조CRT술후6개월상술삼수차이균무명현통계학의의;여CRT무반응조비교,CRT유반응조CRT술전우실경선D1、D2、D3무현저차별,이우실유리벽기저단、중단수축기응변급응변솔칙현저교고;CRT유반응조술후6개월여CRT술전비교,우실경선D1、D2、D3현저감소,우실유리벽기저단、중간단수축기응변급응변솔현저증고,이CRT무반응조CRT술전후상술삼수차이무통계학의의.CRT유반응조CRT술전후우실유리벽기저단、중간단수축기응변급응변솔균여좌실12절단Ts-SD정현저부상관.결론 CRT치료능유효개선CHF환자우실중구급수축공능,CRT술전장CHF환자우실공능지표납입린선표준가능유조우제고CRT치료적유효성.
Objective To evaluate the right ventricular function in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) by 2-dimensional speckle imaging (2D-STI).Methods 46 patients with CHF were divided into responders to CRT and non-responders to CRT according the standard of a decline in LV end-systolic volume ≥ 10％.All the patients received echocardiography examination 1-3 days before CRT and 6 month after CRT.Tissue Doppler imaging (TDI) indices included SD of time to peak velocity in systole (Ts-SD) among 12 segments.Right ventricular diameters included RV basal transverse diameter (D1),RV middle transverse diameter (D2) and RV longitudinal diameter (D3) in apical four views.2D-STI indices included systolic strain (S) and stain rate (SR) of basal or middle segment of RV free wall.Results Compared with before CRT,LVEDd,LVEDV,LVESV and Ts-SD significantly decreased,LVEF significantly increased in responders 6 months after CRT.Before CRT,compared with nonresponders,there was no significant difference of D1,D2 and D3 in responders,while S and SR in basal or middle segment of RV free wall were higher than non-responders.Compared with before CRT,D1,D2 and D3 in responders decreased significantly,S and SR in basal or middle segment of RV free wall increased significantly,while there was no difference in non-responders.There were significant negative correlation between S and SR in basal or middle segment of RV free wall and Ts-SD in responders.Conclusions The remodeling and systolic function of RV are improved after CRT.It may help for improving the efficacy of CRT when takes RV function data into account before CRT.