三维斑点追踪成像技术评价肥厚型心肌病患者早期左心室局部收缩功能的临床研究

Assessment of left ventricular regional systolic function in early stage of the patients with HCM by three-dimensional speckle tracking imaging

目的应用3D-STI评估HCM患者左心室早期局部收缩功能障碍。方法心脏超声检查诊断的肥厚型心肌病患者为肥厚型心肌病组(HCM组)共35例,非梗阻型(NHCM)19例,梗阻型(OHCM)16例,同时收纳体检者30例为对照组(NOR),3D-STI技术测量3组样本左心室16节段径向应变(RS)、纵向应变(LS)、圆周应变(CS)进行比较。结果与NOR组比较,NHCM组、OHCM组病例组的常规二维指标IVSD、LVPWD、LVMI、LVOT-PG增加明显(P<0.05);与NHCM组比较,OHCM组样本的IVSD、LVPWD以及LVOT-PG增加显著(P<0.05);与NOR组比较,NHCM组、OHCM组病例组大部分节段LS明显减低(P<0.05);与NHCM组比较,OHCM组的后间隔及前壁基底段LS显著降低(P<0.05);与NOR组比较,NHCM组、OHCM组病例组室间隔基底段、中段以及前、下壁基底段RS显著降低(P<0.05),其余各节段的RS虽有降低趋势但差异无统计学意义(P>0.05);与NOR组比较,NHCM组、OHCM组前间隔基底段CS显著降低(P<0.05),侧壁基底段CS显著增加(P<0.05)。结论3D-STI技术所获得HCM患者的左心室16节段LS及RS能够准确评价患者早期左心室局部收缩功能的改变,以期为临床提供早期诊断及早期干预的可靠依据。

Objective To explore the left ventricular regional systolic function in early stage of the patients with HCM by 3D-STI.Methods Thirty five patients were selected in the study,including 19 patients with non-obstructive hypertrophic myocardium(NHCM),16 patients with obstructive hypertrophic cardiomyopathy(OHCM);thirty cases of healthy physical examination volunteers were selected as normal control group(NOR).The LV regional longitudinal strain(LS),regional radial strain(RS),regional circumference strain(CS)was measured by 3D-STI,the differences among three groups were compared.Results The IVSD,LVPW,LVOT-PG and LVMI in the two HCM groups were significantly higher than those in NOR group(P<0.05).Compared with NHCM group,the IVSD,LVPW,LVOT-PG in OHCM group were significantly higher than those in the NOR group(P<0.05);The segment LS in the two HCM groups were lower than those in the NOR group(P<0.05).Compared with the NHCM group,the LS in IVS of the OHCM group were significantly decreased(P<0.05);The RS of the basal IVS,the apex IVS,the basal LVAW and the basal LVLW in the two HCM groups were lower than those in the NOR group(P<0.05);The CS of the basal IVS in the two HCM groups were lower than those in the NOR group(P<0.05),the basal LVLW was significantly increased(P<0.05).Conclusion The LV systolic and diastolic functions are damaged,even with a normal LVEF.LV systolic dysfunction impairment in HCM patients can be sensitively revealed by 3D-STI.3D-STI can be provided important information for early diagnosis and prevention.