超声二维斑点追踪成像评价原发性3级高血压患者的左室扭转重构  

The Clinical Investigations of Two-Dimensional Speckle Tracking Imaging on the Left Ventricular Twisting in Patients with Staging Ⅲ Primary Hypertension

作　　者：王静[1] 谢明星[1] 韩伟[1] 王新房[1] 吕清[1] 张玲丽[1] 贺林[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院超声影像科湖北省分子影像重点实验室,武汉市430022

出　　处：《中国超声医学杂志》2008年第9期806-810,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨超声二维斑点追踪成像(two-dimensional speckle tracking imaging,2D-STI)评价原发性高血压患者左室扭转(left ventricular twist,LVtw)重构特征的应用价值。方法25例原发性3级高血压患者与30例正常成人经胸采集标准动态左室基底部及心尖部的胸骨旁短轴二维图像并存贮。在Echo PAC超声工作站上获取各层面在收缩期和舒张期左室的旋转角度和旋转率度曲线。LVtw(率)值定义为左室心尖部与基底部2个层面旋转角度(速度)的差值。为消除不同个体间心率差异,对时间参数进行标化。结果原发性3级高血压患者与正常人的左室旋转和解旋曲线的走行趋势基本一致。扭转曲线图:收缩期左室呈短暂的逆时针扭转后,心底水平迅速呈顺时针旋转,同时心尖水平呈逆时针旋转,2个水平的旋转角度均于收缩期末达峰值。左室扭转角度均在(97±10)%(收缩末期)达到峰值。至舒张期,心室则表现为快速反向的解旋运动;与正常组相比,原发性3级高血压患者的左室峰值扭转度明显增大(P<0.001),左室峰值扭转速度及达左室峰值扭转速度时间测值则无明显差异(P>0.05);左室舒张期解旋率显著减小(P<0.001),解旋速度达峰时间延长(P<0.05),解旋峰值速度增大(P<0.05)。结论超声二维斑点追踪技术可全程量化左室扭转重构,并从机械力学角度对左室心肌功能进行合理解释,为临床防治原发性高血压提供理论依据。Objective To probe into the clinical value of two-dimensional speckle tracking imaging （2D-STI） on the left ventricular twist （LVtw） in patients with staging 1~ primary hypertension. Methods 25 patients with staging Ⅲ primary hypertension and 30 age-matched healthy control subjects were investigated for systolic and diastolic heart wall motion on a basal and an apical level of the myocardium using 2D-STI. LV twist and the twist velocity were defined as apical rotation （rotation rate） relative to the base level. To adjust the inter-subject differences in heart rates, the time sequences were normalized. Results In the healthy heart, the left ventricle performs a systolic wringing motion, with a counterclockwise rotation at the apex and a clockwise rotation at the base. Apical untwisting precedes diastolic filling. In the patients with staging Ⅲ primary hypertension, the trend of the torsion and untwisting curves remain unchanged. Whereas, LV systolic peak LVtw is significantly increased in primary hypertension patients （P〈0. 001） and diastolic untwist velocity is decreased （P〈0. 001）, the time to peak untwist velocity is prolonged （P 〈 0.05）, the peak untwist velocity is increased （P 〈 0.05） compared with those of control subjects. Conclusions 2D-STI could quantify LV torsion deformation over time. This novel method may enhance the understanding the myocardial function in patients with staging Ⅲ primary hypertension and noninvasive qualification of LV torsion in several clinical settings.

关 键 词：超声心动描记术 斑点追踪 原发性高血压 左室扭转 旋转 

分 类 号：R541.3[医药卫生—心血管疾病] R445.1[医药卫生—内科学]