实时心肌超声造影评价肥厚型心肌病心肌灌注的研究

Evaluation of myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy by myocardial contrast echocardiography

目的应用实时心肌超声造影研究肥厚型心肌病（HCM）患者心肌灌注状况，评价HCM患者心肌微循环障碍。方法HCM患者20例，正常对照组20例，经肘静脉注射Sono Vue行实时心肌超声造影。取闪烁前5个心动周期及闪烁后15个心动周期的心尖四腔、心尖两腔、左心长轴观实时动态图像传输到EchoPAC工作站。启动Q-analysis软件，应用时间-强度曲线分析造影图像。结果HCM患者左室肥厚节段闪烁后造影平台强度（A）、信号强度增加速率（k）及A×k值与正常人心室肌相应节段测值差异有统计学意义（分别P=0．01，P〈0．001，P＜0．036）。HCM患者左室非肥厚节段A、k及A×k值与正常人心室肌相应节段测值差异有统计学意义（均P〈0．001）。HCM患者左室肥厚节段A、k、A×k值与HCM非肥厚心肌节段测值差异有统计学意义（P=0．021，P=0．016，P=0．001）。相应的标化值：HCM患者左室肥厚节段A／A。，（A×k）／（Ao×ko）值明显低于正常人心室肌相应节段（分别P=0．031，P〈0．001），HCM患者左室非肥厚节段A／Ao及（A×k）／（Ao×ko）值明显低于正常人心室肌相应节段（分别P=0．002，P〈0．001），HCM患者左室肥厚节段A／Ao及（A×k）／（Ao×ko）值低于HCM患者非肥厚心肌节段（分别P=0．045，P=0．021）。结论实时心肌超声造影是评价HCM患者心肌微循环障碍的有效方法。

Objective To evaluate the microcirculation abnormalities in the patients with hypertrophic cardiomyopathy（HCM）. Methods Twenty patients with HCM and 20 healthy volunteers were included in the study. Two dimensional images on the apical four-chamber, two chamber and long-axis views,including 5 cardiac cycles before ‘flash’ and 15 cardiac cycles after ‘flash＇, were recorded and stored for off-line analysis in EchoPAC workstation. Then,contrast time intensity curves were obtained for each available left ventricular segment. Results There were significant differences in the A,k and the product A × k between the hypertrophic wall segments （ P = 0.01 , P 〈0. 001, P = 0. 036, respectively） and nonhypertrophic wall segments （ P 〈0. 001,respectively） and healthy subjects. A,k and the product A × k in hypertrophic wall segments were significantly different from those in nonhypertrophic wall segments in patients with HCM （ P = 0. 021, P = 0. 016, P = 0. 001 ,respectively）. Accordingly,the normalized value of A and the product A × k were lower in hypertrophied wall segments （P = 0. 031, P 〈 0. 001, respectively） and nonhypertrophied wall segments（ P = 0. 002, P 〈0. 001 ,respectively） in patients with HCM than those in normal segments of healthy controls. The normalized value of A and the product A ~ k were lower in hypertrophic wall segments than nonhypertrophic wall segments in patients with HCM（ P = 0. 045, P = 0. 021 ,respectively）. Conclusions Myocardial contrast echocardiography is a useful method to investigate myocardial perfusion abnormalities in patients with HCM.