三维径向应变评价射血分数保留的心力衰竭患者左心室收缩功能变化

Three-dimensional Radial Strain in Evaluation of Changes in Left Ventricular Myocardial Contractile Function in Heart Failure Patients with Preserved Ejection Fraction

目的应用三维径向应变(GRS)评价射血分数保留的心力衰竭(HFPEF)患者左心室心肌收缩功能的变化情况。方法采集32例HFPEF患者与32例健康体检者的二维超声心动图、组织多普勒(TDI)与三维斑点追踪(3D-STE)图像,测量并比较左心房收缩末期前后径(LAd)、左心室舒张末期前后径(LVEDd)、室间隔的舒张末期厚度(IVSTd)、左心室后壁的舒张末期厚度(LVPWTd)、二尖瓣口血流的舒张早期峰速(E)和舒张晚期峰速(A)、室间隔及左心室侧壁二尖瓣环处心肌运动速度e’、左心室的舒张末期容积(LVEDV)、收缩末期容积(LVESV)、射血分数(LVEF)和整体径向应变(GRS)间差异。采用Pearson相关分析检验GRS与LVEF间相关性。结果相较于对照组,HFPEF组患者LAd、IVSTd、LVPWTd、A、E/e’升高,E/A、e’、GRS减低,差异均有统计学意义(P<0.05)。GRS与LVEF呈正相关。结论 HFPEF患者LVEF未发生明显变化时,左心室整体收缩功能已有减低,可通过GRS定量评价。

Objective To evaluate early changes of myocardial contractile function in heart failure patients with preserved ejection fraction（HFPEF） using three-dimensional global radial strain（GRS）. Methods A total of 32 patients with HFPEF and 32 healthy volunteers underwent two-dimensional echocardiography,tissue Doppler imaging,and three-dimensional speckle tracking echocardiography（3 D-STE）. Assessment parameters included left atrial diameter（LAd）,left ventricular end-diastolic diameter（LVEDd）,interventricular end-diastolic septal thickness（IVSTd）,left ventricular posterior wall end-diastolic thickness（LVPWTd）,peak E（E）,peak A（A）,e＇at the interventricular septum and left ventricular lateral wall（e＇）,left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）,left ventricular ejection fraction（LVEF）,left ventricular global radial strain（GRS）. The correlations of GRS with LVEF were analyzed. Results LAd,IVSTd,LVPWTd,A,and E/e＇ were significantly greater in the HFPEF group than in controls,and E/A,e＇,and GRS were significantly reduced in the HFPEF group（both P 〈0.05）. There was a positive correlation between GRS and LVEF. Conclusion Left ventricular myocardial contractile function decreased before LVEF changed,and was detected with 3 D-STE with GRS.