超声二维斑点追踪显像技术评价心肌致密化不全心肌病患者左心室收缩功能

摘要

目的 应用超声二维斑点追踪显像(STI)技术评价孤立性心肌致密化不全(IVNC)患者左心室局部心肌收缩功能.方法 对34例IVNC患者(IVNC组)及28名健康志愿者(对照组)进行超声检查,分析左心室二尖瓣、乳头肌、心尖水平短轴切面及心尖左心室长轴、四腔、两腔切面连续3个心动周期的二维灰阶图像.按照18节段划分法,记录左心室各节段心肌径向(Sr)、圆周(Sc)、纵向(εS)收缩期峰值应变,并将受累节段与未受累节段及对照组同水平相应节段进行比较.结果 ①与对照组比较,IVNC组左心室所有节段心肌Sr、Sc、εS均减低(P＜0.05).②IVNC组非致密心肌(乳头肌及心尖水平)Sr、Sc、εS测值较同一水平致密心肌减低(P＜0.05).③与对照组比较,IVNC组心率、LADs、LVEDD、LVM、LVMI、EDV、ESV值均增加,IVSd、LVPWDd、LVEF值均减小(P＜0.01).结论 IVNC患者左心室局部心肌收缩功能减低,以受累节段收缩功能减低尤为明显.STI技术可准确定量分析IVNC患者左心室局部心肌收缩功能.%Objective To evaluate the systolic function of noncompacted and compacted left ventricular segments in patients with isolated ventricular non-compaction (IVNC) using speckle tracking imaging (STI). Methods Thirty four patients with IVNC (IVNC group) and 28 healthy subjects (control group) were enrolled in the study. High frame rate two-dimensional images of three consecutive cardiac cycles at the levels of mitral annulus, papillary muscle and the apex as well as apical long axis view of left ventricle, apical 4 chamber view and apical 2 chamber were collected and analyzed using Qlab 7. 0 work station for offline strain analysis. The peak systolic circumferential strain (Sc) , radial strain(Sr) and longitudinal strain (eS) between groups and within groups were measured, respectively. Results ①Compared with control group, Sr, Sc and eS of all segments reduced significantly (P<0. 05) in patients with IVNC. ②Sc, Sr and eS of noncompacted myocardium at the level of the papillary muscle and the apex in patients with IVNC reduced significantly compared with those of compacted segments at the same level (P<0. 05). ③Compared with control group, the heart rate, LADs, , LVM, LVMI, EDV and ESV increased significantly (P<0. 01), while IVSd, LVPWDd and LVEF reduced significantly (P<0. 01) in patients with IVNC. Conclusion STI technology can accurately assess left ventricular function in IVNC patients. Moreover, it is a noninvasive and sensitive tool to detect regional systolic dysfunction of non-compacted myocardium.