应变率成像评价肥厚型心肌病患者左心室局部功能和室壁运动同步性

Evaluation of regional left ventricular function and synchronism in patients with hypertrophic cardiomyopathy by strain rate imaging

目的 评价应变率成像技术在定量检测肥厚型心肌病（HCM）患者左心室局部心肌功能及室壁运动同步性中的价值。方法HCM患者21例，根据室间隔及左室壁厚度分为3组：①非肥厚组（NH），室壁厚度≤11 mm，101节段；②轻度肥厚组（MH），11mm〈室壁厚度≤15mm，86节段；③重度肥厚组，室壁厚度〉15mm，65节段。对照组18例，216节段。获取各受试者心尖四腔观、左室长轴及两腔观组织速度图像存盘供脱机分析。测量收缩期峰值应变率（SRs）、舒张早期峰值应变率（SRe）、舒张晚期峰值应变率（SRa），计算SRe／SRa；测量收缩期应变率达峰时间（TssR），并计算收缩期应变率达峰时间变异（CVTssR）；测量舒张早期应变率达峰时间（TESR），并计算舒张早期应变率达峰时间变异（CVTESR）。结果与对照组室壁节段比较，HCM组NH、MH、SH亚组SRs、SRe、SRe／SRa均显著降低，且三个亚组间SRe依次降低，即NH〉MH〉SH，NH与MH组间SRe／SRa差异无统计学意义，与NH、MH组比较，SH组SRe／SRa显著减低；与对照组比较，MH、SH组SRa显著降低，而NH组较对照组差异无统计学意义，且NH〉MH〉SH；与对照组比较，HCM组CVTssR及CVTESR显著增大。结论HCM患者无论有无室壁肥厚，其左室局部收缩舒张功能均受损；HCM患者左室心肌运动存在不同步现象，应变率成像技术能准确、定量评价其左室局部心肌功能及其左室心肌运动不同步。

Objective To evaluate the value of strain rate imaging（SRI） in quantitatively detecting regional function and synchronism of left ventricular （ LV ） in patients with hypertrophic cardiomyopathy （ HCM ）. Methods Twenty-one patients with HCM were divided into 3 groups by thickness of interventricular septum and left ventricular wall ： ① non hypertrophy （ NH ）, wall thickness （WT）≤11 mm, 101 segments ; ② mild hypertrophy （MH）, 11 mm〈WT≤15 mm, 86 segments ; ③ severe hypertrophy （ SH ）, WT 〉 15 mm, 65 segments. Eighteen controls （216 segments） were performed echo examination. Tissue velocity imagings of all the patients and controls were accepted in apical four, long axis or two chamber views. The indies included：peak systolic strain rate （SRs） ,peak early diastolic strain rate（SRe）,peak late diastolic strain rate（SRa） and SRe/SRa,time of to peak systolic strain rate （TssR）, cofficient of variation of TssR （CVTssR）, time of to peak early diastolic strain rate （TESR） ,cofficient of variation of TssR （CVTEsR）. Results Compared with controls, SRs, SRe and SRe/SRa of the three groups of HCM decreased significantly; SRe of the three groups of HCM decreased in order, NH〉MH〉 SH, but there was no significant difference of SRe/SRa between NH and MH group of HCM;compared with NH and MH, SRe/SRa of SH decreased significantly. Compared with controls, SRa of MH and SH decreased significantly,but there was no difference between NH and controls,and NH〉MH〉SH. Compared with controls, CVTssR and CVTEsR of patients with HCM increased significantly. Conclusions The regional function of LV in patients with HCM damaged with or without hypertrophy; synchronism existed in patients with HCM and all these can be evaluated quantitatively,accurately by SRI.