心脏再同步化治疗减少继发性二尖瓣反流机制探究.doc

心脏再同步化治疗减少继发性二尖瓣反流机制探究[摘要] 目的 应用常规及组织多普勒超声心动图探讨心脏再同步化治疗（CRT）减少继发性二尖瓣反流的机制。方法 对22例行CRT治疗的心衰患者于术前和术后6个月分别行超声心动图检查。常规超声心动图测量左室球形化指数（SI）、二尖瓣环平面至二尖瓣关闭点的距离（CH）、二尖瓣反流面积与左房面积比（MRA/LAA）；组织多普勒法测量左室6个基底段之间组织运动速度变异（Vs-SD）、达峰时间变异（Tp-SD）以及最大延迟时间（Tp-max）等参数。探讨各参数与二尖瓣反流程度之间的关系。结果 CRT术后二尖瓣反流程度显著降低。左室长轴收缩同步性提高、整体收缩功能改善，左室球形化程度减轻；二尖瓣关闭点向心尖移位程度减轻。相关分析显示长轴同步性提高、长轴平均收缩期速度加快和左室整体收缩功能提高三者结合为二尖瓣反流程度降低的最有力预测因子。结论 CRT可增强左室收缩协调性、提高左室收缩功能、改变左室几何形态，是与二尖瓣反流程度相关的重要因素。 [关键词] 心脏再同步化治疗；二尖瓣反流；超声心动描记术；组织多普勒 [中图分类号] R541.6[文献标识码] B [文章编号] 1673-9701（2011）19-07-03 Mechanism for the Reduction of Secondary Mitral Regurgitation after Cardiac Resynchronization Therapy WANG HanmeiYU DanWANG Xinyu Department of Echocardiogram, Daqing Oilfield General Hospital, Daqing 163001, China [Abstract] Objective To investigate the possible mechanism for reducing mitral regurgitation (MR) after cardiac resynchronization therapy (CRT). Methods We used standard and tissue Doppler imaging echocardiography before and after CRT in 22 patients with advanced heart failure. Spherical index, distance of mitral valve to coaptation site, the ratio of MR area to the left atrial area were assessed, and also, velocity deviation, standard deviation of time to peak velocity in 6 basal segments, and maximal time delay among the 6 segments were measured. Results MR significantly reduced, left ventricular (LV) synchronicity, global contraction improved, while global remodeling reduced after CRT. Conclusion CRT helps to improve synchrony, contract ability, and reduce LV remodeling, which might be the mechanism of reducing MR in patients with heart failure. [Key words] Cardiac resynchronization therapy; Mitral regurgitation; Echocardiography; Tissue Doppler imaging 心脏再同步化治疗（cardiac resynchronization therapy，CRT）方法目前已成为严重心衰且QRS延长患者确定有效的非药物治疗手段。CRT可迅速改善患者血流动力学状态，逐渐改善患者心衰症状、运动耐力和生活质量[1]。以往认为心衰患者从CRT获益的主要机制是由于提高了心室间和左室内部的收缩同步性，从而使得收缩更加有效，并减少继发性二尖瓣反流（MR），降低间隔矛盾运动等[2]。 研究表明，约56%的心衰患者合并不同程度的继发性MR，由此增加左心室前负荷而导致左心室扩大，进一步加重MR，