超声组织速度及应变显像评价肥厚型心肌病局部心肌功能的价值

Tissue Velocity Imaging and Strain Imaging in Assessing Regional Myocardial Systolic Function With Hypertrophic Cardiomyopathy

目的:分析超声定量组织速度(QTVI)及应变显像技术(SI)评价肥厚型心肌病(HCM)患者局部心肌收缩功能的临床价值。方法:随机选取室间隔非对称性HCM患者30例,根据左室流出道压差分为梗阻型及非梗阻型两组,25例正常人为对照组,选取标准的心尖四腔切面,分别测量室间隔与左室侧壁基底段、中间段、心尖段沿心脏长轴方向上的收缩期峰值速度(Vs)及峰值应变(εet),并将病变组和正常组的室壁Vs、εet与相应室壁厚度作相关分析。结果:①正常对照组同一室壁Vs从基底段到心尖段呈显著下降趋势。HCM两组收缩期Vs各节段均较正常组明显减低(P<0.05),中间段Vs与心尖和基底段Vs之间无显著差异(P>0.05)。。HCM两组间Vs亦无显著性差异;②正常组各节段εet差异无显著性意义(P>0.05),HCM两组各节段εet均低于正常对照组(P<0.05),其中室间隔中段εet最低(P<0.001)。HCM两组间εet未见显著性差异;③正常对照组和病变组的Vs与室壁厚度相关性差(r=0.23),εet(绝对值)与室壁厚度高度负相关(r=-0.83)。结论:超声组织速度及应变显像技术均能敏感检测局部心肌收缩功能异常,组织应变显像较组织速度显像更能真实反映局部心肌功能。

Objective To analyze the value of quantitative tissue velocity imaging （QTVI） and strain imaging （SI） in assessing regional myocardial systolic function in patients with hypertrophic cardiomyopathy （HCM）. Methods QTVI and SI were performed in patients with HCM （ n =30） and age - matched healthy subjects （ n =25）. Patients enrolled were divided into nonobstructive HCM （HNCM） and obstructive （HOCM） groups according to pressure gradient through LV outflow tract by continuous wave Doppler echocardiography measurement. Regional longitudinal peak systolic tissue velocity （Vs） and strain （εet） were measured at basal,middle and apical segments of septal and lateral walls of apical four - chamber view. The above parameters were compared between the three groups. Correlation was analyzed between thickness and Vs or εet in mid - septum. Results Vs of different segments displayed degression from basal to apical segment in control group. Vs of different segments in Patients with HCM was significant reduced than that in control group, εet of different segments in control group was not significantly different and εet in patients with HCM was significant reduced than that in control group （ P 〈 0. 05）, εet in the mid - septum was lowest in patient group; Vs and εet were not significant different between HNCM and HOCM. There was a significant negative correlation between absolute value of εet and thickness in mid - septum （ r = - 0. 83）. Conclusion Left ventricular regional myocardial systolic function may be detected by QTVI and SI, SI was a more sensitive and accurate parameter than QTVI.