肥厚型心肌病左室局部与整体舒张功能研究新方法定量组织多普勒速度成像技术

Study on exploring left ventricular regional diastolic function in patients with hypertrophic cardiomyopathy by 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 )患者左室局部与整体心肌舒张功能的价值。方法 应用QTVI获取 36例正常人和 4 2例HCM患者左室长轴方向不同室壁心肌多普勒速度曲线。离线分析正常人与HCM患者不同室壁舒张期心肌多普勒运动速度。测量的快速充盈期和心房收缩期速度 (Ve和Va)、Ve/Va比值反映左室局部舒张功能 ,脉冲多普勒测量二尖瓣舒张期血流频谱E/A值、左室等容舒张期 (IRT)反映左室整体功能 ,常规超声心动图测量室壁厚度。结果 ①HCM患者肥厚室间隔节段Ve、Va、Ve/Va的测值及二尖瓣血流频谱E/A值均比正常人测值明显降低 ,IRT比正常人明显延长(P <0 0 5 ) ;②HCM患者肥厚室间隔节段Ve、Va、Ve/Va的测值比其他左室节段明显降低 ;③E/A比值异常的HCM患者Ve/Va与E/A有相关关系 (r =0 70 4 )。④非梗阻型HCM患者肥厚室间隔厚度IVSt与Ve/Va有负相关关系 (r =- 0 6 14 )。结论 QTVI定量评价HCM患者左室局部心肌舒张功能以及局部与整体心肌舒张功能关系 ,为进一步了解HCM心肌舒张功能的变化提供较为敏感、精确的方法。

Objectives The study was performed to assess the left ventricular(LV) regional and global diastolic function,left ventricular wall motion features in patients with hypertrophic cardiomyopathy by quantitative tissue velocity imaging(QTVI). Me- thods 42 patients with hypertrophic cardiomyopathy and 36 age matched normal subjects underwent TVI studied. Off-line LV regional muscular tissue velocity imaging along LV aplcal long-axis view were obtained. Regional diastolic function was assessed by peak tissue velocities of LV regional muscular tissue during early diastole(Ve) and LA contraction(Va),Ve/Va ratio, derived from tissue velocity imaging. LV global diastolic function was reflected by isovolumic relaxation time(IRT) and mitral valve peak flow velocity(E/A) calculated with pulsed wave doppler, the end-diastolic interventricular septal thickness (IVSt) was measured by conventional 2-dimension echocardiography. Results ①Ve?Va?Ve/Va in interventricular septum significantly reduced wlhile E/A ratio significantly reduced and IRT markedly prolonged in HCM patients than in normal subjects. ②Ve?Ve/Va significantly reduced in the region of hypertrophic interventricular septum(IVS) compared with other LV segments in HCM patients. ③There was a correlation between Ve/Va and E/A in HCM patients with abnormal E/A ratio(r=0.70). ④There was a negative correlation between Ve/Va and IVSt in non-obstruction HCM patients(B group, r=-0.61). Conclusions QTVI offer a newer method in clinical practice which have a higher sensibility and accuracy in evaluating the LV regional and global diastolic function in HCM patients.