运动负荷超声心动图评价肥厚型心肌病患者左心室功能及机械离散变化的临床研究  

The change of left ventricular function and mechanical dispersion in patients with hypertrophic cardiomyopathy:a study with exercise stress echocardiography

作　　者：吴小朋 李一丹[1] 孙兰兰[1] 朱维维[1] 王怡丹[1] 蔡绮哲[1] 姜维[1] 叶晓光[1] 张淼[1] 秦芸芸 吕秀章[1] Wu Xiaopeng;Li Yidan;Sun Lanlan;Zhu Weiwei;Wang Yidan;Cai Qizhe;Jiang Wei;Ye Xiaoguang;Zhang Miao;Qin Yunyun;Lyu Xiuzhang(Department of Echocardiography,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院心脏超声科,100020

出　　处：《中华超声影像学杂志》2019年第6期461-467,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目(81571683);北京朝阳医院1351人才培养计划(CYMY-2017-28).

摘　　要：目的应用超声心动图评价肥厚型心肌病(HCM)患者静息及负荷状态下左室功能及左室机械离散变化与运动能力的关系。方法入选HCM患者65例[非梗阻性肥厚型心肌病(HNCM)40例,梗阻性肥厚型心肌病(HOCM)25例],对照组25例。在静息及峰值负荷状态下测量左室功能参数:左室整体长轴应变(LVGLS)、左室机械离散、左室舒张早期应变率(SRe)、舒张早期二尖瓣峰值流速与二尖瓣环峰值速度之比(E/e′)、左室流出道压差(LVOTG);左室功能储备:左室整体长轴收缩储备(ΔLVGLS)、左室整体长轴舒张储备(ΔSRe);测定反映运动能力的指标代谢当量(METs)。评价左室功能及机械离散改变与运动能力的关系。结果①与对照组相比,静息及峰值负荷状态下,HNCM组LVOTG、E/e′及MD增加,LVGLS、SRe、ΔLVGLS、ΔSRe及METs减低(均P<0.05);②与HNCM组相比,HOCM组LVOTG、E/e′及机械离散进一步增加,LVGLS、SRe、ΔSRe及METs进一步减低(均P<0.05);③峰值负荷状态下左室整体长轴应变及左室机械离散与METs相关(r=-0.68,P<0.001;r=-0.43,P<0.001);④静息及峰值负荷状态下,LVGLS对HCM患者运动能力减低有较好的预测价值,其次是E/e′和机械离散。结论HCM患者左室功能及其储备减低,机械离散增大,HOCM患者改变更显著;左室功能及机械离散变化与运动能力相关,可预测HCM患者运动能力减低。Objective To investigate the association between the change of left ventricular(LV)function and mechanical dispersion(MD)and exercise capacity in patients with hypertrophic cardiomyopathy(HCM)by exercise stress echocardiography.Methods Sixty-five HCM patients[40 cases of hypertrophic non-obstructive cardiomyopathy(HNCM),25 cases of hypertrophic obstructive cardiomyopathy(HOCM)]and 25 control subjects were recruited.LV function,MD and exercise capacity were evaluated by two-dimensional speckle-tracking imaging and echocardiography at rest and during exercise,and the following parameters of LV function were recorded:LV global longitudinal strain(LVGLS),MD,early diastolic strain rate(SRe),the ratio of peak early diastolic mitral inflow and annulus velocity(E/e′),LV outflow tract gradient(LVOTG);LV functional reserve was assessed byΔLVGLS andΔSRe;exercise capacity was evaluated by metabolic equivalents(METs).The association between the change of LV function and MD and exercise capacity was investigated.Results①Compared with normal controls,LVOTG,E/e′and MD increased,and LVGLS,SRe,ΔLVGLS,ΔSRe and METs decreased in HNCM patients at rest and during exercise(all P<0.05).②LVOTG,E/e′and MD were further increased,LVLGS,SRe,ΔSRe and METs were further reduced in HOCM patients compared with HNCM patients(all P<0.05).③LVGLS and MD measured at peak exercise were associated with METs(r=-0.68,P<0.001;r=-0.43,P<0.001).④ROC curve analysis showed LVGLS had a better predictive value for exercise intolerance in HCM patients,followed by E/e′and MD.Conclusions LV function and mechanic reserve are reduced but MD is increased in HCM patients,especially in HOCM patients.Exercise capacity is associated with LV function and MD,which can predict the reduced exercise capacity in HCM patients.

关 键 词：运动负荷超声心动图 二维斑点追踪成像 心肌病 肥厚型 心室功能 左 机械离散 

分 类 号：R542.2[医药卫生—心血管疾病]