斑点追踪成像技术评估糖尿病心脏自主神经病变患者左心室功能和扭转运动

Evaluation of left ventricular function and twist in patients with diabetic cardiovascular autonomic neuropathy by speckle tracking imaging

目的 应用斑点追踪成像技术研究糖尿病心脏自主神经病变患者左心室功能及扭转运动,探讨其临床应用价值.方法 2型糖尿病不伴并发症患者35例（A组）,2型糖尿病伴心脏自主神经病变者21例（B组）,正常对照者34例（对照组）.测量和计算左心室18节段圆周收缩期应变峰值、舒张早期（E′）及舒张晚期（A′）应变峰值、各水平和整体收缩期圆周应变峰值、E′/A′、收缩末期扭转角度、等容舒张末期扭转角度、解旋率和解旋减半时间.结果 与对照组相比A组患者左心室收缩期各水平及整体圆周应变差异无统计学意义（P＞0.05）,但E′/A′降低（P＜0.05）、收缩末期扭转角度和等容舒张末期扭转角度增加（P＜0.05）,解旋率减低（P＜0.05）,解旋减半时间延迟（P＜0.05）,B组患者左心室收缩期各水平及整体圆周应变较A组及对照组减弱[（-12.64±6.49）％比（-19.11 ±9.98）％和（-21.14±10.13）％,P＜0.05]、E′/A′降低[（0.90 ±0.35）比（1.24 ±0.47）和（ 1.98±0.63）,P＜0.05]、收缩末期扭转角度和等容舒张末期扭转角度增加[（19.08 ±5.62）°比（16.57±2.84）°和（14.36±4.06）°,（13.99 ±2.31）°比（11.36 ±2.63）°和（9.04±5.63）°,P＜0.05],解旋率减低[（0.40 ±0.28） ％/ms比（0.46 ±0.14） ％/ms和（0.53±0.21）％/ms,P＜0.05],解旋减半时间延迟[ （489.61 ±97.14）ms比（445.21±54.53） ms和（410.60±50.23） ms,P＜0.05].结论 斑点追踪成像技术能够准确评价2型糖尿病心脏自主神经病变患者左心室功能及扭转运动的异常.

Objective To evaluate left ventricular （LV） function and twist in patients with diabetic cardiovascular autonomic neuropathy （CAN） by two-dimensional speckle tracking imaging （STI）.Methods STI was performed in 56 subjects with type 2 diabetes mellitus （DM） （35 with DM only：group A,21 with CAN：group B） and 34 normal subjects （Control） from LV short-axis view.LV peak systolic,peak early （E′） and peak late （A′） diastolic circumferential strain in 18 myocardial segments were measured at the levels of mitral annulus,papillary muscle and apex and the rotation at mitral annulus and apex levels were also measured.LV peak systolic and the ratio of E′ and A′ of global and three levels,twist,untwisting rate and untwisting half-time were calculated.Results In group A,compared with control group,LV peak systolic radial circumferential strain has no significant difference （ P 〉 0.05 ）,E＇/A＇ was reduced （ P 〈0.05）,twist at aortic valve closure and twist at mitral valve opening were significantly increased （ P 〈0.05）,untwisting rate reduced,and untwisting half time delayed.In group B,compared with control group and group A,circumferential strain parameters [（ - 12.64 ± 6.49）% vs.（ - 19.11 ± 9.98）% and （-21.14±10.13）%,P〈0.05] andE′/A′ [（0.90 ±0.35） vs.（1.24 ±0.47） and （1.98 ±0.63）,P 〈 0.05 ] were significantly decreased,twist at aortic valve closure [ （ 19.08 ± 5.62） ° vs.（ 16.57 ± 2.84） °and （ 14.36 ±4.06） °,P 〈0.05] and twist at mitral valve opening [ （ 13.99 ± 2.31 ） ° vs.（ 11.36 ± 2.63 ） °and （9.04 ± 5.63 ） °,P 〈 0.05 ] were significantly increased,untwisting rate [ （ 0.40 ± 0.28 ） %/ms vs.（0.46 ±0.14）%/ms and （0.53 ±0.21 ）%/ms,P 〈0.05 ] reduced,and untwisting half time[ （489.61 ±97.14）ms vs.（445.21 ±54.53）ms and（410.60 ±50.23）ms,P 〈0.05] delayed.Conclusion Speckle tracking imaging could be used to evaluate early changes on LV twist deformation and LV systolic function in patients with type 2 diabetes mellitus.