斑点追踪技术评价肺动脉高压患者左心室收缩同步性的研究  

Speckle-tracking Approach on Wall Motion Dyssynchrony in Patients with Left Ventricular Mechanical Dyssynchrony and Pulmonary Arterial Hypertension

作　　者：陈勇[1] 何胜虎[2] 顾翔[2] 马勇[1] 

机构地区：[1]江苏省苏北人民医院超声心动图室,江苏省扬州市225001 [2]江苏省苏北人民医院心脏科,江苏省扬州市225001

出　　处：《中国超声医学杂志》2012年第5期425-428,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的应用斑点追踪技术阐明肺动脉高压对左室功能和左室各节段运动同步性的影响。方法选取30例慢性肺心病患者为疾病组,30例年龄相匹配的健康人为对照组。左室中段短轴切面的6个节段运动信号在每一帧上与左室整体运动信号相反的被定义为失同步节段。左室整体的失同步性是计算从QRS波开始到等容舒张期结束所有测定的6个节段中失同步的百分数。结果肺动脉高压患者组织位移显像示随着室间隔矛盾运动有大量失同步的节段出现(22%±7%,P<0.05 vs对照组),这与左室偏心指数(r=0.81,P<0.05)和左室心肌功能综合指数(r=0.78,P<0.05)有着高度相关性。相反,应变显像示肺动脉高压组各节段径向增厚一致,与对照组相似。这说明疾病组没有内在的收缩失同步。结论肺动脉高压患者组织位移显示的左室壁收缩失同步,而组织应变显示没有内在的收缩失同步,左室腔的变形和室间隔的偏移和左室功能受损密切相关。Objective To test the hypothesis that Pulmonary arterial hypertension（PAH） affects regional wall motion, synchronicity, and global LV function using a novel speckle-tracking approach. Methods Displacement and strain imaging echocardiographic studies were performed in 30 patients with PAH and 30 age-matched normal sub- jects. Segmental signals from 6 segments around the mid-LV short axis were defined as dyssynchronous if their chan- ges were opposite to that of the global LV signal at each time frame, and overall LV dyssynchrony was calculated as the percentage of dyssynchrony in all 6 segments within the specified time interval from onset of QRS to the end of iso- volumic relaxation. Results PAH was associated with a large degree of regional dyssynchrony with paradoxical ven- tricular septal motion observed by displacement imaging （22O/oo ：t： 7M, P〈0.05 vs control group）, which was closely associated with LV eccentricity index （r=0.81 ,P〈0.05） and LV myocardial performance index with linear regression （r=0.78, P〈0.05）. In contrast, strain imaging showed uniform segmental radial thickening in the PAH group, which was similar to the control group, and suggests that there was no intrinsic LV contractile dyssynchrony. Conclu- sions LV wall motion dyssynchrony assessed by displacement imaging, not intrinsic contractile dyssynchrony by strain imaging, coexists with LV chamber deformation with ventricular septal shift and is closely associated with im- pairment of LV performance.

关 键 词：超声心动描记术 左心室 斑点追踪显像 肺动脉高压 

分 类 号：R541.5[医药卫生—心血管疾病] R445.1[医药卫生—内科学]