刘敏 田新桥 左蕾 周娟 王珍 付定虎 刘丽文

●论 著

二维斑点追踪成像评价肥厚型心肌病左心室短轴舒张功能及同步性临床研究

刘敏 田新桥 左蕾 周娟 王珍 付定虎 刘丽文

目的 应用二维斑点追踪成像（2D-STI）分析肥厚型心肌病（HCM）患者的左心室短轴局部舒张功能及运动同步性。方法 HCM患者（HCM组）33例，对照组32例。获取左心室短轴二尖瓣水平与乳头肌水平连续三个心动周期的二维灰阶动态图像，应用2D-STI分别测量各节段径向、周向的舒张早期、晚期应变率峰值（SRe-R、SRa-R、SRe-C、SRa-C）及达峰时间，并计算左心室短轴12节段径向及周向的舒张早期、晚期应变率达峰时间标准差（TESRR-SD、TASRR-SD、TESRC-SD、TASRC-SD），比较两组上述参数。结果 与对照组比较，HCM组左心室各节段SRe-R均显著降低（均P＜0.01），绝大多数节段SRe-C显著减低（P＜0.05或0.01），部分节段SRa-R、SRa-C减低（P＜0.05或0.01）。HCM组的TESRR-SD、TESRC-SD明显增大（均P＜0.01），TASRR-SD、TASRC-SD虽较对照组有增大趋势，但无统计学意义（P＞0.05）。结论 HCM患者左心室存在舒张功能减低及室壁运动不同步，2D-STI可以准确地定量评价其左心室局部舒张功能及室壁运动同步性。

超声心动描记术 肥厚型心肌病 心室功能 斑点追踪成像

【 Abstract】 Objective To evaluate left ventricular short axis regional myocardial diastolic function and synchrony in patients with hypertrophic cardiomyopathy(HCM)by two-dimensional speckle tracking imaging (2D-STI). Methods Thirty-three patients with HCM and 32 healthy subjects were enrolled in this study.The dynamic images of left ventricular parasternal short axis mitral view and papillary view were obtained by two-dimensional echocardiography in three consecutive cardiac cycles.The radial,circumferential peak strain rate of early and late of diastole(SRe-R,SRa-R,SRe-C and SRa-C)at each segment of the left ventricular short axis mitral levels and papillary levels were measured.The peak time of early and late diastolic radial,circumferential strain rate(TESRR,TASRR,TESRC,TASRC)were measured from the start point of QRS wave of electrocardiogram．The left ventricular segmental standard deviation (TESRR-SD,TASRR-SD,TESRC-SD,TASRC-SD)was calculated. Results Compared with normal controls,SRe-R of all segments were significantly decreased in HCM group(P＜0.01),SRe-C of most segments were significantly decreased in HCM group(P＜0.05 or 0.01)and SRa-R and SRa-C of some segments were decreased in HCM group(P＜0.05或0.01).TESRR-SD and TESRC-SD were significantly higher in patients with HCM than those in normal controls(P＜0.01).TASRR-SD and TASRC-SD tended to be higher in patients with HCM than those in normal controls,but the difference was significant(P＞0.05). Conclusion The regional diastolic function of left ventricular in patients with HCM is damaged,and synchronism exists in patients with HCM and all these can be accurately and quantitative1y evaluated by 2D-STI.

【 Key words】 Echocardiography Hypertrophic cardiomyopathy Ventricular function Speckle tracking imaging

肥厚型心肌病（HCM）典型的病理改变为心肌细胞肥厚、排列紊乱及心肌间质纤维化，可导致左心室舒张功能异常及室壁运动不同步。以往多采用组织多普勒技术评价HCM患者的舒张功能，但是这种技术存在角度依赖性，限制了其对所有节段心肌运动参数的评估。二维斑点追踪成像技术（2D-STI）是新近发展起来的一种定量评价心肌功能及心肌运动同步性的新技术，优于组织多普勒技术，没有角度依赖性，不仅可以在心室长轴定量评价心肌力学参数，还可在短轴方向评价心肌径向及周向运动参数，全面准确地评价心肌舒张功能及运动协调情况[1]。……