多普勒组织成像技术评估肥厚型心肌病心肌舒缩功能

Myocardial Contractile and Relaxant Function in Hypertrophic Cardiomyopathy Assessed by Doppler Tissue Imaging

目的了解多普勒组织成像技术（ＤＴＩ）在评估肥厚型心肌病（ＨＣＭ）心肌舒缩功能方面的应用。方法应用超声心动图ＤＴＩ技术测量正常人和肥厚型心肌病患者室间隔及左室后壁收缩期、舒张早、晚期的峰值运动速度（分别为Ｓ、Ｅ、Ａ）、内、外膜峰值速度差（ΔＶ）及峰值速度阶差（ＶＧ）、Ｅ／Ｓ及Ａ／Ｅ比值、等容收缩及等容舒张期心肌运动频谱持续时间（ＩＶＣ、ＩＶＲ）等一系列参数，并进行比较。结果ＨＣＭ组室间隔收缩期ＶＧ、舒张早期各指标均低于正常，Ｅ／Ｓ比值低于正常，Ａ／Ｅ高于正常，ＩＶＲ明显延长。梗阻性与非梗阻性ＨＣＭ患者室间隔运动各指标无统计学差异。左室后壁肥厚者收缩期及舒张早期的ＤＴＩ测值多低于正常，而左室后壁不肥厚者收缩期指标无明显变化，舒张早期指标低于正常；两者相比，前者收缩期及舒张早期各参数多低于后者。结论ＤＴＩ技术能实时、直观、准确地记录和测量心肌舒缩运动情况，可为进一步了解局部及整体心肌功能提供更丰富的信息。

Objectives This study was performed to understand the use of Doppler tissue imaging (DTI) assessing myocardial function in patients with hypertrophic cardiomyopathy (HCM).Methods In 32 normal subjects and 18 patients with hypertrophic cardiomyopathy,the interventricular septum (IVS) and left ventricular posterior wall (LVPW) motion was assessed by Doppler tissue imaging.Some parameters such as systolic peak velocity (S),early diastolic and late diastolic peak velocity (E,A respectively),velocity difference (ΔV) and velocity gradient (VG) between endocardium and epicardium,E/S ratio and A/E ratio,isovolumic contraction and isovolumic relaxation duration (IVC,IVR respectively) were measured.Results In comparison with control group,the systolic VG and early diastolic parameters of IVS motion in HCM group were lower ( P <0.001),so was the E/S ratio.IVR was prolonged while IVC had no marked change compared with that of normal subjects.There was no statistically significant difference in parameters of IVS motion between obstructive and nonobstructive HCM.The data of hypertrophic LVPW motion were lower than those of normal subjects,as well as those of nonhypertrophic LVPW in HCM group.Conclusion The results demonstrated that Doppler tissue imaging can interrogate the myocardium and allow the assessment of contractile and relaxant function of regional myocardium directly and precisely, and then,provide further information for assessment of regional and global cardiac function in patients with hypertrophic cardiomyopathy. [