超声心动图评价运动负荷对冠状动脉慢血流患者左心室功能的影响  

Evaluation of exercise on left ventricular function in patients with slow coronary flow by excercise-stress echocardiography

作　　者：李光源[1] 蔡秋雨 马春燕[1] 孔凡鑫 王永槐[1] 孟平平[1] 杨军[1] Li Guangyuan;Cai Qiuyu;Ma Chunyan;Kong Fanxin;Wang Yonghuai;Meng Pingping;Yang Jun(Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院心血管超声科,沈阳110001

出　　处：《中华超声影像学杂志》2019年第5期387-391,共5页Chinese Journal of Ultrasonography

基　　金：沈阳市中青年科技创新人才支持计划(RC170557);辽宁省高等学校基本科研项目(自然科学类):青年项目(LQNK201701)国家自然科学基金项目(81871373).

摘　　要：目的采用平板运动负荷超声心动图评价冠状动脉慢血流(SCF)患者运动负荷峰值状态的左心室收缩及舒张功能变化,为临床指导治疗提供重要信息。方法选取临床诊断为SCF的患者46例作为SCF组,健康成年人40例作为对照组。所有受试者均接受临床评估和运动负荷超声心动图检查。应用常规超声心动图、组织多普勒技术及二维斑点追踪技术评价SCF患者在静息状态及运动负荷峰值状态下左心室收缩及舒张功能。结果①静息状态下左心室功能:SCF组患者左心室收缩期整体纵向峰值应变(LS)小于对照组(P<0.05),但两组之间左心室射血分数(LVEF)差异无统计学意义(P>0.05);SCF组二尖瓣游离壁及室间隔瓣环舒张早期峰值速度的均值(Mitral e′)减小(P<0.01),且二尖瓣舒张早期血流速度与Mitral e′比值(Mitral E/e′)增加(P<0.01)。②运动负荷峰值状态左心室功能变化:与静息状态比较,对照组及SCF组LVEF、LS及Mitral e′均显著增加(P<0.05);但两组之间LVEF、LS、Mitral e′及Mitral E/e′差异无统计学意义(P>0.05)。SCF组LS和Mitral e′增加幅度(ΔLS和ΔMitral e′)大于对照组(P<0.05)。结论静息状态下,SCF患者左心室收缩及舒张功能减低;运动负荷状态下,SCF患者左心室收缩及舒张功能显著改善,其机制可能与冠状动脉具有正常的储备能力及扩张能力有关。Objective To evaluate the role of treadmill exercise-stress echocardiography in the assessment of left ventricular (LV) function in patients with slow coronary flow (SCF), and discuss the possible mechanism of SCF. Methods Forty-six patients with diagnosis of SCF were enrolled as SCF group. Forty age and sex matched adults were included as control group. All subjects had underwent clinical evaluation and exercise stress echocardiography. LV diastolic and systolic functions were assessed by conventional echocardiography, tissue Doppler imaging and two-dimensional speckle tracking echocardiography at rest and during exercise. Results ①LV function in patients with SCF at rest: LV peak systolic longitudinal strain (LS) was lower in patients with SCF than that in controls (P<0.05). There was no difference of LV ejection fraction (LVEF) between the two group(P>0.05). Early diastolic mitral annulus velocity (Mitral e′) and the ratio between the early mitral inflow velocity and Mitral e′(Mitral E/e′) were significantly decreased in SCF group(all P<0.01).②LV function during exercise: LVEF, LS and Mitral e′ were significant increased in two groups (all P<0.05) than those at rest, but there was no significant difference of LVEF, LS, Mitral e′ and Mitral E/e′ between the two groups (all P>0.05). Compared with control group,ΔLS and ΔMitral e′ were significantly higher in SCF group (all P<0.05). Conclusions LV systolic and diastolic function in patients with SCF are impaired at rest. LV systolic and diastolic function recover in patients with SCF during exercise.

关 键 词：超声心动描记术 压力 冠状动脉慢血流 心室功能 左 

分 类 号：R541.4[医药卫生—心血管疾病]