心肌超声造影评价肥厚型心肌病患者局部心肌收缩功能与灌注的关系

Evaluation of correlation between regional myocardial function and perfusion in patients with hypertrophic cardiomyopathy by myocardial contrast echocardiography

目的应用斑点追踪技术评价肥厚型心肌病患者局部心肌收缩功能,同时应用心肌超声造影观察肥厚型心肌病患者局部心肌灌注改变,并探讨局部心肌收缩功能与灌注之间的关系。方法对肥厚型心肌病患者(35例)和健康对照组(17名)行常规超声心动图检查,应用斑点追踪技术测量各节段二维应变值。按照患者就诊顺序随机进行心肌超声造影检查后对35例肥厚型心肌病患者中的20例愿意行造影检查者行心肌超声造影检查,测量系统自动给出心肌造影强度定量分析拟合指数函数Y=A(1-e-Kt)中的A值、K值并进行分析。结果肥厚型心肌病患者心肌的总体纵向应变值、总体圆周应变值和总体径向应变值(23.48±1.86,24.22±3.95,41.05±10.28)均较健康对照组(15.76±3.63,20.03±4.24,30.83±11.28)明显减低,差异有统计学意义(t=-7.775、-3.167、-2.913,P均<0.01);总体圆周应变绝对值和A值正相关,有统计学意义(R=0.610,t=3.079,P<0.01);总体纵向应变绝对值与K值负相关,有统计学意义(R=0.469,t=-2.252,P<0.05);总体圆周应变绝对值与K值负相关,有统计学意义(R=0.550,t=-2.632,P<0.05)。结论肥厚型心肌病患者局部心肌收缩功能减低与灌注损伤有关,心肌超声造影检查是研究和诊断肥厚型心肌病可靠、有效的方法。

Objective To evaluate the regional myocardial function in patients with hypertrophic cardiomyopathy by speckle tracking imaging,then to observe the perfusion by myocardial contrast echocardiography and to explore the correlation between abnormal regional myocardial function and perfusion in patients with hypertrophic cardiomyopathy.Methods Fifty-two persons were investigated(35 patients with hypertrophic cardiomyopathy,17 controls were included)to analyze the two-dimensional strain by speckle tracking imaging in the 3 left ventricle short-axis views(including mitral annulus level view,papillary muscle level view,left ventricle short-axis apical view)and the 3 left ventricle long-axis apical views(two-chamber view,four-chamber view,left ventricle long-axis apical view).Twenty volunteers of the thirty-five patients with hypertrophic cardiomyopathy were examined by myocardial contrast echocardiography after they did it randomized as the order of the time registered.A and K of the exponential function Y=A(1-e-Kt)fitted by the curves and made by the myocardial signal intensity to time were obtained automatically.Results The global longitudinal strain,global circumferential strain and global radial strain of patients with hypertrophic cardiomyopathy were all significantly lower than controls,The difference was significant(23.48±1.86 vs 15.76±3.63,24.22±3.95 vs 20.03±4.24,41.05±10.28 vs 30.83±11.28,t=-7.775,-3.167,-2.913,all P<0.01).The absolute value of circumferential strain were related to A and K(R=0.610,t=3.079,P<0.01;R=0.550,t=-2.632,P<0.05);and the absolute value of longitudinal strain were related to K(R=0.469,t=-2.252,P<0.05).Conclusions The regional myocardial function in patients with hypertrophic cardiomyopathy were impaired compared with control group,and perfusion defects were related to the impairment.Myocardial contrast echocardiography is a reliable and effective way to study and diagnose the hypertrophic cardiomyopathy.