三维斑点追踪成像评价肥厚型心肌病患者左室扭转功能

Assessment of left ventricular twist function by three-dimensional speckle tracking imaging in patients with hypertrophic cardiomyopathy

目的应用三维斑点追踪成像(3D-STI)评价肥厚型心肌病(HCM)患者的左室收缩功能。方法选取19例HCM患者(H CM组)及年龄、性别均与之匹配的19例健康志愿者(对照组),行常规超声心动图检查,获取左室舒张末期容积(LVEDV)、每搏量(SV)、左室收缩末期容积(LVSDV)、左室射血分数(LVEF)及左室流出道压差(LVOT-PG);3D-STI图像分析获取二尖瓣水平旋转角度(Rot-B)、二尖瓣水平扭力(Tor-B)、心尖水平旋转角度(Rot-A)、心尖水平扭力(Tor-A),计算左室整体扭转角度(LVtw)、左室整体扭力(LVtor)及左室纵向应变(GLS),比较两组上述各参数的差异。结果与对照组比较,HCM组LVEDV减小、SV减少,差异均有统计学意义(均P<0.05);LVESV、LVEF、LVOT-PG比较差异均无统计学意义。HCM组Rot-B、Tor-B、Tor-A、LVtw、LVtor及GLS分别为-4.09°±1.63°、(1.57±0.71)°/cm、(1.95±0.82)°/cm、7.04°±1.77°、(1.75±0.63)°/cm、(-9.53±2.39)%,与对照组[-2.61°±1.49°、(1.03±0.53)°/cm、(1.37±0.71)°/cm、4.70°±1.75°、(1.35±0.39)°/cm、(-14.40±2.35)%]比较,差异均有统计学意义(均P<0.05);两组Rot-A比较差异无统计学意义。结论HCM患者左室扭转增加,长轴应变减低,提示心肌功能不同程度受损。3D-STI可以准确反映HCM患者左室整体及局部收缩功能的变化。

Objective To assess the left ventricular systolic function in patients with hypertrophic cardiomyopathy by three-dimensional speckle tracking imaging(3D-STI).Methods Nineteen patients with hypertrophic cardiomyopathy(HCM group)and 19 healthy volunteers with age and sex matched(control group)were examined by two-dimensional echocardiography.Left ventricular end-diastolic volume(LVEDV),stroke volume(SV),left ventricular end-systolic volume(LVSDV),left ventricular ejection fraction(LVEF)and left ventricular outflow tract pressure gradient(LVOT-PG)were obtained.The rotation curves of different plane at the left ventricle were obtained by three-dimensional image analysis,while peak rotation on basal plane(Rot-B),torsion of basal plane(Tor-B),peak rotation on apical plane(Rot-A),and torsion of apical plane(Tor-A)were obtained.Then the left ventricular global twist(LVtw),left ventricular global torsion(LVtor)and global longitudinal strain(GLS)were calculated,the differences were compared between the two groups.Results Compared with those of the control group,the LVEDV,SV in HCM group decreased,the differences were statistically significant(both P<0.05),as the differences of LVESV,LVEF,LVOT-PG were no statistically significant between the two groups.In the HCM group,Rot-B,Tor-B,Tor-A,LVtw,LVtor and GLS were-4.09°±1.63°,(1.57±0.71)°/cm,(1.95±0.82)°/cm,7.04°±1.77°,(1.75±0.63)°/cm,(-9.53±2.39)%,respectively,and the control group were-2.61°±1.49°,(1.03±0.53)°/cm,(1.37±0.71)°/cm,4.70°±1.75°,(1.35±0.39)°/cm,(-14.40±2.35)%,the difference were statistically significant(all P<0.05).There was no statistically significant difference in Rot-A between the two groups.Conclusion Left ventricular twist increases with longitudinal strain decreases when myocardial function is impaired in HCM patients.3D-STI can reflect the changes of left ventricular systolic function accurately in patients with HCM.