CAJ | 학술논문

目的应用三维斑点追踪成像(3D-STI)技术评价早期肥厚型心肌病(HCM)患者左心室局部收缩功能.方法连续纳入早期HCM患者70例,同期纳入健康志愿者70例作为对照组.实时三维超声获取左心室三维全容积图像,运用TomTec脱机分析软件对左室16个节段的纵向应变、圆周应变、径向应变以及整体应变等三维参数进行分析,比较两组间上述各参数的差异.结果与对照组比较,早期HCM患者左心室收缩末期及舒张末期容积显著减小,每搏量显著减少,左室质量指数显著增加,舒张末期室间隔厚度显著增加,舒张末期后壁厚度增加(均P＜0.001),左室射血分数差异无统计学意义(P＞0.05);与对照组相比,HCM患者增厚节段纵向应变明显减低(P＜0.05),而径向、圆周应变明显增加(P＜0.05),整体应变差异无统计学意义(P＞0.05),其他非增厚节段的纵向、径向、圆周及整体应变差异多无统计学意义.室间隔厚度与室间隔纵向应变之间存在线性正相关性(r=0.287,P=0.006).结论早期HCM患者存在局部心肌收缩功能损害,主要表现为增厚部位纵向应变减低,且与室壁肥厚的程度相关;而圆周及径向应变增加.3D-STI可用于早期HCM患者左心室局部收缩功能的评价.
목적 응용삼유반점추종성상(3D-STI)기술평개조기비후형심기병(HCM)환자좌심실국부수축공능.방법 련속납입조기HCM환자70례,동기납입건강지원자70례작위대조조.실시삼유초성획취좌심실삼유전용적도상,운용TomTec탈궤분석연건대좌실16개절단적종향응변、원주응변、경향응변이급정체응변등삼유삼수진행분석,비교량조간상술각삼수적차이.결과 여대조조비교,조기HCM환자좌심실수축말기급서장말기용적현저감소,매박량현저감소,좌실질량지수현저증가,서장말기실간격후도현저증가,서장말기후벽후도증가(균P＜0.001),좌실사혈분수차이무통계학의의(P＞0.05);여대조조상비,HCM환자증후절단종향응변명현감저(P＜0.05),이경향、원주응변명현증가(P＜0.05),정체응변차이무통계학의의(P＞0.05),기타비증후절단적종향、경향、원주급정체응변차이다무통계학의의.실간격후도여실간격종향응변지간존재선성정상관성(r=0.287,P=0.006).결론 조기HCM환자존재국부심기수축공능손해,주요표현위증후부위종향응변감저,차여실벽비후적정도상관;이원주급경향응변증가.3D-STI가용우조기HCM환자좌심실국부수축공능적평개.
Objective To assess the left ventricular (LV) regional systolic function by threedimensional speckle tracking imaging (3D-STI) in patients with early stage of hypertrophic cardiomyopathy (HCM).Methods A total of 70 consecutive patients with early stage of HCM were enrolled.In addition,70 healthy subjects were recruited as a control group.A real-time dynamic 3D echocardiography system (IE33) was used to acquire and store LV full-volume 3D images.LV 16 segments longitudinal strain,radial strain,circumferential strain and global strain were analyzed using off-line TomTec software.The difference between the two groups was compared.Results Compared with the control group,LV end diastolic,endsystolic volumes and stroke volume significantly decreased,while LV mass and LV interventricular septum diastolic thickness significantly increased,LV posterior wall diastolic thickness slightly increased (P ＜ 0.001).However,LVEF had no significant difference (P ＞0.05).Compared with the control group,the results were as followed:the longitudinal strain significantly reduced in hypertrophic segments(P ＜0.05),while circumferential and radial strain significantly increased (P ＜ 0.05),global strain showed no significantly difference (P ＞ 0.05).While longitudinal,radial and circumferential strain had no statistical differences in non-hypertrophic segments.A positive linear correlation existed between LV interventricular thickness and LV interventricular longitudinal strain (r =0.287,P =0.006).Conclnsions The impairment of regional myocardial contractility existed in early stage of HCM.The main features were longitudinal strain decreased in hypertrophic segments,which associated with the degree of LV wall thickness,while circumferential and radial strain increased.3D-STI provided a new method for evaluating LV regional systolic function in patients with early stage of HCM.