CAJ | 학술논문

目的应用三维斑点追踪显像(3D-STI)技术评价肥厚型心肌病(HCM)患者左室收缩不同步性.方法连续纳入HCM患者93例,其中非梗阻性HCM(HNCM)患者63例,梗阻性HCM(HOCM)患者30例,选取健康对照组72例.应用超声诊断仪(iE33)获得和分析二维图像,利用X5-1矩阵探头获取左室三维全容积动态图像,运用TomTec脱机软件进行分析,获取左室16节段面积、环形、纵向、径向应变达峰时间并计算各节段各方向的标准差(TAS-SD、TCS-SD、TLS-SD、TRS-SD)以及任意两节段面积、环形、纵向、径向应变达峰时间最大差值(TAS-diff、TCS-diff、TLS-diff、TRS-diff),同时计算其标准化后的值(TAS-SD％、TCS-SD％、TLS-SD％、TRS-SD％、TAS-diff％、TCS-diff％、TLS-diff％、TRS-diff％)等不同步参数.比较三组间上述参数之间的差异.结果与对照组比较,HCM组左室收缩及舒张末期容积显著减小,每搏量显著减少,左室质量显著增加,左室舒张末期室间隔厚度显著增加,左室舒张末期后壁厚度增加(均P＜0.05),左室射血分数差异无统计学意义(P＞0.05).HCM组TAS-SD％、TLS-SD％、TRS-SD％、TAS-diff％、TLS-diff％、TRS-diff％均较对照组延长,差异有统计学意义(P＜0.05),而TCS-SD％、TCS-diff％差异无统计学意义(P＞0.05).与HNCM组比较,HOCM组TAS-SD％、TRS-SD％、TCS-SD％、TAS-diff％、TCS-diff％、TRS-diff％显著延长(P＜0.05),而TLS-SD％、TLS-diff％差异无统计学意义(P＞0.05).不同步参数与左室流出道压差存在线性正向相关性.结论 HCM患者左室心肌收缩存在明显不同步,表明HCM患者早期存在收缩功能的异常,3D-STI为评价HCM患者早期左室收缩功能的异常提供了新的方法.
목적 응용삼유반점추종현상(3D-STI)기술평개비후형심기병(HCM)환자좌실수축불동보성.방법 련속납입HCM환자93례,기중비경조성HCM(HNCM)환자63례,경조성HCM(HOCM)환자30례,선취건강대조조72례.응용초성진단의(iE33)획득화분석이유도상,이용X5-1구진탐두획취좌실삼유전용적동태도상,운용TomTec탈궤연건진행분석,획취좌실16절단면적、배형、종향、경향응변체봉시간병계산각절단각방향적표준차(TAS-SD、TCS-SD、TLS-SD、TRS-SD)이급임의량절단면적、배형、종향、경향응변체봉시간최대차치(TAS-diff、TCS-diff、TLS-diff、TRS-diff),동시계산기표준화후적치(TAS-SD％、TCS-SD％、TLS-SD％、TRS-SD％、TAS-diff％、TCS-diff％、TLS-diff％、TRS-diff％)등불동보삼수.비교삼조간상술삼수지간적차이.결과 여대조조비교,HCM조좌실수축급서장말기용적현저감소,매박량현저감소,좌실질량현저증가,좌실서장말기실간격후도현저증가,좌실서장말기후벽후도증가(균P＜0.05),좌실사혈분수차이무통계학의의(P＞0.05).HCM조TAS-SD％、TLS-SD％、TRS-SD％、TAS-diff％、TLS-diff％、TRS-diff％균교대조조연장,차이유통계학의의(P＜0.05),이TCS-SD％、TCS-diff％차이무통계학의의(P＞0.05).여HNCM조비교,HOCM조TAS-SD％、TRS-SD％、TCS-SD％、TAS-diff％、TCS-diff％、TRS-diff％현저연장(P＜0.05),이TLS-SD％、TLS-diff％차이무통계학의의(P＞0.05).불동보삼수여좌실류출도압차존재선성정향상관성.결론 HCM환자좌실심기수축존재명현불동보,표명HCM환자조기존재수축공능적이상,3D-STI위평개HCM환자조기좌실수축공능적이상제공료신적방법.
Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI) in evaluating the systolic dyssynchrony of left ventricle(LV) in patients with hypertrophic cardiomyopathy (HCM).Methods A total of 93 consecutive patients with HCM were enrolled,in which 63 patients were non-obstructive HCM (HNCM),30 patients were obstructive HCM(HOCM).In addition,72 healthy subjects were recruited as a control group.An ultrasound system iE33(Philips Medical Systems) was used to acquire and analyze two-dimensional images.Full-volume three-dimensional dynamic images were performed using matrix transducer X5-1.The 16 segments of the time to peak area strain(TAS),the time to peak circumferential strain(TCS),the time to peak longitudinal strain(TLS),the time to peak radial strain(TRS)were analysis using off-line TomTec software (4D LV-Analysis 3.0).Then the standard deviation for the TAS,TCS,TLS,TRS (TAS-SD,TCS-SD,TLS-SD,TRS-SD),the maximal difference value of any of two segments of TAS,TCS,TLS,TRS (TAS-diff,TCS-diff,TLS-diff,TRS-diff),and the indices after standardization(TAS-SD％,TCS-SD％,TLS-SD％,TRS-SD％,TAS-diff％,TCS-diff％,TLS-diff％,TRS-diff％) were calculated,the difference of all these dyssynchroy indices among three groups were compared.Results Compared with the control group,LV end-diastolic,volumes and stroke volume significantly decreased,LV mass and LV diastolic wall thickness significantly increased(P ＜0.05).However,there was no significant difference between LVEF (P ＞0.05).The comparison of the 3D-STI dyssynchrony indices were as followed:compared with the control group,TAS-SD％,TLS-SD％,TRS-SD％,TAS-diff％,TRS-diff％,TLS-diff％ were significantly prolonged in HCM,there were significantly difference(P ＜0.05),while there were no statistics difference in TCS-SD％,TCS-diff％.Compared with the HNCM,TAS-SD％,TCS-SD％,TRS-SD％,TAS-diff％,TRS-diff％,TCS-diff％ were significantly prolonged in HOCM,while there was no statistics difference in TLS-SD％,TLS-diff％.A positive linear correlation exists between left ventricular outflow tract pressure gradient(LVOT-PG) and these dyssynchrony indices.Conclusions The systolic dyssynchrony of the LV are commonly existed in patients with HCM,indicated the impairment of myocardial contractility exists at the early stage of the HCM,3D-STI provided a new method for evaluating LV systolic abnormal in patients with HCM.