超声斑点追踪成像评价尿毒症患者左心室旋转和扭转运动

Evaluation of left ventricular rotation and twist in uremia patients by two-dimensional ultrasound speckle tracking imaging

目的应用超声斑点追踪技术探讨尿毒症患者左心室心肌旋转与扭转运动特征，并评价扭转角度峰值与其他参数间的相关性。方法尿毒症患者与正常对照者各29例，经胸采集并存贮3个心动周期标准左室基底部及心尖部短轴二维图像，运用EchoPAC超声工作站进行脱机分析，测定各个切面各节段及整体心肌旋转角度，并计算左室整体的扭转角度。左室扭转角度定义为左室心尖部旋转值与心底部旋转值的净差值。结果尿毒症组左室整体扭转角度峰值较对照组显著降低[（10．08±2．48）。对（14．78±1．92）°，P〈0．001]，且以心尖部逆时针旋转减低为主[（5．67±1．97）°对（9．38±2．39）°，P〈0．001]，差异均有统计学意义；心底部顺时针旋转角度减低[（-5．21±1．89）°对（-6．05±1．67）°，P〉0．05]，差异无统计学意义。与正常对照组相比，尿毒症组心尖部各个节段旋转角度均显著减低，心底部仅下壁、后壁旋转角度显著减低，差异均具有统计学意义。左室整体扭转角度与左室舒张末期容积、收缩末期容积、射血分数间均有良好的相关性（r分别为-0．549，-0．673，0．645，均P〈0．05）。结论超声斑点追踪成像显示尿毒症患者左室壁多节段心肌旋转角度及整体心肌的扭转角度较正常人有明显改变，该技术为评价尿毒症患者左心室局部与整体收缩功能改变提供了一种新方法。

Objective To analyze the left ventricular（LV） rotation and twist by two-dimensional ultrasound speckle-tracking imaging（STI）,and evaluate the correlation between twist and other components of LV contraction in uremia patients. Methods Twenty nine uremia patients and twenty-nine healthy volunteers were included. High frame rate two dimensional images were recorded from the left ventricular short-axis views both of the basal and apical planes. Segmental and global LV rotation were recorded at both apical and basal short-axis views. LV twist was defined as apical rotation relative to the base. Results （1） The peak systolic LV twist was significantly decreased in uremia patients（ P 〈0. 001 ）. The loss of LV twist occurred mainly by the impairment of maximal global counterclockwise apical rotation（ P 〈0. 001） ,and was augmented by somewhat less reduction in global clockwise basal rotation although the differences was not significant（ P 〉0.05）. （2）Compared to healthy volunteers, segmental LV rotation of the apical plane was significantly reduced（ P 〈0.01）, while only the posterior and inferior of the basal plane was significantly decreased（ P 〈0. 05）. （3）Significant correlations were noted between systolic peak twist and LV ejection fraction（r =0.645, P = 0.000）,LV end-diastolic volume （r = -0.549, P = 0.002）,LV end-systolic volume（ r = - 0. 673, P = 0. 000） in uremia patients. Conclusions STI enables quantification of segmental and global LV rotation in an objective manner in uremia patients,and provides a new method for evaluation of segmental and global LV systolic function.