组织多普勒衍生新技术评价肥厚型心肌病心房局部功能的研究

Evaluation of regional atrial function in patients with hypertrophic cardiomyopathy by new technologies derived from tissue Doppler imaging

目的探讨组织多普勒衍生新技术即组织速度成像及应变率成像评价肥厚型心肌病(HCM)患者心房局部功能的价值。方法 HCM组和健康对照组各30例,测量两组左房前后径,室间隔及左室后壁厚度,左、右室流出道压差,二、三尖瓣口E、A峰(Em、Am及Et、At),计算左房主动排空分数(LAAEF)及左房被动排空分数(LAPEF)。取心尖四腔切面测量左房侧壁(LA)、右房侧壁(RA)、房间隔(IAS)近瓣环部(bas)和中部(mid)的峰值组织速度(Vs、Ve、Va)和峰值应变率(SRs、SRe、SRa)。结果 HCM组左房前后径、室间隔及左室后壁厚度、左室流出道压差及LAAEF明显大于对照组(P<0.05),E/Am、E/At及LAPEF则显著减低(P<0.01)。HCM组LAbas、LAmid及IASbas、IASmid的Ve减低;LAbas、LAmid、IASbas、IASmid和RAmid的SRe减低、SRa增高;LAmid及IASbas、IASmid的SRs减低,与对照组相应各节段测值比较,差异均有统计学意义(P<0.05)。HCM组左房各节段SRa平均值(mSRa)与LAAEF呈显著正相关(r=0.810,P<0.01)。结论 HCM患者的左、右心房局部功能均有不同程度受损,组织速度成像及应变率成像可准确评价心房功能尤其是左心房的局部功能变化情况。

Objective To evaluate the value of the new technologies of tissue velocity imaging （TVI） and strain rate imaging derived from tissue Doppler imaging in detecting regional atrial function in patients with hypertrophic cardiomyopathy （HCM）.Methods Thirty patients with HCM and 30 healthy control subjects were enrolled in this study. Left atrial diameter, interventrieular septal thickness, left ventricular posterior wall thickness, pressure gradients of left ventricular outflow tract and right ventricular outflow tract, peak E and A of mitralis and tricuspid （Em,Am and Et,At）were measured by conventional eehocardiography. Left atrial active ejection fraction （LAAEF） and left atrial passive ejection fraction （LAPEF） were calculated. In four-chamber apical view, the lateral left and right atrial （LA and RA） and interatrial septal（IAS） wall systolic, early and late diastolic velocities （Vs,Ve,Va） in base （bas） and middle （mid） segments, peak systolic stain rate （SRs）, peak early diastolic stainrate（SRe）andpeaklatediastolicstrainrate（SRa）weremeasured. Results Compared with eontrols group, left atrial diameter, interventricular septal thickness, left ventricular posterior wall thickness,pressure gradients of left ventricular outflow tract and LAAEF were significantly larger （P 〈0.05）,while E/Am, E/At and LAPEF significantly decreased （P 〈0.01 ）. Compared with controls group, Ve in LA bas, LA mid, IAS bas and IAS mid segments in HCM group were significantly reduced, SRe in LA bas,LA mid ,IAS bas, IAS mid and RA mid segments were significantly reduced ,while SRa were signifcantly increased; SRs in LA mid, IAS bas and IAS mid segments were significantly reduced（P 〈0.05 ）.There was significant positive correlation between mSRa and LAAEF of different segment in HCM group （r=O.810,P 〈0.01）. Conclusion The left amd right atrial function decreased unequally in patients with HCM. Strain rate imaging and tissue velocity imaging could evaluate the changes of regional atrial functions function especially regional left atrial function in patients with HCM.