三维超声成像评价肥厚型心肌病左室节段收缩同步性与整体功能的初步研究  

Evaluation of Left Ventricular Segmental Systolic Synchrony and Global Systolic Function in Patients with Hypertrophic Cardiomyopathy by Three-dimensional Echocardiography

作　　者：彭源[1] 杨军[2] 谢明星[1] 张丽[1] 方凌云[1] 曹海燕[1] 孙丹丹[2] 

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,武汉430022 [2]中国医科大学附属第一医院心血管超声科,沈阳110001

出　　处：《华中科技大学学报（医学版）》2016年第5期523-528,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：沈阳市社会发展科技攻关专项基金资助项目(No.F12-193-9-19);教育部高等学校博士学科点专项基金资助项目(No.20112104110010)

摘　　要：目的应用实时三维超声心动图(RT-3DE)评价非梗阻性肥厚型心肌病(HCM)患者左室节段收缩同步性与整体收缩功能,并探讨两者的相关性。方法随机选取HCM患者及正常对照组各43例行RT-3DE检查。Tomtec 4D LV-Analysis软件分析RT-3DE图像,获得左室容积、左室射血分数(LVEF)、左室收缩同步性指标(Tmsv16-SD%和Tmsv16-Dif%)等参数。三维斑点追踪成像(3D-STI)软件分析RT-3DE图像获得左室质量(LV Mass)、左室心肌整体纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)、径向应变(GRS)等参数,对组间上述参数进行比较,对左室收缩同步性参数与心肌应变参数进行相关分析。结果①与对照组比较,HCM组左室舒张末容积(LVEDV)明显减小(P<0.01),LV Mass增加(P<0.05),两者LVEF无显著性差异。②与对照组比较,HCM组Tmsv16-SD%与Tmsv16-Dif%增加,差异有统计学意义。③与对照组比较,HCM组左室心肌GLS、GAS、GRS均明显减弱(均P<0.01),两者GCS无显著性差异。④Tmsv16-SD%与GLS、GCS、GAS、GRS有明显相关性(均P<0.01);Tmsv16-Dif%与GLS、GCS、GAS、GRS有明显相关性(均P<0.05)。结论 HCM患者左室各节段收缩同步性降低且整体收缩功能减低,左室心肌收缩不同步是左室整体收缩功能减低的重要原因。Objective To assess the left ventricular segmental systolic synchrony and global systolic function in patients with nonobstructive hypertrophic cardiomyopathy（HCM）using real-time three-dimensional echocardiography（RT-3DE）,and to investigate the correlation of parameters between synchrony and systolic function.Methods 43 HCM patients（HCM group）and43healthy volunteers（control group）were enrolled in this study and the RT-3DE was performed in all the subjects.The RT-3DE data were analyzed by Tomtec 4DLV-Analysis software to obtain left ventricular volume,left ventricular ejection fraction（LVEF）,left ventricular systolic synchrony parameters（Tmsv16-SD%,Tmsv16-Dif%）and by 3D-STI analysis software to get left ventricular mass（LV Mass）,global longitudinal strain（GLS）,global circumferential strain（GCS）,global area strain（GAS）,and global radial strain（GRS）.The parameters mentioned above were compared between HCM and control groups.The correlation of the parameters between left ventricular systolic synchrony and the myocardial deformation was analyzed.Results ①Compared with control group,patients with HCM had lower left ventricular end-diastolic volume（LVEDV）（P〈0.01）and higher LV Mass（P〈0.05）.LVEF was similar in both groups.②Tmsv16-SD% and Tmsv16-Dif%increased significantly in HCM group when compared with control group（P〈0.05）.③GLS,GAS and GRS were significantly lower in HCM group than in control group（all P〈0.01）,but the GCS was similar in both groups.④Tmsv16-SD%and Tmsv16-Dif% were significantly correlated with the myocardial deformations（GLS,GCS,GAS,and GRS）（all P〈0.05）.Conclusion The segmental systolic synchrony and the global systolic function of left ventricule are decreased in patients with HCM.The left ventricular systolic desynchrony is responsible for the reduced systolic function in HCM patients.

关 键 词：超声心动描记术 肥厚型心肌病 三维斑点追踪技术 应变 收缩同步性 

分 类 号：R737.9[医药卫生—肿瘤]