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目的应用三维斑点追踪技术(3D-STI)评价心脏再同步化治疗(CRT)前后患者的心肌力学特征。方法获取53例CRT患者左室环向、纵向及径向应变(CS、LS、RS)来评估左室心肌收缩力;测量并计算左室16节段环向、纵向及径向应变达峰时间标准差(Tcs-16SD、Tls-16SD、Trs-16SD)来评估左室机械同步性。结果 (1)CRT术前,CRT有效组左室心肌收缩力较无效组强,机械同步性较无效组差(P<0.05);(2)CRT术后,CRT有效组心肌收缩力及机械同步性均显著改善;CRT无效组心肌收缩力较术前改善(P<0.05),机械同步性与术前相比无明显差异(P>0.05);(3)在3D-STI指标中,Tls-16SD预测CRT术后疗效最有价值;(4)三维容积及心肌力学指标在观察者内、观察者间有较好的一致性。结论 CRT既能改善左室机械同步性,也能改善左室心肌收缩力,Tls-16SD能够有效地预测CRT疗效。
Objective To evaluate the myocardial mechanics of patients before and after cardiac resynchronization therapy (CRT) by using 3D speckle tracking (3D-STI). Methods The left ventricular circumferential, longitudinal and radial strain (CS, LS, RS) of 53 patients with CRT were measured to assess left ventricular myocardial contractility. The peak, circumferential and radial strain peak time of 16 segments of left ventricle were measured and calculated Standard deviation (Tcs-16SD, Tls-16SD, Trs-16SD) was used to assess left ventricular mechanical synchrony. Results (1) Before CRT, the contractile force of left ventricular myocardium in CRT effective group was stronger than that of invalid group, and the mechanical synchrony was worse than that of ineffective group (P <0.05). (2) After CRT, the contractility and mechanical synchronization (P <0.05); (3) In the 3D-STI index, the Tls- 16SD predict CRT after the most valuable curative effect; (4) three-dimensional volume and myocardial mechanics indicators in the observer, observers have better consistency. Conclusion CRT can not only improve left ventricular mechanical synchronization, but also improve left ventricular myocardial contractility, Tls-16SD can effectively predict the efficacy of CRT.