血流向量显像技术鉴别肥厚型心肌病与高血压性左心室肥厚的应用价值  

Comparison of left ventricular energy loss between patients with hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy

作　　者：刘阳 孜比热·甫拉提 朱梦若 陈海燕[1] 潘翠珍[1] 舒先红[1] Liu Yang;Zibire Pulati;Zhu Mengruo;Chen Haiyan;Pan Cuizhen;Shu Xianhong(Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China)

机构地区：[1]上海市医学影像研究所上海市心血管病研究所复旦大学附属中山医院心脏超声科,200032

出　　处：《中华超声影像学杂志》2019年第10期837-841,共5页Chinese Journal of Ultrasonography

基　　金：上海市科委引导类项目(18ZR1436100).

摘　　要：目的探讨能否通过血流向量成像(VFM )技术测量心动周期期间的能量损耗(EL )的变化来识别原发性心脏肥大和继发性心脏肥大.方法 2017年6月至2018年9月于复旦大学附属中山医院心脏超声科随机入组左室射血分数(LVEF)正常的肥厚型心肌病(HCM )患者25例(HCM组),高血压性左室肥厚患者21例(H‐LV H组),对照组36例,进行常规超声心动图检查,并测量和记录常规超声数据.取三腔心切面,根据主动脉瓣与二尖瓣开放关闭的帧数,计算左室单个心动周期整体能量损耗(T‐EL )及等容收缩期能量损耗(IVC‐EL )、射血期能量损耗(EP‐EL )、射血期峰值能量损耗(EP‐PEL )、等容舒张期能量损耗(IVR‐EL )、充盈期能量损耗(FP‐EL )、充盈期峰值能量损耗(FP‐PEL ).测量结果取三个心动周期的平均值.结果①与对照组相比,两组患者的FP‐PEL均降低,其中HCM组最低( P <0 .05).与对照组相比, HCM 组EP‐EL和EP‐PEL增加,而FP‐EL减少(均P < 0 .05 );H‐LVH 组 IVC‐EL 、 EP‐PEL 和 EP‐EL 均升高(均 P < 0 .05 );②与 HCM 组相比, H‐LV H组具有更高的IVC‐EL 、 FP‐PEL 、 IVR‐EL和FP‐EL (均 P <0 .05);③HCM组与H‐LVH组5个差异有统计学意义的参数行ROC曲线分析, FP‐EL与IVC‐EL两个参数对于 HCM和H‐LVH鉴别诊断的效能较高.结论 LVEF正常的 HCM 、 H‐LVH患者在心动周期不同时相存在左室EL的差异,且H‐LVH患者在多个时相EL显著高于HCM 患者, EL可作为临床鉴别 H‐LVH和 HCM 敏感且有价值的参数.Objective To evaluate left ventricular energy loss (EL) in patients with hypertrophic cardiomyopathy (HCM) and hypertensive left ventricular hypertrophy (H-LVH) using vector flow map (VFM). Methods Twenty-five HCM patients, 21 H-LVH patients and 36 healthy subjects were selected as HCM group, H-LVH group and control group respectively in Zhongshan Hospital Fudan University. Color Doppler imaging of long-axis view loops were recorded for VFM analysis. According to the opening and closing of the aortic valve and mitral valve, isovolumic contraction (IVC), isovolumic relaxation (IVR), ejection period (EP) and filling period (FP) were determined. The total left ventricular EL(T-EL), IVC-EL, IVR-EL, EP-EL and FP-EL as well as peak EL during EP and FP were quantified. The measurement results were taken as the average of three cardiac cycles. Results ①Compared to the control group, FP-PEL was decreased in both patient groups, and HCM group was the lowest (P<0.05). Compared to the control group, EP-EL and EP-PEL were increased, while FP-EL was decreased in HCM group (all P<0.05);IVC-EL, EP-PEL, and EP-EL were increased in H-LVH group (all P<0.05).②Compared with HCM group, the IVC-EL, FP-PEL, IVR-EL and FP-EL of H-LVH were higher(all P<0.05).③The ROC analysis of five parameters with statistical difference between HCM group and H-LVH group showed that FP-EL and IVC-EL were more effective in the differential diagnosis of HCM and H-LVH. Conclusions Patients with cardiac hypertrophy and normal LVEF have increased systolic EL and reduced diastolic EL. H-LVH patients have more energy loss than HCM patients.EL might be a sensitive and valuable parameter to distinguish cardiac hypertrophy of different etiologies.

关 键 词：超声心动描记术 心室功能 左 能量损耗 肥厚型心肌病 高血压 

分 类 号：R542[医药卫生—心血管疾病]