应变率成像评价高血压和冠心病患者左室心肌功能

Evaluation of left ventricular cardiac function in patients with hypertension and coronary heart disease by strain rate imaging

目的应用应变率成像(SRI)技术评价高血压和冠心病患者的左心室功能,探讨SRI评价左心室功能的临床价值。方法A组30例健康人群,B组23例原发性高血压病患者,C组19例冠心病合并原发性高血压患者,取心尖四腔、心尖两腔、心尖左室长轴切面的心肌应变率曲线,测定左室各室壁的收缩期、舒张早期、舒张晚期的峰值应变率(SRS、SRE、SRA)和收缩期峰值应变(εS),计算其平均峰值应变率(mSRS、mSRE、mRSA)和平均峰值应变(mεS);统计各组左室各壁出现的收缩后缩短(PSS)的节段数;观察左心室曲线M型应变率成像(CMM-SRI)图像特点,定量检测各节段收缩-舒张转换时间(TCEC),冠状动脉造影确定缺血节段,比较各组左心室壁各节段TCEC的差异。结果与正常组(A组)相比,高血压病组(B组)患者和冠心病合并高血压组(C组)患者的mSRS、mSRE、mRSA和mε均有明显降低(P<0.05);与A组及B组相比,C组各节段PSS的检出率明显增多(P<0.05),而A、B两组各节段的PSS检出率的差异无显著性(P>0.05);与非缺血节段比较,缺血节段TCEC延长(P<0.05)。结论应变率成像(SRI)技术为定量、准确评价高血压和冠心病左室心肌功能提供了新的方法。

Objective To explore the clinical value of strain rate imaging （SRI） technology in evaluating the left ventricular cardiac function in patients with hypertension and coronary heart disease. Methods Thirty healthy volunteers （group A）, 23 patients with essential hypertension （group B） and 19 patients with essential hypertension and coronary heart disease （group C） were examined by SRI. Longitudinal strain rate （SR） during systole, early diastole and atrial contraction （SRS, SRE, SRA） and longitudinal systolic strain （εS） were measured at apical four chamber view, two chamber view and apical longitudinal view. Mean strain rate （mSR） and mean strain （mεS） were obtained. Numbers of PSS segments were calculated in the left ventricular segments. The CMM-SRI characteristics of left ventricle and TCEC were observed and detected quantitatively. Myocardium segments of patients with hypertension and coronary heart disease were divided into ischemic and non-ischemic segments by selected coronary angiography. In the quantitative analysis system of curved M-mode of stain rate imaging, TCEC was compared between myocardium segments of patients with hypertension or coronary heart disease and those of healthy subjects. Results mSR and mεS of group B and group C were significantly lower than those of group A. The presentation of PSS in the left ventricle of group C was significantly more than group A and group B, while the difference of it between group A and group B is not significant. Most of ischemic myocardium segments had significantly longer TCEC than non-ischemic ones. Conclusion SRI, as a new and accurate method quantitatively evaluates the left ventricular Cardiac function in patients with hypertension and coronary heart disease.