摘要
目的采用多种超声技术探讨不同类型肥厚型心肌病(HCM )患者左心室结构、功能、心肌机械力学、血流动力学及同步性参数的特征.方法连续纳入2016年1月至2017年11月西京医院HCM诊疗中心就诊的成年 HCM 患者85例,根据运动负荷试验中左室流出道峰值压差分为非梗阻性HCM 28例、隐匿梗阻性HCM 27例和梗阻性HCM 30例;此外,纳入 HCM 患者的健康家属16例作为对照组.采用运动负荷试验、二维斑点追踪成像(2D‐STI)以及组织多普勒成像(TDI)对入选研究对象静息和运动状态下左室功能各参数进行测量评估.结果①与对照组相比, HCM 各组左室舒张末期内径(LVEDD )明显减小,左室射血分数(LVEF )明显升高(均 P < 0 .05 );左室最大室壁厚度(MLVWT)和左室质量指数(LVMI)在梗阻性 HCM 最大,隐匿梗阻性和非梗阻性 HCM 次之,对照组最小(均 P <0 .05).②静息时,梗阻性 HCM左室整体纵向应变(GLS)、整体环向应变(GCS)、整体径向应变(GRS)和扭转(twist)均明显低于其他三组(均 P <0 .05);隐匿梗阻性和非梗阻性HCM左室GLS和twist较对照组减低(均 P <0 .05),但GCS和GRS与对照组比较差异无统计学意义(均P>0 .05).梗阻性HCM二尖瓣环收缩期位移和二尖瓣环收缩期速度(s′)最小,左室同步性参数收缩期达峰时间标准差(T s‐SD)和舒张早期达峰时间标准差(Te‐SD)最长(均 P <0 .05).梗阻性 HCM左室舒张功能指标包括二尖瓣环舒张早期速度(e′)、二尖瓣舒张早期血流速度与二尖瓣环舒张早期速度的比值(E/e′)和左房容积指数(LVAI)最差,隐匿梗阻性和非梗阻性 HCM 稍好,对照组最佳(均P<0 .001).③运动状态下,梗阻性 HCM 左室GLS 、 GCS 、 GRS 、 twist和二尖瓣环收缩期位移最小,隐匿梗阻性和非梗阻性 HCM 有所增加,对照组最大(均 P <0 .05);Ts‐SD和 Te‐SD在对照组最短,隐匿梗阻性和非梗阻性HCM有所延长,梗阻性HCM最长(均 P <0 .05).对照组运动时间最长,隐匿梗阻性和非梗阻性 HCM次之,梗阻性HCM最短;梗阻性 HCM的代谢当量(METs)亦明显小于其他三组(均 P <0 .05).结论梗阻性HCM患者左室心肌应变和同步性以及二尖瓣环收缩期位移在静息和运动时均显著受损;隐匿梗阻性和非梗阻性 HCM 患者静息时左室 GLS 、 twist 和 e′减低, GCS 、GRS 、二尖瓣环收缩期位移以及左室同步性在静息时正常,但在运动状态下明显受损.
Objective To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography. Methods A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states. Results ①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P<0.05). Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM, followed by labile-obstructive and non-obstructive HCM, and the lowest in the control group (all P<0.05).②At rest, the left ventricular global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as the twist of obstructive HCM were significantly lower than the other three groups (all P<0.05). As compared with the control group, the GLS and twist decreased in the labile-obstructive and non-obstructive HCM(all P<0.05), but there were no significant changes of GCS and GRS (all P>0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD)(all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001).③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05). Conclusions In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise.
作者
康楠
王静
刘丽文
艾红
杨帆
左蕾
李文霞
周梦垚
耶闯
马志玲
Kang Nan;Wang Jing;Liu Liwen;Ai Hong;Yang Fan;Zuo Lei;Li Wenxia;Zhou Mengyao;Ye Chuang;Ma Zhiling(Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi′an 710032, China;Department of Ultrasound, the First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061, China;Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi′an 710032, China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2019年第10期829-836,共8页
Chinese Journal of Ultrasonography
基金
国家科技部国际合作专项(2014DFA31980)
国家科学自然基金(81671693,81601498)
陕西省重点项目(2017ZDXM-SF-058)
西京医院新技术、新业务资助项目(417432A)
陕西省重点科技创新团队(2014KCT-20).
关键词
二维斑点追踪成像
组织多普勒成像
肥厚型心肌病
运动负荷试验
心肌机械力学
同步性
Two-dimensional speckle tracking imaging
Tissue Doppler imaging
Hypertrophic cardiomyopathy
Exercise stress echocardiography
Myocardial mechanics
Synchrony
