三维斑点追踪成像技术评价尿毒症患者左心室整体应变

The assessment of global left ventricular strain in uremic patients by three-dimensional speckle tracking imaging

目的应用三维斑点追踪技术(3D-STI)评价尿毒症患者不同左室构型左心室整体应变的价值。方法选取2016年6月至2017年7月尿毒症患者75例,其中尿毒症左心室构型正常38例(CA组),尿毒症左心室肥厚37例(CB组),同时选取健康志愿者35例为对照组(CN组)。测量二维常规超声心动图指标:舒张末期室间隔厚度(IVSd)、左室舒张末期内径(LVEDd)、舒张末期左室后壁厚度(LVPWd)、左室质量指数(LVMI)、左室射血分数(LVEF);三维斑点追踪成像指标:左室整体纵向应变(GLS)、左室整体面积应变(GAS)、左室整体径向应变(GRS)、左室整体圆周应变(GCS),比较各组指标间的差异。结果尿毒症患者CB组比CA组及正常对照CN组,IVSd、LVEDd、LVPWd及LVMI升高,差异有统计学意义(P<0.05);LVEF在三组间比较差异无统计学意义(P>0.05);CA组较CN组,GLS、GAS减低,差异有统计学意义(P<0.05);CB组较CA组及CN组,GLS、GAS、GRS、GCS减低,差异有统计学意义(P<0.05)。结论3D-STI技术能反映尿毒症患者早期左室整体收缩功能的变化,以左室整体纵向及面积应变较敏感。

Objective To investigate the value of three-dimensional speckle tracking imaging (3D-STI) in evaluating global left ventricular strain systolic function in patients with uremia of diflerent left ventricular configurations. Methods 38 cases of uremia with left ventricular normal (CA group), 37 cases of uremia with left ventricular hypertrophy (CB group) and 35 cases of healthy subjects as control (CN group ) were selected in this study. Parameters of two dimensional echocardioaphy including interventricular septal thickness at enddiastole (IVSd), left ventricular at end-diastole diameter (LVEDd), left ventricular posterior wall thickness at end-diastole ( LVPWd ), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and parameters of 3D-STI including left ventricular global longitudinal strain (GLS), left ventricular global area strain (GAS), left ventricular global radial strain (GRS), left ventricular global circumferential strain (GCS) were calculated and compared. Results Compared with CA and CN group, IVSd, LVEDd, LVPWd and LVMI were increased in CB group (P<0.05 ).Compared w让h the CN group, GLS, GAS were significantly decreased in CA group ( P<0.05 ), Compared with CA and CN group, GLS, GAS, GRS and GCS were decreased in CB group ( P<0.05 ). Conclusion 3D-STI can detect the early changes of left ventricular systolic function in uremic patients, and the GLS, GAS are more sensitive.