CAJ | 학술논문

目的应用超声三维斑点追踪显像(3D-STI)技术研究肥厚型心肌病患者(HCM)左心室整体收缩功能.方法连续纳入HCM患者90例,其中非梗阻性HCM (HNCM)患者58例,梗阻性肥厚型心肌病(HOCM)患者32例,选取健康对照者72例.应用Philips iE33超声诊断仪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脱机软件对左室整体纵向应变(GLS)、左室整体圆周应变(GCS)、左室整体径向应变(GRS)、左室整体应变(GS)等三维参数进行分析.比较三组间上述指标的差异.结果与对照组比较,HCM组左心室收缩及舒张末期容积显著减小,每搏量显著减少,左心室质量及左心室舒张末室壁厚度显著增加,而左室射血分数差异无统计学意义(P=0.178).与对照组比较,HCM组GS无显著差异性,GLS明显减低,而GRS、GCS显著增强;与HNCM组比较,HOCM组GLS减低更明显,而GRS、GCS明显增加,Bland-Altman分析显示纵向峰值应变测值在HCM组和正常组有良好的一致性.结论 3D-STI可检测HCM患者左心室早期整体心肌收缩功能的损害,从而为其临床早期诊断、治疗评估提供有价值的信息.
목적 응용초성삼유반점추종현상(3D-STI)기술연구비후형심기병환자(HCM)좌심실정체수축공능.방법 련속납입HCM환자90례,기중비경조성HCM (HNCM)환자58례,경조성비후형심기병(HOCM)환자32례,선취건강대조자72례.응용Philips iE33초성진단의획득화분석이유도상,이용X5-1구진탐두획취좌실삼유전용적동태도상,운용TomTec탈궤연건대좌실정체종향응변(GLS)、좌실정체원주응변(GCS)、좌실정체경향응변(GRS)、좌실정체응변(GS)등삼유삼수진행분석.비교삼조간상술지표적차이.결과 여대조조비교,HCM조좌심실수축급서장말기용적현저감소,매박량현저감소,좌심실질량급좌심실서장말실벽후도현저증가,이좌실사혈분수차이무통계학의의(P=0.178).여대조조비교,HCM조GS무현저차이성,GLS명현감저,이GRS、GCS현저증강;여HNCM조비교,HOCM조GLS감저경명현,이GRS、GCS명현증가,Bland-Altman분석현시종향봉치응변측치재HCM조화정상조유량호적일치성.결론 3D-STI가검측HCM환자좌심실조기정체심기수축공능적손해,종이위기림상조기진단、치료평고제공유개치적신식.
Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI) in evaluating the global systolic strain of left ventricular (LV) in patients with hypertrophic cardiomyopathy (HCM).Methods A total of 90 consecutive patients with HCM were enrolled,in which 58 patients were nonobstructive HCM (HNCM),32 patients were obstructive HCM (HOCM).In addition,72 healthy subjects were recruited as a control group.An ultrasound system iE33 (Philips Medical Systems,Bothell) was used to acquire and analyze two-dimensional images.Full-volume three-dimensional dynamic images were performed using matrix transducer X5-1.LV global longitudinal strain(GLS),global circumferential strain(GCS),global radial longitudinal(GRS),global strain (GS),were analysis using off-line TomTec software,the differences among three groups were compared.Results Compared with the control group,LV end-diastolic,end-systolic volumes and stroke volume significantly decreased,LV mass and LV diastolic wall thickness significanty increased.Howeve,there was no significant difference between LVEF in the HCM and control group (P =0.178).The comparson of the 3D systolic strain in the four groups as followed,compared with the control group,GS was no significant difference,GLS was significantly reduced,however GCS,GRS was significantly increased in HCM groups.When compared with the HNCM,GLS was significant reduced,however GCS,GRS were significant increased in the HOCM group.Bland-Altman analysis showed there were good agreements in both patients with HCM and control subjects.Conclusions 3D-STI can detecte the early impairment of LV global myocardial contractility in HCM,and provides valuable information for clinical in early diagnosis,prevention and treatment.