超声心动图评价缺血性心脏病左心室收缩同步性和心功能变化
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摘要
目的:研究超声心动图评价缺血性心脏病患者左心室收缩同步性和心功能变化。方法:连续选择84例缺血性心脏病患者,其中无症状性心力衰竭28例,轻中度心力衰竭40例,重度及难治性心力衰竭16例。采用超声心动图评价室间同步性,以室间机械延迟(IVMD)表示,室内收缩同步性以收缩达峰时间标准差(Ts-SD)表示;心功能指标包括左室射血分数(LVEF)、左室舒张末内径(LVEDd)、B型利钠肽(BNP)和QRS波时限。结果:IVMD、Ts-SD和QRS波时限随心衰加重逐渐升高,差异有统计学意义(P<0.05)。3组间QRS波时限≥120 ms比例比较无差异(P=0.593),各组QRS波时限≥120 ms较<120 ms患者的IVMD、Ts-SD、LVEDd和BNP水平升高,LVEF水平降低,差异有统计学意义(P<0.05)。结论:缺血性心脏病不同程度患者的左心室收缩同步性不同,需结合心功能进行综合评估。
Objective To study left ventricular systolic synchrony and cardiac function in ischemic heart disease patients with ultrasonic cardiogram. Methods A total of 80 patients with ischemic heart diseases were enrolled, including 28 cases of silent heart failure, 40 of mild to moderate heart failure and 16 of severe and refractory heart failure. Ultrasonic cardiogram was used to evaluate interventricular synchrony with interventricular mechanical delay(IVMD) and intraventricular systolic synchrony with standard deviation of the time to peak systolic velocity(Ts-SD). The evaluated cardiac function indicators included left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDd), type B natriuretic peptide(BNP), and QRS duration. Results The values of IVMD, Ts-SD and QRS duration were gradually increased as heart failure aggravated(P<0.05).No statistical difference was found in the proportion of QRS duration ≥120 ms among 3 groups(P=0.593). Compared with those in patients with QRS duration <120 ms, the values of IVMD, Ts-SD, LVEDd and BNP were all significantly higher, while LVEF level was lower in patients with QRS duration ≥120 ms, with statistical differences(P<0.05). Conclusion The left ventricular systolic synchrony in patients with varying degrees of ischemic heart disease is different, Therefore a comprehensively evaluation considering cardiac functions is necessary.
Objective To study left ventricular systolic synchrony and cardiac function in ischemic heart disease patients with ultrasonic cardiogram. Methods A total of 80 patients with ischemic heart diseases were enrolled, including 28 cases of silent heart failure, 40 of mild to moderate heart failure and 16 of severe and refractory heart failure. Ultrasonic cardiogram was used to evaluate interventricular synchrony with interventricular mechanical delay(IVMD) and intraventricular systolic synchrony with standard deviation of the time to peak systolic velocity(Ts-SD). The evaluated cardiac function indicators included left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDd), type B natriuretic peptide(BNP), and QRS duration. Results The values of IVMD, Ts-SD and QRS duration were gradually increased as heart failure aggravated(P<0.05).No statistical difference was found in the proportion of QRS duration ≥120 ms among 3 groups(P=0.593). Compared with those in patients with QRS duration <120 ms, the values of IVMD, Ts-SD, LVEDd and BNP were all significantly higher, while LVEF level was lower in patients with QRS duration ≥120 ms, with statistical differences(P<0.05). Conclusion The left ventricular systolic synchrony in patients with varying degrees of ischemic heart disease is different, Therefore a comprehensively evaluation considering cardiac functions is necessary.
引文
[1]邢作英,王永霞,朱明军.慢性心力衰竭流行病学研究现状及其病因[J].中华实用诊断与治疗杂志,2012,26(10):937-938.XING Z Y,WANG Y X,ZHU M J.Epidemiological study and etiology of chronic heart failure[J].Chinese Journal of Practical Diagnosis and Treatment,2012,26(10):937-938.
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[7]兰亭玉,王浩,孙欣.应用超声心动图探讨心脏再同步化治疗患者的应变率与左心室舒张功能的关系[J].中国循环杂志,2014,29(11):899-902.LAN T Y,WANG H,SUN X.Evaluation on left ventricular diastolic function by echocardiographic strain rate in patients with cardiac resynchronization therapy[J].Chinese Journal of Circulation,2014,29(11):899-902.
[8]李婷,徐文贵,李剑明,等.探讨门控SPECT心肌灌注显像在慢性心衰患者心脏再同步化治疗中的临床应用价值[J].中国临床医学影像杂志,2015,26(5):325-328.LI T,XU W G,LI J M,et al.Clinical application value of gated SPECT myocardial perfusion imaging on cardiac resynchronization therapy in patients with chronic heart failure[J].Chinese Journal of Clinical Medical Imaging,2015,26(5):325-328.
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[10]钟舒文,张玉奇.超声心动图评估左心室收缩同步性研究的新进展[J].医学综述,2015,21(5):865-868.ZHONG S W,ZHANG Y Q.Recent progress in echocardiography for assessment of ventricular systolic synchronicity[J].Medical Recapitulate,2015,21(5):865-868.
[11]高敬,华琦,王彩荣,等.实时三维超声心动图定量评价心力衰竭患者左心室收缩同步性[J].中华老年心脑血管病杂志,2011,13(1):6-9.GAO J,HUA Q,WANG C R,et al.Quantitative evaluation of left ventricular systolic synchrony in patients with heart failure by realtime three-dimensional echocardiography[J].Chinese Journal of Senile Cardiocerebrovascular Diseases,2011,13(1):6-9.
[12]桂燕萍,廖德宁,张家友.QRS时限评价慢性收缩性心力衰竭患者心脏机械收缩不同步[J].第二军医大学学报,2010,31(2):161-164.GUI Y P,LIAO D N,ZHANG J Y.Assessment of cardiac mechanical systolic asynchrony in patients with chronic systolic heart failure by QRS time limit[J].Academic Journal of Second Military Medical University,2010,31(2):161-164.
[13]MILANI-NEJAD N,CANAN B D,ELNAKISH M T,et al.The FrankStarling mechanism involves deceleration of cross-bridge kinetics and is preserved in failing human right ventricular myocardium[J].Am J Physiol Heart Circ Physiol,2015,309(12):H2077-H2086.
[14]张骞,刘小慧,董建增.慢性心力衰竭药物治疗进展[J].中国实用内科杂志,2016,36(4):272-276.ZHANG Q,LIU X H,DONG J Z.Advance of drug therapy for chronic heart failure[J].Chinese Journal of Practical Internal Medicine,2016,36(4):272-276.
[15]BEELA A S,üNLüS,DUCHENNE J,et al.Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy[J].Eur Heart J Cardiovasc Imaging,2019,20(1):66-74.
[16]SCIARRA L,GOLIA P,PALAMàZ,et al.Patients with left bundle branch block and left axis deviation show a specific left ventricular asynchrony pattern:implications for left ventricular lead placement during CRT implantation[J].J Electrocardiol,2018,51(2):175-181.
[17]LASZLO R,KONZ H,KUNZ K,et al.Evaluation of left and right ventricular systolic and diastolic electromechanical synchrony in older people:a population-based observational study[J].Physiol Res,2017,66(6):933-948.
[18]ERDEM F H,OZTURK S,?ZTüRK S,et al.The effects of ivabradine on left ventricular synchronization and Tei index in patients with systolic heart failure[J].Acta Cardiol Sin,2017,33(1):58-65.
[19]AT'KOV O I,POPOVA E I,GOROKHOVA S G.Tissue Doppler imaging of physiological asynchrony in intracardiac myocardium[J].Fiziol Cheloveka,2014,40(3):66-72.
[20]HUANG X S,GU C X,YANG J F,et al.A pilot study of systolic dyssynchrony index by real-time three-dimensional echocardiography predicting clinical outcomes to surgical ventricular reconstruction in patients with left ventricular aneurysm[J].Interact Cardiovasc Thorac Surg,2014,19(6):938-945.
[2]付蓉,刘美娜.国内外心力衰竭治疗质量评价的研究现状[J].中国医院管理,2015,5(1):47-50.FU R,LIU M N.Research of the status assessment of treatment quality evaluation for heart failure at home and abroad[J].Chinese Hospital Management,2015,5(1):47-50.
[3]王晓梅,张健,史蓉芳.平衡法核素心室显像评价心力衰竭患者的心脏收缩同步性[J].中国医学影像学杂志,2013,21(9):683-686.WANG X M,ZHANG J,SHI R F.Contractile synchrony in patients with heart failure:assessment by equilibruim radionulide angiography[J].Chinese Journal of Medical Imaging,2013,21(9):683-686.
[4]张健,邹长虹.《2016年欧洲心脏病学会急慢性心力衰竭诊断与治疗指南》非药物治疗部分解读[J].中国介入心脏病学杂志,2016,11(24):612-615.ZHANG J,ZOU C H.Interpretation of non-drug treatment in guidelines for diagnosis and treatment of acute and chronic heart failure,European Society of Cardiology,2016[J].Chinese Journal of Interventional Cardiology,2016,11(24):612-615.
[5]卢庭义,考国营,苏立.心脏再同步化治疗心力衰竭的Meta分析[J].重庆医科大学学报,2011,36(10):1237-1242.LU T Y,KAO G Y,SU L.Meta-analysis of cardiac resynchronization therapy for heart failure patients[J].Journal of Chongqing Medical University,2011,36(10):1237-1242.
[6]赵璐露,赵玲.超声心动图技术在提高心脏再同步化治疗疗效上的应用[J].心血管病学进展,2015,36(2):183-186.ZHAO L L,ZHAO L.Application of echocardiography in improving the efficacy of cardiac resynchronization therapy[J].Advances in Cardiology,2015,36(2):183-186.
[7]兰亭玉,王浩,孙欣.应用超声心动图探讨心脏再同步化治疗患者的应变率与左心室舒张功能的关系[J].中国循环杂志,2014,29(11):899-902.LAN T Y,WANG H,SUN X.Evaluation on left ventricular diastolic function by echocardiographic strain rate in patients with cardiac resynchronization therapy[J].Chinese Journal of Circulation,2014,29(11):899-902.
[8]李婷,徐文贵,李剑明,等.探讨门控SPECT心肌灌注显像在慢性心衰患者心脏再同步化治疗中的临床应用价值[J].中国临床医学影像杂志,2015,26(5):325-328.LI T,XU W G,LI J M,et al.Clinical application value of gated SPECT myocardial perfusion imaging on cardiac resynchronization therapy in patients with chronic heart failure[J].Chinese Journal of Clinical Medical Imaging,2015,26(5):325-328.
[9]SULLIVAN R M,MURILLO J,GERRITSE B,et al.Do baseline diastolic echocardiographic parameters predict outcome after resynchronization therapy?Results from the PROSPECT trial[J].Pacing Clin Electrophysiol,2013,36(2):214-220.
[10]钟舒文,张玉奇.超声心动图评估左心室收缩同步性研究的新进展[J].医学综述,2015,21(5):865-868.ZHONG S W,ZHANG Y Q.Recent progress in echocardiography for assessment of ventricular systolic synchronicity[J].Medical Recapitulate,2015,21(5):865-868.
[11]高敬,华琦,王彩荣,等.实时三维超声心动图定量评价心力衰竭患者左心室收缩同步性[J].中华老年心脑血管病杂志,2011,13(1):6-9.GAO J,HUA Q,WANG C R,et al.Quantitative evaluation of left ventricular systolic synchrony in patients with heart failure by realtime three-dimensional echocardiography[J].Chinese Journal of Senile Cardiocerebrovascular Diseases,2011,13(1):6-9.
[12]桂燕萍,廖德宁,张家友.QRS时限评价慢性收缩性心力衰竭患者心脏机械收缩不同步[J].第二军医大学学报,2010,31(2):161-164.GUI Y P,LIAO D N,ZHANG J Y.Assessment of cardiac mechanical systolic asynchrony in patients with chronic systolic heart failure by QRS time limit[J].Academic Journal of Second Military Medical University,2010,31(2):161-164.
[13]MILANI-NEJAD N,CANAN B D,ELNAKISH M T,et al.The FrankStarling mechanism involves deceleration of cross-bridge kinetics and is preserved in failing human right ventricular myocardium[J].Am J Physiol Heart Circ Physiol,2015,309(12):H2077-H2086.
[14]张骞,刘小慧,董建增.慢性心力衰竭药物治疗进展[J].中国实用内科杂志,2016,36(4):272-276.ZHANG Q,LIU X H,DONG J Z.Advance of drug therapy for chronic heart failure[J].Chinese Journal of Practical Internal Medicine,2016,36(4):272-276.
[15]BEELA A S,üNLüS,DUCHENNE J,et al.Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy[J].Eur Heart J Cardiovasc Imaging,2019,20(1):66-74.
[16]SCIARRA L,GOLIA P,PALAMàZ,et al.Patients with left bundle branch block and left axis deviation show a specific left ventricular asynchrony pattern:implications for left ventricular lead placement during CRT implantation[J].J Electrocardiol,2018,51(2):175-181.
[17]LASZLO R,KONZ H,KUNZ K,et al.Evaluation of left and right ventricular systolic and diastolic electromechanical synchrony in older people:a population-based observational study[J].Physiol Res,2017,66(6):933-948.
[18]ERDEM F H,OZTURK S,?ZTüRK S,et al.The effects of ivabradine on left ventricular synchronization and Tei index in patients with systolic heart failure[J].Acta Cardiol Sin,2017,33(1):58-65.
[19]AT'KOV O I,POPOVA E I,GOROKHOVA S G.Tissue Doppler imaging of physiological asynchrony in intracardiac myocardium[J].Fiziol Cheloveka,2014,40(3):66-72.
[20]HUANG X S,GU C X,YANG J F,et al.A pilot study of systolic dyssynchrony index by real-time three-dimensional echocardiography predicting clinical outcomes to surgical ventricular reconstruction in patients with left ventricular aneurysm[J].Interact Cardiovasc Thorac Surg,2014,19(6):938-945.
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