双脉冲波多普勒超声成像同步评价健康成年人左心室心肌与心包运动

Synchronous motion assessment of left ventricular myocardium and pericardium in normal adult using dual pulse wave Doppler echocardiography

目的应用双脉冲波多普勒超声成像同步观察健康成年人左心室心肌与相邻心包运动规律及时空相关关系,探讨其临床应用价值。方法应用双脉冲波多普勒超声成像同步采集99名健康成年人3个完整心动周期内二尖瓣水平、乳头肌水平、心尖水平左心室标准短轴切面,测取前壁、后壁共6个节段的同步心肌与相邻心包组织双脉冲频谱多普勒图像。观察不同水平和节段室壁心肌与相邻心包运动规律。在线测量左心室短轴3个水平前壁、后壁心肌与相邻心包在收缩期、舒张早期、舒张晚期的运动峰值速度、速度起始时间及达峰时间,分析节段心肌与相邻心包速度及时间的相关性。结果双脉冲波组织多普勒图像显示,在左心室短轴切面,同一水平同一室壁即同一节段心肌和相邻心包运动方向一致,同一水平前壁(心肌及相邻心包)与后壁(心肌及相邻心包)运动方向相反。峰值速度比较:前壁二尖瓣水平收缩期、舒张晚期,乳头肌水平收缩期心肌峰值速度小于相邻心包峰值速度;后壁二尖瓣水平舒张早期、舒张晚期,乳头肌水平收缩期、舒张早期,心尖水平舒张早期心肌峰值速度大于相邻心包峰值速度,差异均有统计学意义(t=-4.207、-2.078、4.575、-2.277、-2.440、-2.292、5.980、2.604,P均<0.05)。起始时间比较:前壁乳头肌水平收缩期、后壁二尖瓣水平舒张早期心肌起始时间小于相邻心包起始时间,差异均有统计学意义(t=-2.447、-2.020,P均<0.05)。达峰时间比较:后壁二尖瓣水平收缩期及舒张晚期心肌达峰时间小于相邻心包达峰时间,差异均有统计学意义(t=-3.530、-2.411,P均<0.05)。所测各节段心肌与邻近心包的峰值速度、起始时间、达峰时间均具有良好的相关性(r=0.407～0.933,P均<0.01)。结论应用组织多普勒超声实时同步双脉冲频谱技术可观察到健康成年人左心室各节段心肌与相邻心包的运动速度显著相关、运动方向一致。有望为临床诊断缩窄性心包炎及其与限制性心肌病相鉴别提供一种新方法。

Objective To investigate the clinical value,the motive regularity,the temporal and spatial correlation between myocardium and adjacent pericardium of left ventricular short-axis in normal adsults by using dual pulse wave Doppler echocardiography.Methods Tissue dual pulse spectral Doppler images about segmental myocardium and adjacent pericardial of three complete cardiac cycles in 99 normal adults were collected synchronously by using dual pulse wave Doppler techenology,6 segments were enrolled in this study,including the anterior and posterior wall at mitral valve,papillary muscles,and apex level of left ventricular short-axis view.The motive regularity of myocardium and adjacent pericardium at different levels and segments were observed.Peak speed,onset time and peak time between myocardium and adjacent pericardium in anterior and posterior wall of three valves were measured online in systolic,early diastolic,and late diastolic,and the correlation between segmental myocardium and adjacent pericardium in speed and time were analyzed.Results Dual pulse wave Doppler echocardiography showed that in left ventricular short-axis view,motion between myocardium and adjacent pericardium in the same segment had consistent direction,motions between myocardium and adjacent pericardium in anterior and posterior wall at the same level had opposite directions.Comparison of peak velocity,in anterior wall,the peak velocities of myocardium in systolic and late diastolic at mitral valve level,and the peak velocity of myocardium in systolic at papillary muscle level were lower than that of adjacent pericardium.In posterior wall,the peak velocities of myocardium in early diastolic and late diastolic at mitral valve level,the peak velocities of myocardium in systolic and early diastolic at papillary muscle level,and the peak velocity of myocardium in early diastolic at apex level were higher than that of adjacent pericardium,with statistical significance(t=-4.207,-2.078,4.575,-2.277,-2.440,-2.292,5.980,2.604,all P<0.05).Comparison of onset time,the onset time of myocardium in systolic at papillary muscle level in anterior wall,and the onset time of myocardium in early diastolic at mitral valve level in posterior wall were lower than that of adjacent pericardium,with statistical significance(t=-2.447,-2.020,both P<0.05).Comparison of peak time,except the peak time of myocardium in systolic and early diastolic at mitral valve level in posterior wall was lower than that of adjacent pericardium,the remaining differences were statistically significant(t=-3.530,-2.411,both P<0.05).Peak velocity,onset times and peak times of each segment measured between myocardium and adjacent pericardium were well correlated(r=0.407-0.933,all P<0.01).Conclusions Dual pulse wave Doppler echocardiography can provide relativity and accordance between motive velocity and direction of left ventricular myocardium and adjacent pericardium in normal adults.It is a promising new method for the clinical diagnosis of constrictive pericarditis and differentiation with restrictive cardiomyopathy.