· 临床研究·

    作者单位:430030 武汉,华中科技大学同济医学院附属同济医院

    超声影像科

    定量组织多普勒速度成像对肥厚型心肌病

    患者左心室局部舒张功能的研究

    潘敏 邓又斌 常青 杨好意 毕小军 向慧娟 黎春蕾

    【摘要】 目的 应用定量组织多普勒速度成像(QTVI)评价肥厚型心肌病(HCM)患者左心室局部心

    肌长轴方向舒张功能。方法 分别获取 10 例 HCM患者和 11 例正常对照者标准心尖位左心长轴观、二腔

    观和四腔观图像 ,应用 QTVI脱机分析左室中部、基部和二尖瓣环各节段心肌长轴方向在舒张早期( rVe)

    和心房收缩期(rVa)室壁运动速度曲线 ,计算左室中部、基部和二尖瓣环水平的平均 rVe、平均 rVa 及平均

    rVe/ rVa值。脉冲波多普勒测量二尖瓣口舒张早期最大血流流速曲线( E)和心房收缩期最大血流流速曲

    线(A) ,计算 E/ A值。结果 HCM组左室各节段 rVe 室壁运动曲线明显低于正常对照组( P < 0. 05) ,而

    左室大部分节段的 rVa室壁运动曲线与正常对照组相比差异无显著性意义( P > 0. 05) 。比较两组 E差异

    具有显著性意义( P = 0. 036) ,在两组平均 rVe室壁运动曲线的比较中此种差异更为显著( P < 0. 000 1) 。

    比较两组A和 E/ A值差异无显著性意义( P = 0. 22 , P = 0. 101) ,而两组各水平平均 rVa和平均 rVe/ rVa

    值差异具有显著性意义( P < 0. 05) 。结论 HCM患者局部心肌舒张功能受损。脉冲波多普勒血流信号

    E、 A受前负荷、心肌舒张功能和心房收缩的多重影响 ,而 QTVI提取多普勒组织信号成像 ,能独立反映局

    部心肌组织的舒张功能。

    【关键词】 超声心动描记术;组织速度成像;心肌病 ,肥大性;心室功能 ,左

    Detection of left ventricular regional relaxation abnormalitie s in patients with hypertrophic cardiomyopathy by

    quantitative tissue velocity imaging PA N Min , DEN G You2bin , CHA N G Qing , et al . Department of

    Medical Ul t rasound , Tongji Hospital , Tongji Medical College , Huaz hong University of Science and

    Technology , Wuhan 430030 ,China

    【Abstract】 Objective To assess the left vent ricular regional relaxation abnormalities in patients with

    hypert rophic cardiomyopathy ( HCM) by quantitative tissue velocity imaging ( QTVI ) . Methods Doppler

    echocardiography and QTVI were performed in HCM ( n = 10) and healthy subjects ( n = 11) at apical long2

    axis , two2chamber and four2chamber view. Regional early diastolic velocity (rVe) and regional at rial cont raction

    (rVa) were measured at each segment of vent ricular middle , basal and annular levels. Mean rVe and mean rVa at

    three levels as well as mean rVe/ rVa ratio were calculated. Transmit ral inflowpeak velocities during early diastole

    (E) and at rial cont raction (A) were also measured and E/ A ratio was calculated. Re sults rVe of all left

    vent ricular segments in HCM were lower than that of healthy subjects ( P < 0. 05) , but compared with healthy

    subjects majority of rVa in HCM were not different exce pt inferior wall and anterior wall . E between HCM and

    healthy subjects was different ( P = 0. 036) , while mean rVe between them was significantly different ( P <

    0. 000 1) . Mean rVa and mean rVe/ rVa of three levels were lower in HCM than in health y subjects ( P <

    0. 05) , but there were no differences of A and E/ A between them ( P = 0. 22 , P = 0. 101) . Conclusions Left

    vent ricular regional myocardial relaxation is impaired in HCM. Transmit ral inflow E and A are influenced b y

    preload , relaxation of myocardium and at rial contraction , etc , but rVe and rVa reflect myocardial relaxation function

    independently. QTVI is more sensitive and accurate than conventional Do ppler imaging for characterizing regional

    diastolic properties in HCM.

    【Key words】 Echocardiography ; Tissue velocity imaging ; Cardiomyopathy , hypert rophic ; Vent ricular

    function ,left

    肥厚型心肌病(HCM)是一种肌节病 ,与肌节收缩

    蛋白基因 ,尤其β肌球蛋白重链 (β 2Myosin heavy

    chain)基因的错义突变有关[1 ,2 ]。本病电镜检查最典

    型的改变是肌细胞和肌原纤维排列紊乱 ,间质内胶原

    增生[123 ]。HCM 患者普遍存在肌细胞收缩功能的下

    降 ,心室的肥厚只是其继发性的结局[224 ]。定量组织

    多普勒速度成像(quantitative tissue velocity imaging ,QTVI)是基于组织多普勒显像的一种新的超声心动

    图技术 ,可以精确地捕获组织运动速度变化和时相变

    · 354 · 中华超声影像学杂志2003 年8 月第12 卷第8 期 Chin J Ult rasonogr ,August 2003 ,Vol 12 ,No. 8

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