多普勒组织成像技术在鉴别生理性与高血压性左室肥厚诊断中的价值

Value of Doppler tissue imaging in differentiating physiologic hypertrophyin athletes and left ventricular hypertrophy in hypertension patients

目的:探讨应用多普勒组织成像(DTI)技术对生理性肥厚和高血压性左心室肥厚进行鉴别,并对高血压左心室肥厚的左心室功能进行评价。方法:研究对象为28例经临床与超声诊断的高血压左心室肥厚患者(高心组)、8例有心肌肥厚的职业运动员(运动员组)和22例正常人(对照组)。应用DTI技术测量各组室间隔及左室后壁收缩期,舒张早、晚期峰值运动速度(分别是Vs,Ve,Va)、内外膜峰值速度差(ΔV)及峰值速度阶差(VG)、Ve?Va比值、等容收缩期及等容舒张期心肌运动频谱持续时间(IVC,IVR),并进行比较。结果:运动员组各期的峰值速度及速度阶差与正常对照组无明显差别。高血压性心肌肥厚组虽反映心室整体收缩功能指标EF是正常的,但是其E波运动速度及Ve、舒张早期速度阶差(VGe)均较正常组和运动员组有显著下降。结论:DTI技术可实时、准确地反映心肌舒缩功能状况,并可依此对生理性肥厚心肌和高血压左心室肥厚进行鉴别。

Objective: This study was performed to distinguish physiologic left ventricular myocardial hypertrophy in athletes and in patients from hypertension with left ventricular hypertrophy(LVH) to assess the myocardial systolic and diastolic function by Doppler tissue imaging(DTI). Methods: In 22 normal subjects and 28 patients with hypertension and LVH and 8 elite athletes with myocardial hypertrophy, the motion of interventricular septum(IVS) and left posterior ventricular wall(LPVW) were assessed by DTI. Some parameters such as systolic peak velocity(Vs), early-diastolic and late-diastolic peak velocity(Ve, Va respectively), velocity difference(ΔV) and velocity gradient(VG) between endocardium and epicardium, VeVa ratio, isovolumic contraction time and isovolumic relaxation time(IVCT, IVRT respectively) were measured. Results: No significant difference was observed between normal subjects and the athletes with respect to Vs, Ve, ΔV, VG. The Ve, ΔVe and VGe of the LPVW and IVS in LVH group were significantly lower than those of normal subjects and athletes. Conclusion: We can use DTI to distinguish hypertension with left ventricular hypertrophy in patients and physiologic myocardial hypertrophy in athletes and to assess the function of left ventricle.