相对压成像技术评估非梗阻性肥厚型心肌病患者左心室功能的临床价值  

Clinical value of relative pressure imaging technology in evaluating left ventricular function in patients with nonobstructive hypertrophic cardiomyopathy

作　　者：王锐 苏叶 张莉[2] 彭熠[2] 尹立雪[2] WANG Rui;SU Ye;ZHANG Li;PENG Yi;YIN Lixue(Zunyi Medical University,Guizhou 563000,China)

机构地区：[1]遵义医科大学,贵州省遵义市563000 [2]电子科技大学附属医院,四川省人民医院超声医学研究所超声心脏电生理与生物力学,四川省重点实验室

出　　处：《临床超声医学杂志》2023年第8期593-600,共8页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金项目(81671852);国家重点研发计划项目(2020YFC2008000);中央高校基本科研业务基金项目(ZYGX2020ZB038)。

摘　　要：目的 应用相对压成像(RPI)技术可视化观察非梗阻性肥厚型心肌病(nHCM)患者左心室内相对压差(IVPD)及相对压力梯度(IVPG)的变化情况,探讨其评估nHCM患者左心室功能的临床价值。方法 选取四川省人民医院心血管内科及老年心血管内科就诊的nHCM患者50例(nHCM组)和同期健康体检志愿者50例(对照组),应用RPI技术获取等容舒张期、快速充盈期、心房收缩期、等容收缩期、快速射血期左心室基底-心尖段IVPD(T-IVPD)和IVPG、左心室基底-中间段IVPD(B-M IVPD)、左心室中间-心尖段IVPD(M-A IVPD),并计算B-M IVPD与T-IVPD的比值(B-M/T IVPD),比较两组上述参数的差异;分析nHCM组舒张期与收缩期RPI参数的相关性。结果 (1)两组舒张期IVPD比较:与对照组比较,nHCM组等容舒张期T-IVPD、B-M IVPD、B-M/T IVPD,快速充盈期T-IVPD、B-M IVPD、B-M/T IVPD,心房收缩期T-IVPD、B-M IVPD均减小,快速充盈期M-A IVPD增大,差异均有统计学意义(均P<0.05);两组等容舒张期M-A IVPD、心房收缩期M-A IVPD和B-M/T IVPD比较差异均无统计学意义;(2)两组收缩期IVPD比较:与对照组比较,nHCM组等容收缩期T-IVPD、B-M IVPD、B-M/T IVPD和快速射血期B-M IVPD、B-M/T IVPD均减小,等容收缩期M-A IVPD增大,差异均有统计学意义(均P<0.05);两组快速射血期T-IVPD、M-A IVPD比较差异均无统计学意义;(3)两组舒张期及收缩期IVPG比较:与对照组比较,nHCM组等容舒张期、快速充盈期、心房收缩期、等容收缩期、快速射血期IVPG均减小,差异均有统计学意义(均P<0.05)。相关性分析显示:快速充盈期IVPG与等容收缩期IVPG、T-IVPD,快速充盈期T-IVPD与等容收缩期IVPG、T-IVPD,快速充盈期B-M/T IVPD与等容收缩期IVPG、T-IVPD、B-M IVPD和快速射血期IVPG、T-IVPD,快速充盈期B-M/T IVPD与等容收缩期B-M IVPD,心房收缩期M-A IVPD与等容收缩期B-M IVPD、B-M/T IVPD,心房收缩期B-M/T IVPD与等容收缩期B-M/T IVPD均相关(均P<0.05)。结论 RPObjectiveTo explore the clinical value of relative pressure imaging(RPI)technology in evaluating left ventricular function by visually observing the changes of left ventricular intraventricular pressure differences(IVPD) and intraventricular pressure gradients(IVPG)in patients with nonobstructive hypertrophic cardiomyopathy(nHCM).MethodsA total of 50 patients with nHCM were selected from the department of cardiology and geriatric cardiology(nHCM group),and 50contemporaneous healthy volunteers were selected as the control group in Sichuan provincial people's hospital.RPI technology was used to obtain left ventricular basal-apical segment IVPD(T-IVPD)and IVPG,left ventricular basal-middle segment IVPD(B-M IVPD)and left ventricular intermediate-apical segment IVPD(M-A IVPD)during isovolumic diastolic phase,rapid filling phase,atrial systole phase,isovolumic systole phase,and rapid ejection phase.The ratio of B-M IVPD and T-IVPD(B-M/T IVPD)was calculated.The differences of the above parameters between the two groups were compared.The correlation between diastolic and systolic RPI parameters in nHCM group were analyzed.Results(1)Comparison of diastolic IVPD between the two groups:compared with the control group,T-IVPD,B-M IVPD,B-M/T IVPD during isovolumic diastolic phase,T-IVPD,B-M IVPD,B-M/T IVPD during rapid filling phase,T-IVPD and B-M IVPD during atrial systole phase decreased in nHCM group,while M-A IVPD during rapid filling phase increased.The differences were statistically significant(all P<0.05).There were no statistically significant differences in M-A IVPD during isovolumic diastolic phase,M-A IVPD during atrial systole phase and B-M/T IVPD during atrial systole phase between the two groups.(2) Comparison of systolic IVPD between the two groups:compared with the control group,T-IVPD,B-M IVPD and B-M/T IVPD during isovolumic systolic phase,B-M IVPD and B-M/T IVPD during rapid ejection phase decreased in nHCM group,while M-A IVPD during isovolumic systolic phase increased.The differences were statistically sig

关 键 词：超声心动描记术 相对压成像 肥厚型心肌病 非梗阻性 相对压差 相对压力梯度 心室功能 左 

分 类 号：R540.45[医药卫生—心血管疾病] R541[医药卫生—内科学]