定量组织速度成像对肥厚型心肌病左心室局部心肌舒张功能的分析

Evaluation of left ventricular regional diastolic function in patients with hypertrophic cardiomyopathy using quantitative tissue velocity imaging

目的探讨定量组织速度成像(QTVI)评价肥厚型心肌病(HCM)患者左室局部心肌舒张功能的价值。方法获标准心尖长轴切面、心尖二腔切面和心尖四腔切面,应用QTVI技术分析17例HCM患者和18例健康者左室长轴方向不同室壁节段的多普勒速度曲线,测量各节段心肌运动舒张早期峰值速度(Ve)和舒张晚期峰值速度(Va),计算左室二尖瓣环、基底段、中段水平的平均Ve、平均Va。应用脉冲多普勒技术分别测量二尖瓣口舒张早期峰值速率(E)、舒张晚期速率(A)、计算E/A。结果HCM组左室各节段Ve明显低于正常组(大部分P<0.001),肥厚节段Va低于正常组(P<0.05),而非肥厚节段Va两组间差异无显著性意义(P>0.05)。两组同一水平平均Ve、Va的比较均有显著性意义(P<0.05)。HCM组与正常组二尖瓣口E、A、E/A差异无显著性意义(P>0.05)。结论QTVI能定量评价HCM患者左室局部心肌舒张功能。HCM患者左室长轴各节段心肌松弛性显著降低,肥厚节段的心肌顺应性受损。

Objective To determine the value of quantitative tissue velocity imaging （QTVI） for the evaluation of the left ventricular （LV） regional diastolic function in patients with hypertrophic cardiomyopathy （HCM）. Methods The LV apical long axis, apical two-chamber and four-chamber views were obtained. Regional early diastolic velocity （Ve） and regional atrial contraction （Va） along long-axis were measured in 17 patients with HCM and 18 healthy subjects using QTVI. Mean Ve and mean Va at each segment of ventricular annular, basal and middle levels were calculated. Transmitral peak rapid filling velocity （E）, peak atrial filling velocity （A） were measured and E/A ratio was calculated. Results Ve of all left ventricular segments were significantly reduced in HCM patients than in normal subjects （most P〈0. 001）. Va in hypertrophic segments were lower than that of healthy subjects （P〈0.05）, but Va in other segments were not different （P〉0. 05）. Mean Ve and mean Va were different （P〈0.05）. There were no differences in E, A, E/A between HCM patients and normal subjects （P〉0.05）. Conclusion The left ventricular myocardial relaxation along the longitudinal axis is reduced, and myocardial compliance is impaired in hypertrophic segments. QTVI can accurately evaluate the LV regional diastolic function in HCM patients.