二维斑点追踪成像评价舒张性心功能衰竭患者左心室局部收缩功能

Evaluation of left ventricular regional systolic function in diastolic heart failure patients by two-dimensional speckle tracking imaging

目的探讨二维斑点追踪成像（speckle tissue imaging，STI）评价射血分数正常的舒张性心功能衰竭（diastolic heart failure，DHF）患者的左心室心肌局部收缩功能。方法临床确诊的DHF患者与正常对照组各32例。分别存储胸骨旁左心室短轴基底水平、乳头肌水平及心尖水平连续3个心动周期的二维灰阶图像，使用Qlab7．0工作站进行脱机分析，记录上述三个短轴切面共18个节段径向收缩期峰值应变率；记录基底水平、心尖水平旋转角度峰值，计算左心室扭转峰值（Twist）。结果DHF组的各节段径向应变率曲线形态与正常对照组相似，两组内同一水平不同节段间的径向应变率峰值差异均无统计学意义（P〉0.05）。与正常对照组相比，DHF组左心室心尖水平前间隔、侧壁、后壁、下壁，乳头肌水平后壁、后间隔，基底水平后壁、下壁及后间壁的收缩期峰值应变率低于正常对照组（P〈0．05）。DHF组左心室心尖、基底水平旋转角度峰值及左心室整体扭转角度峰值均较正常组减低，但差异无统计学意义（P〉0．05）。结论二维斑点追踪成像显示左心室射血分数正常的DHF患者早期存在局部心肌收缩功能异常。

Objective To evaluate the left ventricular（LV） twist and segmental peak systolic radial strain rate（SRr） by two-dimensional speckle tracking imaging（2D-STI）, and to evaluate the systolic performance in diastolic heart failure patients （DHF） with a normal LV ejection fraction （LVEF）. Methods Thirty-two consecutive patients presenting congestive heart failure and thirty-two healthy subjects were enrolled in this study. High frame rate dynamic two-dimensional images were recorded at the LV short-axis view, including basal, papillary muscle and apical planes. Segmental SRr, rotation（Rot）and twist angle were measured offline using Qlab7.0 software. Results In DHF patients,the curve character of SRr was similar with the healthy subjects; there was no significant difference in SRr between different segments at the same level in both DHF patients and healthy subjects. In comparison with the control group,segmental LV SRr was reduced in the DHF patients（ P〈0.05） ,while the peak systolic LV twist was no significantly decreased. Conclusions Although LVEF in DHF patients was normal, segmental systolic function was still impaired in the early stage by 2D-STI.