三维斑点追踪技术评价肥厚型心肌病患者左心室整体应变的研究  

Assessment of left ventricular global systolic strain in hypertrophic cardiomyopathy by three-dimensional speckle tracking echocardiography

作　　者：雷常慧 刘丽文[1] 纳丽莎[2] 左蕾[1] 齐伟[1] 拓胜军[1] 孙超[1] 刘缨[1] 杨娇娇[1] 

机构地区：[1]第四军医大学西京医院超声科,西安710032 [2]宁夏医科大学总医院心脏中心超声心动图室

出　　处：《中华超声影像学杂志》2014年第5期377-382,共6页Chinese Journal of Ultrasonography

基　　金：科技部国家国际合作专项（2014DFA31980）;陕西省国际科技合作项目（2013KW33-03）;陕西省社发攻关项目（2013k5-02-05）

摘　　要：目的 应用超声三维斑点追踪显像（3D-STI）技术研究肥厚型心肌病患者（HCM）左心室整体收缩功能.方法 连续纳入HCM患者90例,其中非梗阻性HCM （HNCM）患者58例,梗阻性肥厚型心肌病（HOCM）患者32例,选取健康对照者72例.应用Philips iE33超声诊断仪获得和分析二维图像,利用X5-1矩阵探头获取左室三维全容积动态图像,运用TomTec脱机软件对左室整体纵向应变（GLS）、左室整体圆周应变（GCS）、左室整体径向应变（GRS）、左室整体应变（GS）等三维参数进行分析.比较三组间上述指标的差异.结果 与对照组比较,HCM组左心室收缩及舒张末期容积显著减小,每搏量显著减少,左心室质量及左心室舒张末室壁厚度显著增加,而左室射血分数差异无统计学意义（P=0.178）.与对照组比较,HCM组GS无显著差异性,GLS明显减低,而GRS、GCS显著增强;与HNCM组比较,HOCM组GLS减低更明显,而GRS、GCS明显增加,Bland-Altman分析显示纵向峰值应变测值在HCM组和正常组有良好的一致性.结论 3D-STI可检测HCM患者左心室早期整体心肌收缩功能的损害,从而为其临床早期诊断、治疗评估提供有价值的信息.Objective To explore the value of three-dimensional speckle tracking imaging （3D-STI） in evaluating the global systolic strain of left ventricular （LV） in patients with hypertrophic cardiomyopathy （HCM）.Methods A total of 90 consecutive patients with HCM were enrolled,in which 58 patients were nonobstructive HCM （HNCM）,32 patients were obstructive HCM （HOCM）.In addition,72 healthy subjects were recruited as a control group.An ultrasound system iE33 （Philips Medical Systems,Bothell） was used to acquire and analyze two-dimensional images.Full-volume three-dimensional dynamic images were performed using matrix transducer X5-1.LV global longitudinal strain（GLS）,global circumferential strain（GCS）,global radial longitudinal（GRS）,global strain （GS）,were analysis using off-line TomTec software,the differences among three groups were compared.Results Compared with the control group,LV end-diastolic,end-systolic volumes and stroke volume significantly decreased,LV mass and LV diastolic wall thickness significanty increased.Howeve,there was no significant difference between LVEF in the HCM and control group （P =0.178）.The comparson of the 3D systolic strain in the four groups as followed,compared with the control group,GS was no significant difference,GLS was significantly reduced,however GCS,GRS was significantly increased in HCM groups.When compared with the HNCM,GLS was significant reduced,however GCS,GRS were significant increased in the HOCM group.Bland-Altman analysis showed there were good agreements in both patients with HCM and control subjects.Conclusions 3D-STI can detecte the early impairment of LV global myocardial contractility in HCM,and provides valuable information for clinical in early diagnosis,prevention and treatment.

关 键 词：超声心动描记术 心肌病 肥厚型 心室功能 左 三维斑点追踪技术 

分 类 号：R540.45[医药卫生—心血管疾病] R542.2[医药卫生—内科学]