定量组织多普勒速度成像评价肥厚型心肌病左室功能的研究

Assessment of left ventricular function in patients with hypertrophic cardiomyopathyby quantitative tissue velocity imaging

目的探讨定量组织多普勒速度成像技术(QTVI)评价肥厚型心肌病(HCM)患者左室心肌收缩与舒张功能的价值。方法应用QTVI获取30例正常人和30例HCM患者左室长轴方向不同室壁即左室前壁、后壁、下壁、侧壁及室间隔的心肌多普勒速度曲线。分别测量正常人与HCM患者上述不同左室壁心肌运动收缩期峰值速度(Vs)、加速度(a)、快速充盈期和心房收缩期的速度(Ve和Va)、收缩期内外膜峰值速度阶差(MVG)、二尖瓣舒张期血流频谱E蛐A值、左室射血分数(LVEF)、Ve蛐Va值。比较正常人与HCM患者室间隔、HCM患者室间隔与左室其它室壁间的上述参数的差异。结果①HCM患者肥厚室间隔的Vs、Ve、Va、MVG、a均比正常人室间隔明显降低(P<0.05);②HCM患者E蛐A比正常人低,Ve蛐Va与E蛐A有轻度的相关关系(r=0.734)。③非梗阻型HCM患者肥厚室间隔厚度IVSt与Ve蛐Va有负相关关系(r=-0.614)。④HCM患者E蛐A值比正常人低(P<0.05)。结论QTVI可定量评价HCM患者左室心肌功能,为进一步了解HCM局部心肌收缩舒张功能变化及其局部与整体心肌功能变化关系提供较为敏感、精确的方法。

Objective:To assess the left ventricular(LV) regional systolic and diastolic function, left ventricular wall motion features in patients with hypertrophic cardiomyopathy by quantitative tissue velocity imaging(QTVI). Methods:30 normal subjects and 30 HCM patients underwent QTVI study. Off-line LV regional velocity imaging along LV apical long-axis view were obtained. Peak tissue velocities of LV regional muscular tissue during systole(Vs),systolic acceleration(a), early diastole(Ve), LA contraction(Va), systolic velocity gradient(MVG) between endocardium and epicardium in the middle of LV segments, LV ejection fraction(LVEF), mitral valve peak flow velocity E/A ratio were measured and compared in normal subjects and HCM patients. Results: ①Vs, Va, Ve, Vs/Ve, MVG, a, E/A were significantly reduced in HCM patients than in normal subjects. ②Vs, Va, Ve, Vs/Ve, MVG were significantly reduced in hypertrophic interventricular septum(IVS) compared with other LV segments. ③Ve/Va in hypertrophic IVS was correlated well with E/A(r=0.70) in HCM patients. ④There was a negative correlation between Ve/Va and IVSt in hypertrophic IVS in non-obstruction HCM patients(r=-0.61). Conclusion: QTVI offers a new method in clinical practice which have a higher sensibility and accuracy in evaluating the LV regional systolic and diastolic function in HCM patients.