超声二维斑点追踪成像技术评价缩窄性心包炎患者心脏功能的改变

Evaluation of Cardiac Function in Patient with Constrictive Pericarditis by Two-dimensional Speckle Tracking Echocardiography

目的应用二维斑点追踪技术定量评价缩窄性心包炎患者左心室功能的改变情况。方法选取正常对照组41例及已确诊为缩窄性心包炎的患者40例,行超声常规检查并存储患者足够帧频二维图像,其中左室长轴图像包括心尖位左室长轴观,二腔心观、四腔心观,短轴图像包括二尖瓣环水平、乳头肌水平及心尖水平左室短轴观,应用二维斑点追踪技术定量分析并记录各个切面观总体纵向峰值应变、径向峰值应变、圆周峰值应变;其中总体纵向峰值应变为软件自动测量得出,二尖瓣环水平、乳头肌水平及心尖水平左室短轴观的总体圆周应变及径向应变为每个切面6个节段的峰值应变的平均值。结果①常规超声心动图检查:缩窄性心包炎患者左房、右房较正常对照组扩大,左室缩小,EF值减低,舒张早期二尖瓣口血流速度E峰减低,差异均具有统计学意义(P<0.05或P<0.01);②二维斑点追踪成像:缩窄性心包炎患者心尖二腔心观、心尖四腔心观及心尖左心室长轴观总体纵向应变明显低于正常对照组(均P<0.01);缩窄性心包炎患者左心室二尖瓣环水平、乳头肌水平及心尖水平短轴切面平均圆周应变和径向应变明显降低,差异均具有统计学意义(P<0.05或P<0.01)。结论缩窄性心包炎患者左心室长轴方向各切面总体纵向应变较正常对照组明显减低,左心室短轴各水平平均圆周应变及平均径向应变明显低于正常对照组,表明缩窄性心包炎患者左心室壁运动功能减低,心肌存在一定的损伤;二维斑点追踪技术可以较射血分数更早地检测出心肌损伤,为缩窄性心包炎患者心功能的评估提供了一种更精确的方法。

Objective To evaluate the cardiac function of patient with constrictive pericarditis by two-dimensional speckle tracking imaging. Methods A total of 40 patients with constrictive pericarditis（CP）and 41 healthy controls underwent echocar- diography to collect the imaging clips of two cavity, four cavity,long axis at apex, short axis at mitral valve, papillary muscle and apex levels. The global longitudinal strain, circumferential strain and radial strain of each imaging clip were measured by two-di- mensional speckle tracking software. The global circumferential and radial strain of the short axis at different levels was defined as the average peak strain of six segments of each level. Results ①Standard ultrasonography：the left and right atria were en- larged and the diameter of the left ventricle decreased in CP patients when compared with the healthy control. Meanwhile, the e- jection fraction and the peak velocity of the mitral valve during early diastole were reduced in CP patients relative to controls. ② Two-dimensional speckle tracking imaging： the global longitudinal strain of two cavity, four cavity and long axis at apex was lower in CP patients than in controls. The global circumferential and radial strains of short axis at mitral valve, papillary muscle and apex levels were also lower in CP patients than in controls. Conclusion The lower global longitudinal strain,circumferential strain and radial strain of each imaging clip of CP patients represent an injury of the myocardium,suggesting that the left ven- tricular function is decreased in CP patients. The two dimensional speckle tracking imaging is more sensitive than ejection frac tion to identify the injury of the myocardium and it provides us with a more accurate way to evaluate the function of CP pa- tients.