Emerging role of three-dimensional speckle tracking strain for accurate quantification of left ventricular dyssynchrony.
Emerging role of three-dimensional speckle tracking strain for accurate quantification of left ventricular dyssynchrony.
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三维散斑跟踪应变在准确量化左心室不同步方面的新兴作用。
DOI：
10.1111/echo.12280
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Hidekazu Tanaka
中科院分区：
文献类型：
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作者：
Takuo Emoto;Naoto Sasaki;Taiji Mizoguchi;Takuya Matsumoto; Keiko Yodoi;Yoshihiro Sasaki;Kazuyuki Kasahara;Tomoya Yamashita;Ken-ichi Hirata;Hidekazu Tanaka
病例为 53 岁女性，患有扩张期肥厚型心肌病。尽管接受了最佳的药物治疗，她仍被归类为纽约心脏协会功能性 III 级心力衰竭。心电图显示心室内传导延迟，QRS 宽度为 194 毫秒。左心室 (LV) 舒张末期和收缩期容积以及射血分数 (EF) 分别为 101 mL、68 mL 和 32%。二维 (2D) 散斑追踪径向应变（定义为前间隔和后壁之间的时间差为 105 毫秒（<130 毫秒））证明，患者没有表现出明显的左心室机械不同步。进行三维 (3D) 散斑跟踪径向应变以进行更详细的左心室机械不同步分析。 3D 散斑跟踪径向应变分析的一个特别重要的发现是，3 个不同左心室水平（基底前间隔、基底间隔、中前间隔、中间隔、心尖间隔）的 5 个隔膜节段的平均峰值应变时间明显短于 3 个不同左室水平（基底后、后、中隔）的 5 个后外侧节段的平均峰值应变时间。 基侧、中后侧、中侧、顶侧）。隔膜和后外侧壁之间的时间差为 216 毫秒（204 毫秒与 420 毫秒），这被认为表明存在显着的左室机械不同步（≥130 毫秒）。心脏再同步治疗 (CRT) 12 个月后，EF 改善至 47%，而收缩末期和舒张期容量分别降至 88 mL 和 47 mL，因此患者被归类为有反应者。总之，新开发的 3D 散斑跟踪应变可以根据同一节拍中获取的锥体 3D 数据集对“真实”左心室机械不同步进行综合评估，从而产生比以前使用 2D 散斑跟踪系统更准确的信息。
A case was 53‐year‐old female with dilated‐phase hypertrophic cardiomyopathy. She was classified as New York Heart Association functional class III heart failure despite receiving optimal medical therapy. The electrocardiogram taken showed intraventricular conduction delay with a QRS width of 194 msec. The left ventricular (LV) end‐diastolic and systolic volumes, and ejection fraction (EF) were 101 mL, 68 mL, and 32%, respectively. The patient showed no significant mechanical LV dyssynchrony as evidenced by two‐dimensional (2D) speckle tracking radial strain, which is defined as the time difference between anterior‐septum and posterior wall, of 105 msec (<130 msec). Three‐dimensional (3D) speckle tracking radial strain was performed for more detailed LV mechanical dyssynchrony analysis. An especially important finding for 3D speckle tracking radial strain analysis was that the average time‐to‐peak strain of 5 septum segments at 3 different LV levels (basal‐anterior‐septum, basal‐septum, mid‐anterior‐septum, mid‐septum, apical‐septum) was significantly shorter than that of 5 posterolateral segments at 3 different LV levels (basal‐posterior, basal‐lateral, mid‐posterior, mid‐lateral, apical‐lateral). This time difference between septum and posterolateral wall was 216 msec (204 msec vs. 420 msec), which was considered to indicate significant LV mechanical dyssynchrony (≥130 msec). 12 months after cardiac resynchronization therapy (CRT), EF had improved to 47%, while end‐systolic and diastolic volumes had decreased to 88 mL and 47 mL, respectively, so that the patient was classified as a responder. In conclusions, a newly developed 3D speckle tracking strain can provide a comprehensive evaluation of “true” LV mechanical dyssynchrony from pyramidal 3D data sets acquired in the same beat, thus yielding more accurate information than previously possible with the 2D speckle tracking system.