三维斑点追踪成像评价肥厚型心肌病患者左心室整体和局部收缩功能

Three-dimensional speckle tracing imaging in assessing left ventricular global and regional systolic function in patients with hypertrophic cardiomyopathy

目的应用三维斑点追踪成像(3D-STI)检测肥厚型心肌病(HCM)患者左心室心肌整体及各节段峰值应变,评估HCM左心室收缩功能。方法收集43例HCM患者(病例组)和23名健康志愿者(对照组),病例组分为室间隔肥厚型HCM(sHCM)亚组(22例)、心尖肥厚型HCM(aHCM)亚组(8例)和混合型HCM(mHCM)亚组(13例),对所有受检者进行3D-STI检测,获得左心室射血分数(LVEF),左心室心肌整体纵向峰值应变(GPLS)、圆周峰值应变(GPCS)、面积峰值应变(GPAS)、径向峰值应变(GPRS)及各节段峰值应变,比较组间上述参数差异。结果病例组LVEF与对照组比较无明显变化(P>0.05)。3D-STI中病例组与对照组比较左心室心肌GPLS、GPAS和GPRS均明显减低(P均<0.01),GPCS无明显变化;心肌应变减低sHCM亚组主要集中于间隔基底段及中间段,aHCM亚组主要集中于心尖段,mHCM亚组主要集中于中间段及心尖段。结论 HCM患者左心室常规收缩功能参数可正常,左心室心肌三维纵向应变、面积应变、径向应变减低,可通过3D-STI进行检测,不同类型HCM患者应变减低节段分布与肥厚部位有关。

Objective To assess the 1eft ventricular systo1 ic function in hypertrophic cardiomyopathy（HCM）patients by measuring the global and partial strains with three-dimensional speckle tracing imaging（3D-STI）.Methods Totally 43 HCM patients（HCM group）and 23 healthy volunteers（control group）were enrolled and HCM patients were divided into septal HCM（sHCM）subgroup（n=22）,apical HCM（aHCM）subgroup（n=8）and mixed HCM（mHCM）subgroup（n=13）.All the subjects underwent 3DSTI to obtain 1eft ventricular ejection fraction（LVEF）,global peak longitudinal strain（GPLS）,global peak circumferential strain（GPCS）,global peak area strain（GPAS）,global peak radial strain（GPRS）,and partial peak strain.Above parameters were compared among different groups and subgroups.Results There was no difference of LVEF between HCM group and control group.In HCM group the GPLS,GPAS and GPRS of left ventricle were obviously lower than those in control group（all P〈0.01）,but the GPCS had no obvious change.The partial strains significantly decreased on basal and middle segments of septum region in sHCM subgroup,on apical segments in aHCM subgroup,and on middle and apical segments in mHCM subgroup.Conclusion In HCM,the left ventricular myocardial longitudinal strain,area strain and radial strain decrease even though the conventional systolic function parameters are normal,which can be detected by 3DSTI.The distribution of the decreased strain segments in different types of HCM patients is mainly associated with thick parts.