实时三维超声心动图评价肥厚型心肌病患者左室收缩协调性研究

Study of real-time three-dimensional echocardiography in the assessment of left ventricular systolic synchronization in patients with hypertrophic cardiomyopathy

目的:探讨实时三维超声心动图(RT3DE)评价肥厚型心肌病(HCM)患者左室心肌收缩协调性的临床价值。方法:40例左室射血分数正常的HCM患者和25例正常人,应用RT3DE方法分析其左室特定节段到达最小收缩容积时间(Tmsv)的标准偏差和最大差值被标准化为心动周期的百分比(Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%)。结果:HCM患者的Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%与对照组比较均显著延长(P<0.05),梗阻型与非梗阻型HCM相比无显著统计学差异(P>0.05)。与对照组比较,HCM患者RT3DE的左室各节段容积-时间曲线交错紊乱,同步性差。结论:HCM患者无论梗阻型或者非梗阻型均存在左室收缩协调性障碍,RT3DE技术能识别HCM患者早期左室收缩协调性异常,对于明确HCM患者心肌损害进程有重要意义。

Objective：To assess left ventricular myocardial systolic dyssynchrony in patients with hypertrophic cardiomyopathy （HCM） by real-time three-dimensional echocardiography （RT3DE）.Methods：Forty patients with HCM,25 age and sex matched normal controls underwent examinations with 2D and full volume RT3DE.Ejection fraction was 〉0.55 in all subjects.According to with or without left ventricular outflow tract obstruction at rest,HCM patients were divided into 2 groups,nonobstructive HCM group and obstructive HCM group.With QLab 7.0 off-line software the 17 segmental volume-time curves were obtained.The difference（Dif） and standard deviation（SD） of the time to the point with minimal systolic volume（Tmsv） in 16,12,and 6 segments were measured and adjusted by R-R interval （Tmsv Dif%,Tmsv SD%）.Results：Compared with control group,the Tmsv 16-SD%,and there were no significant differences between non-obstructive and obstructive HCM group.The left ventricle volume-time curves of the HCM patients had disordered arrangement compared with the normal control.Conclusion：Systolic asynchrony is impaired in HCM patients with or without left ventricular outflow tract obstruction.The RT3DE is an useful method for detecting left ventricular dyssynchrony of HCM patients and provide additional value for understanding myocardial damage of HCM patients.