三维斑点追踪成像技术评价肥厚型心肌病左心室心肌功能

发布时间：2018-10-21 18:59

【摘要】：目的应用三维斑点追踪成像(3D-STI)技术测量射血分数在正常范围的非梗阻性肥厚型心肌病(HCM)患者的左心室心肌功能。资料与方法选取研究组28例非梗阻性HCM患者及对照组30例健康志愿者,行常规二维超声心动图和3D-STI检查,比较两组常规超声心动图指标左心室室间隔舒张末期厚度(IVST)、左心室后壁舒张末期厚度(LVPWT)、左心室内径、左心室容积、收缩末期左心室容积、二尖瓣口舒张早期血流速度峰值(E)、二尖瓣口舒张晚期血流速度峰值(A)、主动脉瓣及左心室流出道血流频谱,描绘左心室流出道的速度频谱得出左心室流出道最大压差(LVOT-PG)、左心室流出道速度时间积分(LVOT-VTI)、组织多普勒二尖瓣环舒张早期速度峰值(Ea)、二尖瓣环舒张晚期速度峰值(Aa),计算E/A、Ea/Aa、E/Ea,并比较左心室三维射血分数、左心室球形指数、面积应变(GAS)、纵向应变(GLS)、圆周应变(GCS)、径向应变(GRS)的差异。结果与对照组比较,HCM组左心室IVST和LVPWT增加(P0.01),Ea/Aa、E/A显著减低(P0.01),E/Ea增高(P0.01),LVOT-PG、LVOT-VTI明显增加(P0.05、P0.01);与对照组三维应变值比较,HCM组GCS、GAS、GRS、GLS明显减低(P0.01),局部应变值显示心尖水平和乳头肌水平减低,其中室间隔、前壁、下壁等节段应变值减低更显著。结论 HCM患者存在不同程度的心肌收缩力下降,局部心肌功能下降多位于乳头肌水平和心尖水平,并且减低的节段集中在室间隔、前壁、下壁等处。3D-STI可以作为评价HCM患者左心室早期整体及局部心肌功能损害的一种新技术。
[Abstract]:Objective to measure left ventricular function in patients with non obstructive hypertrophic cardiomyopathy (HCM) with normal ejection fraction (EF) by three dimensional speckle tracing imaging (3D-STI). Materials and methods Twenty-eight patients with non-obstructive HCM in study group and 30 healthy volunteers in control group were examined by conventional two-dimensional echocardiography and 3D-STI. The left ventricular septal end diastolic thickness (IVST), left ventricular posterior wall diastolic thickness (LVPWT), left ventricular volume (LV), left ventricular volume (LVV) were compared between the two groups. Peak of mitral orifice early diastolic velocity (E), mitral orifice late diastolic velocity peak (A), aortic valve and left ventricular outflow tract flow spectrum. The left ventricular outflow tract maximum pressure difference (LVOT-PG), left ventricular outflow tract velocity time integral (LVOT-VTI), tissue Doppler mitral annular early diastolic velocity peak, (Ea), mitral annular late diastolic velocity peak (Aa), were obtained by describing the left ventricular outflow velocity spectrum. Calculate E / A, and compare the left ventricular three dimensional ejection fraction. The difference of left ventricular spherical index, area strain, (GAS), longitudinal strain, (GLS), circumferential strain, (GCS), radial strain (GRS). Results compared with the control group, left ventricular IVST and LVPWT increased significantly in HCM group (P0.01), Ea/Aa,E/A decreased significantly (P0.01), E/Ea increased (P0.01), LVOT-PG,LVOT-VTI significantly increased (P0.05 P0.01), GCS,GAS,GRS,GLS in HCM group decreased significantly (P0.01), local strain value showed a decrease in apical level and papillary muscle level, and ventricular septum in HCM group. The decrease of strain value of anterior wall and inferior wall is more significant. Conclusion the myocardial contractility decreased in different degree in HCM patients, and the regional myocardial function decline was mainly located at the level of papillary muscle and the apical level, and the decreased segment was concentrated in the interventricular septum and anterior wall. 3D-STI can be used as a new technique to evaluate the early global and local myocardial dysfunction in patients with HCM.
【作者单位】：中国医科大学附属盛京医院超声科;
【分类号】：R542.2;R445.1

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