超声二维应变成像技术评价孤立性左心室心肌致密化不全心肌病患者左心室收缩功能

摘要

Objective To assess the left ventricular systolic function in patients with isolated ventricular non-compaction( IVNC )by using two-dimensional strain( 2DS ). Methods 2DS images of threeconsecutive cardiac cycles at mitral valve, papillary muscle and the apical short-axis views as well as apical long axis view of left ventricle, apical 4 chamber view and apical 2 chamber view were acquired in 20 healthy subjects and 54 patients with IVNC which were divided into two groups based on left ventricular ejection fraction( LVEF ) < 50% ( n = 34 ) and LVEF =5 50% ( n = 20 ), and then the peak systolic circumferential strain( Sc ),radial strain( Sr ) and longitudinal strain( ∑) in IVNC were calculated by 2DS. Results Sc,Sr and ￡ measured on the mitral valve level,papillary level and apex level in the group with reduced LVEF with IVNC were [ -(8.12 ±4. 63)% ,(6. 81 ±4.90)%, -( 7. 10 ±4.72 )% ],[ -(6. 72 ±4. 11 )% ,( 6. 14 ±4. 21 )% ,-( 6.40 ±4.31 )% ],[ -( 6.62 ±5. 13 )% ,( 5.61 ±3. 92 )% , -( 7. 22 ±4. 93 )% ],respectively. Sc,Sr and ￡ measured in the group with normal LVEF with IVNC were[ -( 16.72 ±7.41 )% ,( 19.41 ±8. 32 )% ,-( 14. 33 ± 6. 21 )%)],[ - ( 15. 31 ± 4. 42 )% , ( 16. 61 ± 6. 82 )% , - ( 12. 91 ± 7. 42 )% ], [ -( 15.51 ±7.22)% ,( 12.03 ±8.81 )% , -( 13.71 ±6.81 )% ],respectively. The difference between the two groups was significant( mitral valve level:? =7. 24,9. 18,6. 63;papillary level:? =5. 51,9. 82,11. 30; apex level:q = 8. 17,9. 85 ,10. 33 ;all P <0. 05 ). Sc,Sr and ￡ measured in the group with healthy subjects were[ -(18.11 ±6.02 )% ,( 20.43 ±10.72)%, -( 16. 12 ±8. 01)% ],[ -( 17. 82 ±5. 50 )% ,( 25. 33 ± 11.32)%, -( 17.41 ±6.52)% ],[ -(18.33 ±5.61 )%,(21.11 ±8.92)%, -( 19.33 ±4.81 )% ],the difference between the healthy subjects and reduced LVEF subjects with IVNC was significant mitral valve level:? = 9.02,8. 57,9. 83;papillary level:? = 9. 31,11.76,10. 30; apex level:? = 8. 86,10. 65,9. 45; all P < 0.05 ). There were no differences in clinical and traditional echocardiographic characteristics between IVNC( the group with normal LVEF ) and the healthy subjects, while the Sc, Sr and ￡ of myocardium at the level of the papillary muscle and the apex in patients with with narmal LVEF reduced significantly in comparison with those of the healthy subjects( papillary level:? = 10. 01,8. 67,7. 84;apex level:? =9. 58, 9. 25,10. 62; all P <0. 05 ). Significant correlations were noted between the number of affected segments and LVEF( r= - 0. 48, P < 0. 05 ), left ventricular end-systolic volume( ESV )( r = 0. 50, P < 0. 05 ), left ventricular end-diastolic volume( EDV )( r = 0. 50, P < 0. 05 )in IVNC patients. Conclusions Local left ventricular systolic dysfunction could happen in patients with IVNC. 2DS is the most accurate, sensitive, specific and objective method to detect early left ventricular dysfunction in patients with IVNC ( those with normal LVEF ).%目的 应用超声二维应变成像技术评价孤立性左心室心肌致密化不全心肌病(IVNC)患者左心室局部心肌收缩功能.方法 选择IVNC患者54例,根据患者左心室射血分数(LVEF)将其分为LVEF降低组(LVEF＜50%,34例),LVEF正常组(LVEF≥50%,20例).选择28名健康志愿者作为健康对照组.获取受试者左心室短轴二尖瓣、乳头肌及心尖水平及心尖位左心室长轴、心尖四腔、心尖两腔观二维图像,应用超声二维应变成像技术测量并记录各节段的圆周收缩期应变峰值(Sc)、径向收缩期应变峰值(Sr)及纵向收缩期应变峰值(ε).结果 (1)健康对照组二尖瓣水平Sc、Sr及ε分别为-(18.11±6.02)%、(20.43±10.72)%、-(16.12±8.01)%,乳头肌水平分别为-(17.82±5.50)%、(25.33±11.32)%、-(17.41±6.52)%,心尖水平分别为-(18.33±5.61)%、(21.11±8.92)%、-(19.33±4.81)%;LVEF降低组IVNC患者二尖瓣水平Sc、Sr及ε分别为-(8.12±4.63)%、(6.81±4.90)%、-(7.10±4.72)%,乳头肌水平分别为-(6.72±4.11)%、(6.14±4.21)%、-(6.40±4.31)%,心尖水平分别为-(6.62±5.13)%、(5.61±3.92)%、-(7.22±4.93)%;LVEF值正常组IVNC患者二尖瓣水平Sc、Sr及ε分别为-(16.72±7.41)%、(19.41±8.32)%、(-14.33±6.21)%,乳头肌水平分别为-(15.31±4.42)%、(16.61±6.82)%、-(12.91±7.42)%,心尖水平分别为-(15.51±7.22)%、(12.03±8.81)%、-(13.71±6.81)%.LVEF降低组IVNC患者二尖瓣、乳头肌、心尖水平Sc、Sr及ε均较LVEF值正常组IVNC患者降低,且差异均有统计学意义(二尖瓣水平:q值分别为7.24、9.18、6.63,P均＜0.05;乳头肌水平:q值分别为5.51、9.82、11.30,P均＜0.05;心尖水平:q值分别为8.17、9.85、10.33,P均＜0.05＝;LVEF降低组IVNC患者二尖瓣、乳头肌、心尖水平Sc、Sr及ε也均较健康对照组降低,差异也均有统计学意义(二尖瓣水平:q值分别为9.02、8.57、9.83,P均＜0.05;乳头肌水平:q值分别为9.31、11.76、10.30,P均＜0.05;心尖水平:q值分别为8.86、10.65、9.45,P均＜0.05＝.LVEF值正常组IVNC患者一般临床资料和常规超声心动图参数与健康对照组比较差异无统计学意义,但乳头肌、心尖水平Sr、Sc、ε均较健康对照组降低,差异均有统计学意义(乳头肌水平:q值分别为10.01、8.67、7.84,P均<0.05;q值分别为9.58、9.25、10.62,P均<0.05).IVNC患者左心室受累节段数与LVEF呈负相关(r=-0.48,P<0.05),与左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)呈正相关(r值均为0.50,P均＜0.05＝.结论 IVNC部分患者虽然左心室整体收缩功能正常,但局部心肌收缩功能已发生改变,超声二维应变成像技术能敏感、准确地发现IVNC患者早期左心室心肌收缩功能受损.