斑点追踪应变成像评价类风湿关节炎左心室收缩功能早期损伤  

Assessment on Early Impairment of Left Ventricular Myocardial Systolic Function in Patients With Rheumatoid Arthritis by Speckle Tracking Strain Imaging

作　　者：丁茜[1] 刘栩[1] 周慧青[1] 朱天刚[1] 

机构地区：[1]北京大学人民医院心脏中心超声心动室,北京市100044

出　　处：《中国循环杂志》2013年第3期207-210,共4页Chinese Circulation Journal

摘　　要：目的:应用斑点追踪应变成像评价类风湿关节炎患者左心室收缩功能早期损伤。方法:选取常规超声心动图检查的类风湿关节炎患者25例(类风湿组)及健康查体者25例(正常组),常规应用M型超声测量左心室舒张末内径、室间隔厚度、左心室后壁厚度;改良辛普森式法测定左心室射血分数;脉冲组织多普勒测量二尖瓣环收缩期峰值速度;斑点追踪成像测定左心室心尖四腔、两腔、三腔切面长轴方向心肌收缩期峰值应变(Strain)及应变率(strain rate,SRs)和二尖瓣水平、乳头肌水平、心尖水平左心室短轴周径方向Strain及SRs。结果:两组左心室舒张末内径、室间隔厚度、左心室后壁厚度、左心室射血分数、二尖瓣环收缩期峰值速度均无统计学差异;类风湿组心尖四腔、两腔长轴Strain降低(P<0.05),而各短轴周径Strain、SRs均增大(P<0.01);心尖四腔、两腔长轴Strain与病程呈正相关(相关系数分别为0.372及0.308,P<0.05),心尖短轴周径Strain与病程呈负相关(r=-0.435,P<0.01)。结论:常规超声检查正常的类风湿患者可出现亚临床左心室收缩功能异常,累及心内膜下心肌,表现为长轴Strain降低。斑点追踪应变是研究左心室收缩功能早期损伤的有效工具。Objective： To assess the early impairment of left ventricular （LV） myocardial systolic function in patients with rheumatoid arthritis （RA） by speckle tracking strain imaging. Methods： Our work included two groups, RA group, n=25 patients, and Control group, n=25 healthy subjects from normal physical examination. Standard echo and speckle tracking strain imaging were conducted to analyze and compare the LV systolic peak longitudinal strain with strain rate from apical 4-chamber, 2-chamber and 3-chamber views and LV systolic peak circumferential strain with strain rate from short axis views at mitral valve, papillary and apical levels between two groups. Results： There were no statistic differences observed by standard echo and tissue Doppler imaging between two groups. Compared with Control group, RA group showed reduced apical longitudinal strain of 4-chamber and 2-chamber, P〈0.05, while all short axis circumferential strain and strain rate were increased, P〈0.01. The apical longitudinal strain of 4-chamber and 2-chamber were positively related With disease duration （r=0.372 and r=0.308, P〈0.05 respectively）. The apical short axis circumferential strain was negatively related with disease duration （r=-0.435, P〈0.01 ） . Conclusion： RA patients may have abnormal LV systolic function as reduced peak longitudinal strain even they have normal result by standard echo examination. Speckle tracking strain imaging is an effective method for detecting the early LV systolic dysfunction in RA patients.

关 键 词：类风湿关节炎 斑点追踪 应变 应变率 

分 类 号：R541.4[医药卫生—心血管疾病]