二维斑点追踪成像对心肌淀粉样变患者左心室旋转和扭转运动的初步研究  

Preliminary evaluation of left ventricular rotation and torsion in patients with cardiac amyloidosis by two-dimensional speckle tracking imaging

作　　者：张晶[1] 毕文静[1] 任卫东[1] 肖杨杰[1] 郭亚军[1] 

机构地区：[1]中国医科大学附属盛京医院超声科,辽宁沈阳110004

出　　处：《生物医学工程与临床》2013年第4期330-334,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的应用斑点追踪成像(STI)技术测量心肌淀粉样变(CA)患者左心室短轴方向旋转和扭转角度,探讨STI评价CA患者左心室旋转和扭转运动的临床价值。方法 20例CA患者,其中男性13例,女性7例;年龄42～65岁,平均年龄54.80岁。30例健康志愿者,其中男性18例,女性12例;年龄45～62岁,平均年龄54.85岁。采集CA患者和健康志愿者的常规超声左心室短轴图像,测量二尖瓣口舒张早期血流峰速(E峰)、舒张晚期血流峰速(A峰)、收缩期S波峰值速度(Sm)、舒张早期E波峰值速度(Em)、舒张晚期A波峰值速度(Am);采用STI测量各平面的内膜下心肌旋转(endo-rot)、外膜下心肌旋转(epi-rot)、平面旋转(bulk-rot)及跨壁扭转(mural-tor)峰值。计算左心室整体扭转(lv-tor)峰值。结果 CA组同对照组比较,E/Em明显增高(23.04±6.21 vs 7.82±1.19),E波速度下降时间、Sm、Em、Am明显减低[(143.20±43.32)ms vs(201.46±14.99)ms,(4.68±1.02)cm/s vs(7.74±0.86)cm/s,(4.08±1.80)cm/s vs(11.15±1.44)cm/s,(4.11±1.41)cm/s vs(8.23±1.05)cm/s],差异具有极显著统计学意义(P<0.001);E/A增高(1.79±1.54 vs 1.27±1.11),A减低[(0.51±0.16)m/s vs(0.68±0.06)m/s],差异具有显著统计学意义(P<0.01);E差异无统计学意义(P>0.05)。CA组各平面的endo-rot、epi-rot、bulk-rot及mural-tor峰值均显著低于对照组(P<0.05)。与对照组比较,CA组lv-tor角度峰值[(5.93±1.96)°]显著低于对照组[(8.75±1.42)°],差异具有显著统计学意义(P<0.001)。结论 CA患者心功能受损,左心室旋转及扭转运动发生变化,左心室短轴各平面endo-rot、epi-rot、bulk-rot、mural-tor及lv-tor角度均显著减低,示二维STI能够从短轴各平面心肌旋转和扭转运动的角度更准确及敏感反映CA患者心肌功能变化。Objective To evaluate the clinical value of speckle tracking imaging（STI） for the measurement of left ventricular（LV） rotation and torsion in the patients with cardiac amyloidosis（CA）.Methods A total of 20 patients with CA（13 males and 7 females,aged 42-65 years old,mean age of 54.80 years old） and 30 healthy volunteers（18 males and 12 female,aged 45-62 years old,mean age of 54.85） were enrolled.High frame rate two-dimensional images from the LV at basal and apical short-axis views of the patients with CA（CA group） and healthy controls（control group） were acquired.The peak subendocardial rotation（endo-rot）,peak subepicardial rotation（epi-rot）,peak bulk rotation（bulk-rot）,and peak mural torsion（mural-tor） were measured separately.Then,the peak left ventricular torsion（lv-tor） were calculated.Results Compared with the control group,E/Em in the CA group significantly increased（23.04 ± 6.21 vs 7.82 ± 1.19）,whereas DT,Sm,Em and Am significantly decreased[（143.20 ± 43.32） ms vs（201.46 ± 14.99） ms,（4.68 ± 1.02） cm/s vs（7.74 ± 0.86） cm/s,（4.08 ± 1.80） cm/s vs（11.15 ± 1.44） cm/s,and（4.11 ± 1.41） cm/s vs（8.23 ± 1.05） cm/s,respectively]（P 0.001）.E/A was increased（1.79 ± 1.54 vs 1.27 ± 1.11） and A was decreased[（0.51 ± 0.16） m/s vs（0.68 ± 0.06） m/s],with statistically significant differences（P〈 0.01）;The difference in E was not statistically significant（P〉0.05）,while the peak endo-rot,peak epi-rot,peak bulk-rot and peak mural-tor were significantly decreased in the patients with CA（all P〈 0.05）.The lv-tor of the patients with CA was significantly lower than that of the healthy controls[（5.93 ± 1.96）° vs（8.75 ± 1.42）°;P 0.001].Conclusion It is demonstrated that cardiac function is impaired in CA patients,with abnormalities of left ventricular rotation and torsion,the peak of endo-rot,epi-rot,bulk-rot,mural-tor and lv-tor are significantly decreased.STI could exactly and sensitively ev

关 键 词：斑点追踪成像技术 心肌淀粉样变性 左心室 心肌 旋转运动 扭转运动 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]