运动负荷超声心动图评估肥厚型心肌病患者心肌收缩力和心脏-血管耦联的研究  

Changes of Myocardial Contractility and Ventricular-vascular Coupling in Hypertrophic Cardiomyopathy:Insights From Exercise Stress Echocardiography

作　　者：康楠 王静 刘丽文 艾红[1] 杨帆 李文霞 王博 Kang Nan;Wang Jing;Liu Liwen;Ai Hong;Yang Fan;Li Wenxia;Wang Bo(Department of Ultrasound,the First Affiliated Hospital of Xi′an Jiaotong University,Xi’an,Shanxi 710061,China;Department of Ultrasound,the First Affiliated Hospital of Air Force Medical University,Xi'an,Shanxi 710032,China)

机构地区：[1]西安交通大学第一附属医院超声科,西安市710061 [2]空军军医大学西京医院超声医学科

出　　处：《中国超声医学杂志》2020年第11期998-1002,共5页Chinese Journal of Ultrasound in Medicine

基　　金：国家国际科技合作专项(No.2014DFA31980);国家自然科学基金(No.81601498,81901755);陕西省重点项目(No.2017ZDXM-SF-058);陕西省重点科技创新团队(No.2014KCT-20);西京医院新技术、新业务资助项目(No.417432A);西京医院学科助推计划(No.XJZT18ML74,XJZT18MJ51)。

摘　　要：目的采用运动负荷超声评估肥厚型心肌病(HCM)心肌收缩力和心脏-血管耦联特征。方法评估成人HCM患者(85例)及其正常家属(40例)静息和运动状态下左室及外周血管功能。结果(1)与对照组相比,HCM患者左室壁最大厚度和左室质量指数明显增加,二尖瓣环收缩期和舒张早期速度减低,E/e′比值和左房容积指数增加(P<0.005)。(2)静息时HCM患者左室射血分数(LVEF)和左室流出道压差(LVOT-PG)较对照组增高,左室收缩末容积减小,前负荷补充搏功指数(PRSWI)及左室收缩末弹性(Ees)增加,整体动脉顺应性及心脏-血管耦联(Ea/Ees)减低(P<0.05)。(3)运动时HCM患者LVOT-PG较对照组增高,舒张压及平均动脉压减低;运动后HCM患者LVEF的升高(△LVEF)减低,LVOT-PG的升高(△LVOT-PG)增加,△PRSWI和△Ea/Ees亦减低(P<0.05)。结论静息时HCM患者左室收缩末弹性和心肌收缩力,以及心脏-血管耦联功能虽优于对照组,但运动中储备功能均明显不足。Objective To evaluate the characteristics of myocardial contractility and ventricular-vascular coupling in hypertrophic cardiomyopathy(HCM)using exercise stress echocardiography.Methods The study population consisted of 85 adult HCM patients and their 40 normal family members.Their left ventricular and peripheral vascular performances were evaluated.Results(1)As compared to the controls,HCM patients had increased maximal left ventricular wall thickness and left ventricular mass index,reduced mitral annular systolic and early diastolic velocity,and elevated the E/e′ration and left atrial volume index(all P<0.005).(2)HCM patients had higher left ventricular ejection fraction(LVEF)and outflow tract pressure gradient(LVOT-PG),yet smaller left ventricular end-systolic volume at rest.The resting preload recruitable stroke work index(PRSWI)and single-beat end-systolic elastance(Ees)increased,while the total arterial compliance and ventricular-vascular coupling(Ea/Ees)decreased in HCM(all P<0.05).(3)During exercise,HCM patients had higher LVOT-PG as expected,yet lower diastolic blood pressure and mean arterial pressure(all P<0.05).(4)Moreover,the degree of exercise-induced augmentation of LVEF(△LVEF),PRSWI(△PRSWI)and Ea/Ees(△Ea/Ees)in HCM patients decreased,while the elevation of LVOT-PG(△LVOT-PG)increased in HCM(all P<0.05).Conclusions The resting left ventricular end-systolic elastance,myocardial contractility and ventricular-vascular coupling are superior to control group.However,the reserve function of these above were significantly impaired during exercise.

关 键 词：肥厚型心肌病 运动负荷超声心动图 心脏-血管耦联 储备功能 

分 类 号：R540.45[医药卫生—心血管疾病] R542.2[医药卫生—内科学]