二维斑点追踪成像评估阻塞性睡眠呼吸暂停综合征左心室整体及分层心肌应变

Two-dimensional Speckle Tracking in Evaluating Obstructive Sleep Apnea Syndrome Left Ventricular Global and Layered Myocardial Strain

目的评估阻塞性睡眠呼吸暂停综合征(OSAS)患者左心室收缩功能。资料与方法 60例OSAS患者按多导睡眠监测结果分为轻度OSAS组16例,中度OSAS组18例,重度OSAS组26例;以20例健康者为对照组。应用二维斑点追踪成像测量OSAS组与对照组的左心室整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS),左心室长轴切面的心内膜层、心肌中层、心外膜层纵向应变(Endo-LS、Mid-LS、Epi-LS)及左心室短轴切面的心内膜层、心肌中层、心外膜层圆周应变(Endo-CS、Mid-CS、Epi-CS)。结果 (1)轻度OSAS组GLS、GCS无明显变化(P>0.05),GRS较对照组增加(P<0.05);中度OSAS组GLS、GRS、GCS均较对照组减低,差异有统计学意义(P<0.05);重度OSAS组GLS较对照组、轻度及中度OSAS组减低,GRS、GCS较对照组、轻度OSAS组减低,差异均有统计学意义(P<0.05)。(2)OSAS组均表现为Endo-LS减低,且随着OSAS疾病严重程度加重,Endo-LS减低的切面数增加。(3)从中度OSAS组开始,心肌圆周应变开始减低,表现为Endo-CS、Mid-CS减低。结论应用二维斑点追踪成像评估左心室整体及分层心肌应变可早期发现OSAS患者左心室收缩功能障碍,为临床提供更多有价值的信息,指导临床对OSAS患者进行早期干预。

Purpose To evaluate left ventricular systolic function of patients with obstructive sleep apnea syndrome（OSAS）. Materials and Methods Sixty OSAS patients were divided into 16 cases in mild OSAS group, 18 cases in medium OSAS group and 26 cases in severe OSAS group in line with polysomnography results. 20 healthy people were in the control group. Two-dimensional speckle tracking imaging was adopted to measure left ventricular global longitudinal strain（GLS）, global radial strain（GRS）, global circumferential strain（GCS）, Endo-LS, Mid-LS and Epi-LS of left ventricular long axial section and EndoCS, Mid-CS and Epi-CS of short axial section in OSAS group and control group. Results（1） There was no obvious change of GLS and GCS in mild OSAS group and compared with those in control group（P〉0.05）, GRS was increased（P〈0.05）. GLS, GRS and GCS in medium OSAS group was decreased when compared with those in control group, and the difference was of statistical significance（P〈0.05）. GLS in severe OSAS group was reduced compared with that in control group, mild and medium OSAS group and GRS and GCS were also reduced compared with that in control group and mild OSAS group. The difference was of statistical significance（P〈0.05）.（2） OSAS group was represented by Endo-LS reduction and as OSAS worsened, Endo-LS reduced section was enhanced.（3） Starting from medium OSAS group, myocardial circumference strain began to decrease, which was represented by Endo-CS and Mid-CS reduction. Conclusion Adoption of two-dimensional speckle tracking imaging for left ventricular global and layered myocardial strain could figure out early stage left ventricular systolic function disorder in OSAS patients, providing more valuable information for clinical activities and guidance of early intervention for OSAS patients.