实时三维超声心动图和定量组织速度成像对高血压患者左心室舒张功能的研究

Clinical study on the left ventricular diastolic function of hypertrophy by real-time three-dimensional echocardiography and quanti-tative tissue velocity imaging

目的:应用实时三维超声心动图(RT-3DE)、定量组织速度成像(QTVI)评价高血压患者与正常人左心室舒张功能的差异及其与传统超声心动图评价方式的相关性。方法:应用RT-3DE、QTVI分别测量20例正常人和20例高血压患者的左室重量(LVM)、充盈率(PFR)、二尖瓣环最大位移(TMAD Midpt)、左室室间隔和侧壁基底段的舒张早期组织速度(Ve)及舒张晚期组织速度(Va),计算其比值(Ve/Va),并与传统超声心动图检测二尖瓣口血流频谱进行比较。结果:40例受测者均获得了具有清晰内膜边界的实时三维图像和二维图像,2组间LVM、左室质量指数(LVMI)、PFR测值间差异有统计学意义(P<0.01)。TMAD Midpt测值间差异有统计学意义(P<0.01)。室间隔、左室侧壁基底段的Ve、Va及其比值(Ve/Va)间差异有统计学意义(P<0.01)。左室PFR、左室间隔及侧壁基底段Ve/Va值、TMAD Midpt测值与传统二维超声心动图测得舒张早期与舒张晚期峰值流速比(E/A)高度相关,相关系数分别为0.962,0.961,0.434。结论:高血压患者与正常人左室舒张功能存在差异,RT-3DE、QTVI是可行的、准确定量评价左室舒张功能的新技术。

Objective： To assess the feasibility and accuracy of real-time three-dimensional echocardiography （RT-3DE） and quantitative tissue velocity imaging（QTVI） in quantifying left ventricular diastolic function. Methods： Twenty healthy volunteers without cardiovascular diseases and twenty patients with left ventricular hypertrophy were investigated, and the quantitative analyses were blinded to each other. To measure the left ventricular mass （LVM）, peak filling rate （PFR） of them by realtime three-dimensional echocardiography （RT-3DE）. To measure tissue move ahead duration midpt （TMAD Midpt）, peak myocardial sustained early diastolic velocity （Ve）, peakmyocardial sustained late diastolic velocity （Va） of them by quantitative tissue velocity imaging （QTVI）. Results： Clear endocardial border, real-time three-dimensional and two-dimensional images were obtained in all 40 cases. There were significant differences of left ventricular mass （LVM）, left ventricular mass index （LVMI）, filling rate （PFR）between the two groups （ P 〈0.01）. Mitral annulus maximum displacement （TMAD Midpt） also showed significant differences between the measured values （ P 〈0. 01）. Septal, lateral basal segment of left ventricular early diastolic and late diastolic peak velocity （Ve, Va） and the ratio （Ve / Va） showed significant difference between measured values （ P 〈0.01）. Left ventricular filling rate （PFR）, left ventricular septal and lateral basal diastolic peak early and late diastolic velocity ratio （Ve / Va）, the largest mid-point of mitral annular displacement （TMAD Midpt） had a high correlation with the early diastolic and late diastolic velocity ratio （E/A） on traditional two-dimensional echocardiography test, the correlation coefficients were 0. 962, 0. 961, 0. 434. Conclusion.. Diastolic function left ventricular in healthy adult and patients with left ventricular hypertrophy has heterogeneity. RT-3DE and QTVI provides a new method in assessing the left ventricular function.