三维斑点追踪超声心动图在心尖肥厚型心肌病诊断中的应用  

Application of three-dimensional speckle tracking echocardiography in diagnosis of apical hypertrophic cardiomyopathy

作　　者：夏良华[1] 董云[1] 孟凡霞[1] 陈田[1] 张宇辉[1] 张波[1] XIA Liang-hua;DONG Yun;MENG Fan-xia;CHEN Tian;ZHANG Yu-hui;ZHANG Bo(Dept.of Ultrasound Medicine,Shanghai East Hospital,School of Medicine,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院医学超声科,上海200120

出　　处：《同济大学学报（医学版）》2021年第5期616-621,共6页Journal of Tongji University(Medical Science)

基　　金：上海市卫健委青年科研项目(20154Y0073);上海市浦东新区重要薄弱学科建设(PWZbr2017-09)。

摘　　要：目的应用三维斑点追踪超声心动图(three-dimensional speckle tracking echocardiography,3D-STE)定量测定其心尖部心肌应变及旋转角度,探讨3D-STE在心尖肥厚型心肌病(apical hypertrophic cardiomyopathy,AHCM)诊断中的应用价值。方法分别对42例AHCM患者和20例正常被检者行心脏磁共振检查及超声心动图检查。将42例AHCM患者根据其MRI测量的左心室心尖部心肌厚度进行分型,其中早期心尖肥厚型心肌病患者(P-AHCM,舒张末期心尖壁厚度≥12 mm且<15 mm)20例、典型心尖肥厚型心肌病(T-AHCM,舒张末期心尖壁厚度≥15 mm)22例。所有受检者应用彩色超声诊断仪获取二维及三维全容积动态图像,并对左心室整体三维应变峰值(left ventricle global 3D strain,LVG3DS)、左心室心尖各节段三维应变峰值(left ventricle 3D strain,LV3DS)等三维应变参数及左心室心尖部各节段旋转角度(rotation angle,Rot)、左心室整体旋转角度(global rotation angle,G-Rot)进行分析,比较三组间上述指标的差异。结果与对照组比较,P-AHCM组和T-AHCM组的LVG3DS、LV3DS均减低(P<0.01),且T-AHCM组LV3DS减低更为显著(P<0.05),而P-AHCM组和T-AHCM组间的LVG3DS差异无统计学意义(P>0.05)。左心室心尖部旋转角度在T-AHCM组最高,P-AHCM组次之,对照组最低(P<0.01)。结论3D-STE能够定量测定AHCM患者左室心尖部心肌应变及旋转运动的改变,常规超声心动图结合3D-STE检查能够提高AHCM的诊断准确率。Objective To evaluate the application of three-dimensional speckle tracking echoca-rdiography(3D-STE)in diagnosis of apical hypertrophic cardiomyopathy.Methods Forty-two patients with apical hypertrophic cardiomyopathy(AHCM)and 20 healthy subjects underwent cardiac magnetic resonance(CMR)and echocardiogram examinations.Among 42 patients,20 cases were pre-apical hypertrophic cardiomyopathy(P-AHCM)and 22 cases were typical apical hypertrophic cardiomyopathy(T-AHCM).The 3D-STE analysis was performed in all subjects.The real-time 3D datasets were analyzed to obtain the 1eft ventricle global 3D strain(LVG3DS)and the segmental left ventricle 3D strain(LV3DS)in the apical level,as well as the segmental rotation angle(Rot)in apical level and global rotation angle(G-Rot).The values of each 3D-STE parameters were compared between the AHCM patients and healthy controls.Results Compared with healthy group,AHCM group has lower LVG3DS and LV3DS in apical level,and higher rotation angle(both P<0.05).Compared with P-AHCM,T-AHCM has lower LV3DS in apical level,and higher rotation angle(both P<0.05).There was no statistically significant difference in LVG3DS between P-AHCM and T-AHCM.Conclusion 3D-STE can quantitatively measure the changes of 3D strain and rotation angle of left ventricular apex in patients with AHCM,indicating that it can improve the diagnostic precision.

关 键 词：三维斑点追踪超声心动图 心尖肥厚型心肌病 三维应变 旋转角度 

分 类 号：R445.1[医药卫生—影像医学与核医学]