三维面积应变评价射血分数保留心力衰竭患者左心室收缩功能变化

Three-dimensional area strain in evaluatinon on changes of left ventricular myocardial contractional function in heart failure patients with preserved ejection fraction

目的应用整体面积应变(GAS)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早期变化情况。方法收集32例HFpEF患者和32名健康志愿者,采集二维超声心动图、组织多普勒(TDI)与三维斑点追踪(3D-STI)图像,测量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)、左心室后壁舒张末期厚度(LVPWTd),二尖瓣口血流舒张早期峰速(E)和舒张晚期峰速(A)、舒张早期二尖瓣环运动速度(e')和E/e'比值以及左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、射血分数(LVEF)和GAS;比较两组间各参数差异,以Pearson相关分析评价GAS与LVEF间的相关性。结果 HFpEF组LVEDd、E、LVEDV、LVESV及LVEF与对照组差异均无统计学意义(P均>0.05)。HFpEF组LAd、IVSTd、LVPWTd、A、E/e'升高,E/A、e'减低(P均<0.05)。HFpEF组左心室GAS峰值[(-18.36±8.48)%]明显低于对照组[(-25.12±4.76)%],差异有统计学意义(P均<0.05);GAS值与LVEF呈负相关(r=-0.50,P<0.05)。结论 HFpEF患者在早期LVEF未发生明显变化时即已存在左心室整体收缩功能减低,可通过3D-STI测量GAS而予以定量评价。

Objective To observe the early changes of myocardial contractile function in heart failure patients with preserved ejection fraction（HFpEF）with three-dimensional global area strain（GAS）.Methods Totally 32 patients with HFpEF（HFpEF group）and 32 healthy volunteers（control group）were enrolled.Two-dimensional echocardiography,tissue Doppler imaging and three-dimensional speckle tracking imaging（3D-STI）were performed,and the parameters were calculated and compared,including left atrial diameter at end-systole（LAd）,left ventricular diameter at end-diastole（LVEDd）,interventricular septum thickness at end-diastole（IVSTd）,left ventricular posterior wall thickness at enddiastole（LVPWTd）,peak E（E）,peak A（A）,the ratio of E/A,early diastolic mitral annular velocity（e＇）,the ratio of E/e＇,left ventricular volume at end-diastole（LVEDV）,left ventricular volume at end-systole（LVESV）,left ventricular ejection fraction（LVEF）and left ventricular global area strain（GAS）.The correlation between GAS and LVEF was analyzed.Results There was no difference of LVEDd,E,LVEDV,LVESV and LVEF between the two groups（all P〈0.05）.Compared with those of control group,HFpEF group had higher LAd,IVSTd,LVPWTd,A and E/e＇,lower E/A and e＇,while GAS significantly reduced（[-18.36±8.48]% vs.[-25.12 ±4.76]%）,and all the differences were statistically significant（all P〈0.05）.There was negative correlation between GAS and LVEF（r=-0.50,P〈0.05）.Conclusion The left ventricular myocardial contractile function might have reduced before LVEF changes in HFpEF patients,which could be quantitatively evaluated with 3D-STI GAS.