肥厚型心肌病左心室局部及整体舒张功能的研究

Evaluation of the left ventricular global and regional diastolic function in patients with hypertrophic cardiomyopathy

目的探讨肥厚型心肌病（HCM）患者左心室局部及整体舒张功能的变化。方法以40例肥厚型心肌病患者和40名健康人为研究对象，脉冲多普勒（PWD）测量二尖瓣口血流E峰、A峰，组织多普勒（TDI）测量二尖瓣环的前间隔、后间隔、前壁、下壁、后壁及侧壁6个位点的舒张早期峰值速度（Em）、舒张晚期峰值速度（Am），计算E／A、Em／Am、E／Em，对各组参数之间的差异、Em与室壁厚度的相关性分别进行分析。结果HCM组二尖瓣瓣环各位点Em分别为前壁（0．053±0．019）m／s、后壁（0．055±0．016）m／s、前间隔（0．038±0．017）m／s、后间隔（0．049±0．015）m／s、侧壁（0．052±0．018）m／s、下壁（0．056±0．015）m／s；对照组二尖瓣环各位点Em分别为前壁（0．144-±0．031）m／s、后壁（0．139±0．033）m／s、前间隔（0．136±0．029）m／s、后间隔（0．143±0．028）m／s、侧壁（0．138±0．025）m／s、下壁（0．139±0．030）m／s，HCM组二尖瓣环各位点Em较对照组明显降低（P〈0．05），但各位点间仅室壁增厚明显的前、后间隔瓣环位点与其他位点Em差异有统计学意义（P〈0．05）。HCM组E／Em为15．876±6．579，对照组E／Em为5．949-±1．283，二者比较差异有统计学意义（P〈0．05）。Em与心室壁厚度成线性负相关（r=-0．535，P〈0．05），随着心室壁厚度增加而降低。结论HCM患者左心室局部及整体舒张功能明显降低，左室壁局部舒张功能降低与室壁厚度相关。

Objective To evaluate the left ventricular diastolic function in patients with hypertrophic car-diomyopathy （HCM）. Methods 40 patients with hypertrophic cardiomyopathy and 40 healthy subjects were per-tormed by pulsed wa c Doppler（PWD）, TDI. The mitral valve inflow velocity （E wave and A wave） by PWD and the mitral valve annulus motion （including Em wave, Am wave from six sites including posterospetum, lateral, anterior, inferior, posterior and anteroseptum） were measured by TDI at each segment of the left ventricular in all patients with hypertrophic cardiomyopathy and healthy subjects. E/A, Em/Am and E/Em were calculated. The dif-ferences in variables and the evolution of Em with gestation were analyzed. Results Em were （0.053±0.019）m/s, （0.055±0.016）m/s, （0.038±0.017）m/s, （0.049±0.015）m/s, （0.052±0.018）m/s, （0.056±0.015）m/s in anteri-or, posterior, anteroseptum, posterospetum, lateraland inferior, in patients with hypertrophic cardiomyopathy, Em were （0.144±0.031）m/s, （0.139±0.033）m/s, （0.136±0.029）m/s, （0.143±0.028）m/s, （0.138±0.025）m/s, （ 0.139±0.030）m/s in anterior, posterior, anteroseptum, posterospetum, lateral and inferior in healthy subjects, Em of all sites in HCM decreased significantly （P〈0.05）, but Em decreased significantly from anteroseptal and posterospetal site decreased significantly（P〈0.05）. E/Era were （15.876±6.579） and （5.949±1.283） in HCM and healthy subjects, and there was significant difference between the two teams. Em was negatively related to wall thickness （r=-0.535, P〈0.05）, Em decreased with wall thickness increasing. Conclusion The left ventricular global and regional diastolic function in patients with hypertrophic cardiomyopathy （HCM） decrease significantly. The decrease of the left ventricular regional function is related to wall thickness.