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目的 探讨定量组织速度成像(QTVI)评价充血性心力衰竭(CHF)患者左心室心肌的非同步性运动及其与左心功能、QRS间期的关系。方法 正常人和CHF患者各40例,利用QTVI技术,获取标准心尖部左室长轴、两腔和四腔观,获得左心室6个壁基底段、中间段和心尖段共18个位点的多普勒速度曲线,测量各位点QRS波起始至心肌收缩期峰值速度和舒张早期峰值速度的时限(TS和TE)。计算同一节段6个壁间TS和TE的最大差值(Inter ΔTS和Inter ΔTE)、同一壁内3个节段间TS和TE的最大差值(Intra ΔTS和Intra ΔTE)及左心室18个位点间TS和TE的最大差值(Max ΔTS和Max ΔTE)。同时计算二尖瓣环6个位点收缩期峰值速度和舒张早期峰值速度的均值(MeanVs和MeanVe)及左心室射血分数(LVEF)。结果 CHF组Inter ΔTS、Inter ΔTE、Intra ΔTS、Intra ΔTE、Max ΔTS和Max ΔTE较正常组明显延长(均P<0. 05 );CHF组Max ΔTs与LVEF、MeanVs负相关(r= -0. 761, P<0. 01; r= -0. 738, P<0. 01),与QRS间期不相关; Max ΔTE与QRS间期正相关(r=0. 470,P<0. 01),与MeanVe负相关(r=-0. 656,P<0. 01)。结论 CHF患者左心室同一节段及同一壁内均存在非同步运动,且与左心功能、QRS间期关系密切。
Objective To investigate the relationship between left ventricular myocardial asymmetry and left ventricular function and QRS interval in patients with congestive heart failure (CHF) assessed by quantitative tissue velocity imaging (QTVI). Methods Forty normal and CHF patients were enrolled in this study. QTVI technique was used to obtain the standard apex apical long axis, two-chamber and four-chamber views. Sixteen basal segments of the left ventricle, 18 segments of the middle segment and apical segment Doppler velocity curves were used to measure the duration of TSS and TE peaked at QRS onset to peak systolic velocity and early diastole velocity at each site. The maximum difference (Inter ΔTS and Inter ΔTE) between TS and TE, the maximum difference between TS and TE (Intra ΔTS and Intra ΔTE) between the three segments in the same wall and the left ventricular Maximum difference between sites TS and TE (Max ΔTS and Max ΔTE). The MeanVs and MeanVe and left ventricular ejection fraction (LVEF) of systolic peak velocity and early diastolic peak velocity at the 6 mitral annulus were also calculated. Results The Inter ΔTS, Inter ΔTE, Intra ΔTS, Intra ΔTE, Max ΔTS and Max ΔTE in CHF group were significantly longer than those in normal group (all P <0.05). The Max ΔTs in CHF group were negatively correlated with LVEF and MeanVs (r = -0. 761, P <0.01; r = -0.738, P <0.01), not related to QRS interval; Max ΔTE positively correlated with QRS interval (r = 0.470, P <0.01) , Negatively correlated with MeanVe (r = -0.656, P <0.01). Conclusions CHF patients with asynchrony in the same segment of the left ventricle and the same wall, and with left ventricular function, QRS interval closely related.