摘要
目的应用四维自动左室定量分析(4D Auto LVQ)技术评估左室中部梗阻(MVO)对肥厚型心肌病(HCM)患者左心整体及局部收缩功能的影响。方法回顾性分析了2020年12月至2022年10月郑州大学第一附属医院收集的57例梗阻性HCM患者, 根据有无MVO分为两组:HCM 1组, 不合并MVO的梗阻性HCM 34例;HCM 2组, 合并MVO的梗阻性HCM 23例。另外选取同期健康体检者25例作为对照组。所有受检者均使用GE Vivid E95超声诊断仪采集常规超声参数, 应用4D Auto LVQ获取左室心肌力学参数, 包括左室整体纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)、径向应变(GRS)及各节段纵向应变(SLS)、面积应变(SAS), 比较三组间上述参数的差异。结果①与对照组相比, HCM两组的最大室间隔基底段厚度、最大室间隔中间段厚度、室间隔心尖段厚度、左室后壁厚度、左心房前后径显著增大, 6 min步行距离、左室舒张末期内径减少, HCM 1组的最大左室流出道压差高于HCM 2组, 三组间在合并心尖部室壁瘤上差异有统计学意义(均P<0.05), 但三组间左室射血分数的差异无统计学意义(P>0.05)。②与对照组相比, HCM两组GLS降低, 且HCM 2组低于HCM 1组(均P<0.05);与对照组相比, HCM两组GRS、GAS降低(均P<0.05), 但两组间差异无统计学意义(均P>0.05), 三组间GCS差异无统计学意义(均P>0.05)。③与对照组相比, HCM两组的基底段、中间段、心尖段以及后间隔、下壁、侧壁的心尖段SLS明显减低, HCM 2组后间隔、前间隔、前壁、后壁、下壁的中间段及后间隔、侧壁、下壁的心尖段SLS较HCM 1组明显减低(均P<0.05), 但后间隔、前间隔、前壁、侧壁、下壁的基底段SLS两组间差异无统计学意义(均P>0.05)。④与对照组相比, HCM两组后间隔基底段、中间段, 前间隔中间段, 前壁基底段、中间段、心尖段, 侧壁基底段、中间段、心尖段, 后壁基底段、中间段, 下壁基底段、中间段以及心尖帽的SAS均明显减低(均P<0.05), 但在HCM两组间上述室壁SAS差异无统计学意义(均P>0.05)。结论 4D Auto LVQ能够评价MVO对HCM患者左心收缩功能的损害, 尤其对中间段和心尖段局部心肌功能受损情况的评估更具意义。
Objective To investigate the effect of mid-ventricular obstruction(MVO)on left ventricular systolic function in patients with hypertrophic cardiomyopathy(HCM)by four-dimensional automatic left ventricular quantitation technology(4D Auto LVQ).Methods Fifty-seven hypertrophic obstructive cardiomyopathy patients were selected from December 2020 to October 2022 in the First Affiliated Hospital of Zhengzhou University.According to the presence of MVO,HCM patients were divided into two groups:HCM 1 group,HCM without MVO(n=34);HCM 2 group,HCM with MVO(n=23).In addition,25 healthy subjects in the same period were selected as the control group.Conventional ultrasound parameters were collected,and 4D Auto LVQ technology was used to obtain the mechanical parameters of left ventricular myocardium,including left ventricular longitudinal strain(GLS),circumferential strain(GCS),area strain(GAS),radial strain(GRS),segmental longitudinal strain(SLS)and area strain(SAS).The differences of these parameters among the three groups were compared.Results①Compared with the control group,the thickness of the maximum basal segment of interventricular septum,the thickness of the middle segment of the maximum interventricular septum,the thickness of the apical segment of the interventricular septum,the thickness of the left ventricular posterior wall and left atrium diameter were significantly increased.Six-minute walk distance and the left ventricular end-diastolic diameter was decreased in the two groups of HCM(all P<0.05).Left ventricular outflow tract gradients in HCM 1 group was higher than HCM 2 group(P<0.05),but there was no significant difference in left ventricular ejection fraction among the three groups(P>0.05).There was significant difference in the incidence of left ventricular apical aneurysm among the three groups(P<0.05).②Compared with the control group,the GLS in both HCM groups was lower,and it was lower in the HCM 2 group than in the HCM 1 group(all P<0.05)the GRS and GAS in both HCM groups were lower than in the control group(P<0.05),and there was no significant difference between the two groups of HCM,and there was no significant difference in GCS among the three groups(all P>0.05).③Compared with the control group,the SLS of basal segment,middle segment,apical cap,posterior septum,inferior wall and lateral wall in HCM group were significantly lower than those in control group.The SLS of apical segment of posterior septum,anterior septum,anterior wall,posterior wall,inferior wall and apical segment of posterior septum,lateral wall and inferior wall in HCM 2 group were significantly lower than HCM 1 group(all P<0.05),but there was no significant difference in SLS of posterior septum,anterior septum,anterior wall,lateral wall and inferior wall between the two groups(all P>0.05).④Compared with the control group,the SAS of posterior septal basal segment,middle segment,anterior septal middle segment,anterior wall basal segment,middle segment,apical segment,lateral wall basal segment,middle segment,apical segment,posterior wall basal segment,middle segment,inferior wall basal segment,middle segment and apical cap in HCM groups were significantly lower than the control group(all P<0.05),but there was no significant difference in SAS between the two groups of HCM(P>0.05).Conclusions 4D Auto LVQ can quantitatively evaluate the damage of MVO on the left ventricular systolic function in patients with HCM,especially for the evaluation of local myocardial function damage in the medial segment and apical segment.
作者
王方铭
刘海艳
杨灵霄
师文强
秦俊昌
韩正阳
张姗
张瑞芳
Wang Fangming;Liu Haiyan;Yang Lingxiao;Shi Wenqiang;Qin Junchang;Han Zhengyang;Zhang Shan;Zhang Ruifang(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Henan Hypertrophic Cardiomyopathy Center,Zhengzhou 450000,China;Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2023年第8期664-671,共8页
Chinese Journal of Ultrasonography
基金
国家自然科学基金(81871364)
河南省医学科技攻关计划省部共建项目(SBGJ2018014)。
