腺苷负荷心肌超声造影评价肥厚型心肌病患者心肌灌注异常

Adenosine stress myocardial contrast echocardiography evaluates myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy

目的应用心肌超声造影(MCE)结合腺苷负荷试验检测肥厚型心肌病(HCM)患者心肌血流灌注异常改变。方法前瞻性选取2021年5月至2022年3月在阜外华中心血管病医院就诊的成人HCM患者15例为HCM组,选取同期性别、年龄及体表面积相匹配的健康志愿者18例为对照组,行常规超声心动图、静息及腺苷负荷左室MCE检查,运用QLab软件对MCE图像进行分析,获得心肌灌注参数:峰值信号强度(A值)、曲线上升斜率(β值)及A×β值,比较两组间以上参数的差异。根据舒张末期室壁厚度是否≥12 mm,将HCM组心肌节段分为肥厚节段和非肥厚节段,比较其与对照组心肌节段之间心肌灌注参数的差异,并分析HCM组负荷心肌血流量与左室壁最大厚度(MLVWT)、左室质量指数(LVMI)及左房容积指数(LAVI)的相关性。结果与对照组相比,静息与腺苷负荷状态下,HCM组整体心肌、肥厚节段和非肥厚节段的A值、β值及A×β值明显减低,差异有统计学意义(均P<0.05);负荷状态下,HCM组肥厚节段的A值、β值及A×β值较HCM组非肥厚节段明显减低,且HCM组灌注异常节段的检出率较静息状态明显提高,差异有统计学意义(均P<0.05);与对照组相比,HCM组整体心肌、肥厚节段和非肥厚节段的心肌血流量储备明显减低,差异有统计学意义(均P<0.05);HCM组负荷心肌血流量与MLVWT、LVMI及LAVI均呈负相关(r=-0.815、-0.805、-0.742,均P<0.05)。结论HCM患者的肥厚及非肥厚心肌均可发生心肌血流灌注异常,腺苷负荷MCE能够明显提高心肌灌注异常检测的敏感性;HCM患者的负荷心肌血流量与MLVWT、LVMI及LAVI均呈负相关。

Objective To detect the abnormal changes of myocardial blood perfusion in patients with hypertrophic cardiomyopathy(HCM)by myocardial contrast echocardiography(MCE)combined with adenosine stress test.Methods Fifteen adult patients with HCM who were treated in Fuwai Central China Cardiovascular Hospital from May 2021 to March 2022 were prospectively selected as the HCM group,and eighteen healthy volunteers matched by gender,age and body surface area during the same period were chosen as the control group.All subjects underwent routine echocardiography,rest and adenosine stress MCE.The MCE images were analyzed by QLab software to obtain the myocardial perfusion parameters:peak signal intensity(A value),rising slope of the curve(βvalue)and A×βvalue,and the differences of above parameters between the two groups were compared.According to whether the end-diastolic wall thickness≥12 mm,the myocardial segments in the HCM group were divided into hypertrophic segments and non-hypertrophic segments.The differences in myocardial perfusion parameters were compared among control group segments,hypertrophic segments and non-hypertrophic segments of the HCM group.The correlations of stress myocardial blood flow with maximal left ventricular wall thickness(MLVWT),left ventricular mass index(LVMI)and left atrial volume index(LAVI)in the HCM group were analyzed.Results Compared with the control group,the A value,βvalue and A×βvalue of whole myocardium,hypertrophic segments and non-hypertrophic segments in the HCM group were significantly decreased in the rest and adenosine stress state,and the differences were statistically significant(all P<0.05).In the stress state,the A value,βvalue and A×βvalue of the hypertrophic segments were significantly lower than those in the non-hypertrophic segments in the HCM group,and the detection rate of abnormal perfusion segments in the HCM group was significantly higher than that in the rest state(all P<0.05).Compared with the control group,the myocardial blood flow reserve of whole myocardium,hypertrophic segments and non-hypertrophic segments in the HCM group were significantly decreased,and the differences were statistically significant(all P<0.05).The stress myocardial blood flow in the HCM group was negatively correlated with MLVWT,LVMI and LAVI(r=-0.815,-0.805,-0.742;all P<0.05).Conclusions Myocardial blood perfusion abnormalities can occur in both hypertrophic and non-hypertrophic myocardial segments in patients with HCM,and adenosine stress MCE can significantly improve the sensitivity of detecting myocardial perfusion abnormalities.The stress myocardial blood flow in patients with HCM is negatively correlated with MLVWT,LVMI and LAVI.