运动负荷心肌超声造影评价肥厚型心肌病患者心肌微循环异常的价值  

Evaluation of myocardial microcirculation abnormalities in patients with hypertrophic cardiomyopathy by myocardial contrast echocardiography combined with exercise stress test

作　　者：周琦 田新桥 汤萌 马玉磊 李亚琼 陈哲 王美红 Zhou Qi;Tian Xinqiao;Tang Meng;Ma Yulei;Li Yaqiong;Chen Zhe;Wang Meihong(Department of Ultrasonography,People′s Hospital of Zhengzhou University,Henan Provincial People′s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院,河南省人民医院,阜外华中心血管病医院超声科,郑州450003

出　　处：《中华超声影像学杂志》2022年第3期208-213,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金-河南联合基金项目(U1704175)。

摘　　要：目的应用心肌超声造影(MCE)结合运动负荷试验评价肥厚型心肌病(HCM)患者心肌血流灌注异常改变。方法选取2020年5月至2021年4月就诊于阜外华中心血管病医院临床诊断为非对称性HCM的患者27例作为HCM组,选取同期健康体检者29例为对照组,均行常规超声心动图、静息及运动负荷状态下MCE检查,定量分析两组室间隔各节段的心肌血流灌注参数:平台峰值强度(A值)、曲线上升斜率(β值)及A×β值。根据舒张末期心肌厚度,将HCM组室间隔分为肥厚节段和非肥厚节段,与对照组室间隔的MCE参数进行对比,计算两组的心肌血流量储备值,并分析心肌血流量储备值与左心室质量指数(LVMI)及左心室重构指数(LVRI)的相关性。结果无论静息还是负荷状态下,HCM组室间隔肥厚及非肥厚节段的A值、β值及A×β值均低于对照组,差异有统计学意义(P<0.05);负荷状态下,HCM组室间隔肥厚节段的A值、β值及A×β值均低于非肥厚节段,差异有统计学意义(P<0.05);HCM组心肌血流量储备与LVMI及LVRI呈负相关(γ=-0.899、-0.676,均P<0.001)。结论静息与运动负荷状态下,HCM患者的肥厚心肌及非肥厚心肌均存在微循环障碍,其心肌血流量储备与LVMI及LVRI均呈负相关。Objective To detect the abnormal changes of myocardial blood perfusion in patients with hypertrophic cardiomyopathy(HCM)by myocardial contrast echocardiography(MCE)combined with exercise stress test.Methods Twenty-seven patients with clinically diagnozed of asymmetric HCM in Fuwai Central China Cardiovascular Hospital from May 2020 to April 2021 were selected as the HCM group,and 29 healthy subjects during the same period were selected as the control group.All patients underwent routine echocardiography,resting and exercise stress MCE.The myocardial perfusion parameters of each segment of interventricular septum in the 2 groups were quantitatively analyzed:the peak plateau intensity(A value),ascending slope of the curve(βvalue)and value of A×β.According to the end-diastolic myocardial thickness,the interventricular septum of the HCM group was divided into hypertrophic and non-hypertrophic segments,and the myocardial contrast parameters of the interventricular septum of the study group were compared with those of the control group.The myocardial blood flow reserve value of the two groups were calculated,and the correlation of myocardial blood flow reserve value with left ventricular mass index(LVMI)and left ventricular remodeling index(LVRI)were analyzed.Results No matter at rest or under stress,the A value,βvalue and A×βvalue of ventricular septal hypertrophic and non-hypertrophic segments in the hypertrophic cardiomyopathy group were lower than those in the control group,and the differences were statistically significant(all P<0.05).Under stress,the A value,βvalue and A×βvalue of interventricular septal hypertrophic segments were lower than those in non-hypertrophic segments in the HCM group,and the differences were statistically significant(all P<0.05).The myocardial blood flow reserve in the HCM group was negatively correlated with LVMI and LVRI(γ=-0.899,-0.676;all P<0.001).Conclusions In patients with HCM under resting and exercise stress,microcirculation disorders were found in both hypertrophic an

关 键 词：超声造影 肥厚型心肌病 心肌微循环 运动负荷 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]