超声三维斑点追踪成像联合心脏磁共振成像-钆延迟增强序列对成人肥厚型心肌病左室整体收缩功能与心肌纤维化的关联性研究  

Correlation between three-dimensional speckle tracking echocardiography combined with cardiac magnetic resonance imaging-late gadolinium enchancemet on left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy

作　　者：纳丽莎 刘蕾 朱力[3] 张晓春[3] Na Lisha;Liu Lei;Zhu Li;Zhang Xiaochun(Department of Echocardiography,Division of Cardiac Center Functional Examination,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Ultrasound Diagnosis,Xianyang Central Hospital,Xianyang 712000,China;Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院心脏中心功能检查部超声心动图室,银川750004 [2]陕西省咸阳市中心医院超声诊断科,712000 [3]宁夏医科大学总医院放射科,银川750004

出　　处：《中华超声影像学杂志》2020年第1期6-12,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81760318)。

摘　　要：目的应用超声三维斑点追踪成像(3D-STE)技术评价成人肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者左室整体收缩功能,联合3D-STE与心脏磁共振成像(CMRI)技术的钆延迟强化(LGE)序列对HCM患者心肌纤维化进行评价,并探讨左室整体收缩功能与心肌纤维化之间的关联性。方法对2018年2-12月宁夏医科大学总医院30例HCM患者(HCM组)和33例健康成人(对照组)行常规二维超声心动图(2DE)、组织多普勒成像(TDI)、3D-STE检查,比较两组间室间隔舒张末期厚度(IVSD)、左室后壁舒张末期厚度(LVPWD)、左室质量(LVM)、左室质量指数(LVMI)、左房容积(LAV)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室流出道压差(LVOT-PG)、左室流出道速度时间积分(LVOT-VTI)、等容舒张时间(IVRT)、整体应变(GS)、整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)等常规二维及三维GS相关参数的差异。其中符合CMRI适应证的28例HCM患者接受CMRI-LGE检查获取LVM,对CMRI与3D-STE所得LVM结果进行相关性及一致性检验,并根据LGE结果将HCM患者分为LGE(+)组与LGE(-)组,比较两组间GLS、GRS及GCS的差异。结果①与对照组比较,HCM组常规二维超声指标IVSD、LVPWD、LVMI、LAV、LVOT-PG、LVOT-VTI及IVRT显著增加(P<0.05);②两组间GS差异无统计学意义(P>0.05),HCM组GLS、GRS明显减低,GCS明显增加,差异均有统计学意义(P<0.05);③3D-STE与CMRI对LVM测量结果具有较高的相关性(r=0.807,P<0.001);④与LGE(-)组相比,LGE(+)组GLS明显减低(P=0.004),两组间GCS及GRS差异无统计学意义(P=0.597,0.534)。结论3D-STE能够检测出HCM患者早期三维应变左心室整体收缩功能的损害,3D-STE联合CMRI-LGE技术可为HCM患者三维应变左室整体收缩功能及心肌纤维化之间的关联性评价提供重要的影像学参考依据。Objective To evaluate the left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy(HCM)patients by three-dimensional speckle tracking echocardiography(3D-STE)combined with cardiac magnetic resonance imaging-late gadolinium enchancemet(CMRI-LGE)sequence,and to explore the association between left ventricular global systolic function and myocardial fibrosis.Methods Thirty patients with HCM(HCM group)and 33 healthy controls(control group)were enrolled in the study.All patients underwent conventional two-dimensional echocardiography(2DE),tissue Doppler imaging(TDI),and 3D-STE.The following parameters were acquired and compared between the groups:interventricular septal end-diastolic thickness(IVSD),left ventricular posterior wall end-diastolic thickness(LVPWD),left ventricular mass(LVM),left ventricular mass index(LVMI),left atrial volume(LAV),and left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular outflow tract pressure gradient(LVOT-PG),left ventricular outflow tract velocity time integral(LVOT-VTI),isovolumic relaxation time(IVRT),global strain(GS),global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS).And 28 patients who met the CMRI indications underwent CMRI-LGE to obtain the LVM,and the correlation and consistency of LVM results obtained from CMRI and 3D-STE were performed.According to LGE results,HCM patients were divided into LGE(+)group and LGE(-)group,the differences of GLS,GRS and GCS between the two groups were analyzed.Results①Compared with the control group,IVSD,LVPWD,LVMI,LAV,LVOT-PG,LVOT-VTI and IVRT were significantly increased in the HCM group(all P<0.05);②There was no significant difference in GS between the two groups(P>0.05),while GLS and GRS decreased and GCS increased significantly in HCM group(P<0.05);③The correlation between 3D-STE and CMRI in measuring measured LVM in HCM patients was good,and the results showed good concordance(r=0.807,P<0.01).④G

关 键 词：超声心动描记术 三维斑点追踪成像 肥厚型心肌病 心脏磁共振成像 心室功能 左 心肌纤维化 

分 类 号：R540.4[医药卫生—心血管疾病] R542.2[医药卫生—内科学]