二维斑点追踪技术评价舒张性心力衰竭患者左室心内膜和心外膜下心肌功能  

Evaluation of the difference of rotation between subendocardium and subepicardium in diastolic heart failure patients by two-dimensional speckle tracking imaging

作　　者：陈玉媛[1] 谢明星[1] 吕清[1] 王静[1] 贺林[1] 帅欣欣[1] 段利科[1] 李薇玢[1] 刘莹莹[1] 李静雅[1] 张丽[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430022

出　　处：《中华超声影像学杂志》2011年第1期5-9,共5页Chinese Journal of Ultrasonography

摘　　要：目的 应用二维斑点追踪成像技术评价射血分数正常的舒张性心力衰竭（diastolic heart failure,DHF）患者左室心内、外膜下心肌功能.方法 临床确诊的DHF患者36例、收缩性心力衰竭（systolic heart failure,SHF）患者20例及正常对照组41例.二维超声心动图分别存储胸骨旁左室短轴基底水平、心尖水平连续3个心动周期的二维灰阶图像.使用Qlab 7.0工作站进行脱机分析,记录左室上述两短轴切面心内、外膜下心肌旋转角度.结果 ①所有受检者左室同一水平心内、外膜下心肌旋转运动呈相同方向运动,心尖水平呈逆时针方向旋转,基底水平呈顺时针方向旋转.②心尖水平及基底水平心内膜下心肌旋转角度均大于心外膜下心肌旋转角度.③与正常对照组相比,DHF及SHF患者心尖水平心内膜下心肌旋转角度减低 DHF患者心尖水平心外膜下心肌旋转角度与正常组比较未见明显减低,SHF组较正常组及DHF组明显减低.④DHF组基底水平心内、外膜下心肌旋转角度较正常对照组相应心肌层旋转角度值减低,但差异无统计学意义.SHF患者基底水平心内、外膜下心肌旋转角度显著减低.结论 SHF患者左室心内膜下心肌和心外膜下心肌旋转运动减低 DHF患者左室心尖水平心内膜下心肌旋转运动减弱,射血分数正常的DHF患者存在收缩功能异常.Objective To observe the rotation of subendocardium and subepidium by two-dimensional speckle tracking imaging（2D-STI）,and to evaluate its performance in diastolic heart failure patients（DHF）with a normal left ventricular ejection fraction. Methods Ninety-seven consecutive clinically stable patients were enrolled in this study [41 healthy controls,36 with diastolic heart failure,20 with systolic heart failure （SHF）]. High frame rate dynamic two-dimensional images were recorded at the left ventricular short-axis view,including basal, papillary muscle and apical planes. Subendocardial and subepicardial global rotation were measured using Q-lab 7.0 software offline. Results ① In all the subjects, the rotation of the subendocardium was obviously greater than that of subepicardium. ②As seen from the apex,left ventricular subendocardium and subepicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex. ③In the apical plane, subendocardial rotation was significantly lower in both heart failure groups than in controls,and was depressed to a larger extent in SHF patients than in those with DHF. Subepicardial rotation was no significant difference between the DHF group and the control group, though it was significantly lower in patients with SHF. ④At the base, the rotation of subendocardium and subepicardium were not different between DHF and control groups, but it was significantly reduced in patients with SHF. Conclusions The subendocardial rotation is reduced, but subepicardial rotation is normal in DHF patients. On the other hand, in patients with SHF, subendocardial and subepicardial rotation are both reduced. The left ventricular systolic properties are impaired in DHF patients.

关 键 词：超声心动描记术 心力衰竭 心室功能 左 斑点追踪技术 

分 类 号：R541.6[医药卫生—心血管疾病] R540.45[医药卫生—内科学]