CAJ | 학술논문

目的探讨速度向量成像结合多巴酚丁胺负荷试验在左室射血分数(LVEF)值正常的糖尿病患者左室长轴心肌应变功能评价中的价值.方法 30例排除冠心病、瓣膜性心脏病、高血压、先天性心脏病,并且经常规的超声心动图检查LVEF值＞50％的糖尿病患者,另选20例性别、年龄相匹配的健康志愿者作为对照,分别在静息状态、各级多巴酚丁胺负荷状态存储心尖四腔观、两腔观及左室长轴观的动态二维图像.用Sygno VVI软件进行脱机分析,获得左室各节段的长轴最大收缩速度(Vs)、应变(ε)、应变率(SR).结果对照组和糖尿病组组内比较,左室各壁Vs、e、SR自基底段至心尖段均呈递减趋势,且差异均具有统计学意义.对照组和糖尿病组组间各相应节段(18节段)配对比较,静息状态下,糖尿病组7个节段的SR、4个节段的ε、3个节段的Vs较对照组显著减低(P＜0.05);多巴酚丁胺最大负荷后,糖尿病组各指标均较对照组显著减低(P＜0.05).其中,静息状态下,糖尿病组心尖段67％的指标低于对照组,而中间段11％的指标低于对照组,基底段各参数与对照组无明显差异.结论左室长轴的Vs、ε、SR从基底段向心尖段逐渐减弱;糖尿病患者早期长轴心肌Vs、e、SR减退最早表现在心尖段的心肌组织;多巴酚丁胺负荷能提高VVI各参数检出心肌收缩功能障碍的敏感性.
목적 탐토속도향량성상결합다파분정알부하시험재좌실사혈분수(LVEF)치정상적당뇨병환자좌실장축심기응변공능평개중적개치.방법 30례배제관심병、판막성심장병、고혈압、선천성심장병,병차경상규적초성심동도검사LVEF치＞50％적당뇨병환자,령선20례성별、년령상필배적건강지원자작위대조,분별재정식상태、각급다파분정알부하상태존저심첨사강관、량강관급좌실장축관적동태이유도상.용Sygno VVI연건진행탈궤분석,획득좌실각절단적장축최대수축속도(Vs)、응변(ε)、응변솔(SR).결과 대조조화당뇨병조조내비교,좌실각벽Vs、e、SR자기저단지심첨단균정체감추세,차차이균구유통계학의의.대조조화당뇨병조조간각상응절단(18절단)배대비교,정식상태하,당뇨병조7개절단적SR、4개절단적ε、3개절단적Vs교대조조현저감저(P＜0.05);다파분정알최대부하후,당뇨병조각지표균교대조조현저감저(P＜0.05).기중,정식상태하,당뇨병조심첨단67％적지표저우대조조,이중간단11％적지표저우대조조,기저단각삼수여대조조무명현차이.결론 좌실장축적Vs、ε、SR종기저단향심첨단축점감약;당뇨병환자조기장축심기Vs、e、SR감퇴최조표현재심첨단적심기조직;다파분정알부하능제고VVI각삼수검출심기수축공능장애적민감성.
Objective To assess the systolic strain of left ventricular(LV) in the long axis views in diabeties mellitus(DM) patients with LVEF value ＞ 50％ with velocity vector imaging (VVI) and dobutamine stress echocardiography (DSE).Methods Thirty DM patients,which were excluded from coronary artery disease,valvular heart diseases,congenital heart diseases,hypertension,and LVEF value ＞50％ by echocardiography,and 20 volunteers with age and sex matched were involved in the study.Two-dimensional VVI echocardiographic cine loops were stored at baseline and dobutamine stress in the apical four-chamber,two-chamber and long axis views of LV.The maximum long systolic velocity (Vs),strain (ε)and strain rate (SR) were obtained from sygno VVI software.Results The Vs,ε and SR decreased from basal to apical in the LV walls whether in the control group or in the DM group.At baseline,SR in 7 segments,ε in 4 segments and Vs in 3 segments in the DM group decreased significantly than those in the control group (P ＜0.05).After the maximum dobutamine stress,all parameters decreased significantly in the DM group than those in the control group (all P ＜0.05).In addition,67％ parameters in apical LV and 11％ parameters in middle LV in the DM group were lower than those in the control group.All parameters in basal LV were comparable between the two groups at baseline.Conclusions The Vs,ε and SR showed decreased tendency from basal to apical in the long axis of LV.The Vs,ε and SR impairment in the long axis of DM patients appeared first in apical tissue of LV.DSE could increase the sensitivity of VVI parameters in the earlier stage.