心肌弹性成像对高血压左心室不同构型患者心肌僵硬度的评价

doi:10.3877/cma.j.issn.1672-6448.2021.02.002

中华医学超声杂志（电子版） ›› 2021, Vol. 18 ›› Issue (02) : 128 -134. doi: 10.3877/cma.j.issn.1672-6448.2021.02.002

所属专题：文献；

心血管超声影像学

心肌弹性成像对高血压左心室不同构型患者心肌僵硬度的评价

魏丽群¹, 李一丹¹, 丁雪晏¹, 朱维维¹, 王娟², 王江涛³, 吕秀章¹^,^†(

)

^1. 100020　首都医科大学附属北京朝阳医院心脏超声科
^2. 100020　首都医科大学附属北京朝阳医院心内科
^3. 100020　北京通用电气医疗心血管超声临床科研部

收稿日期:2020-05-31 出版日期:2021-02-01
通信作者: 吕秀章
基金资助:
国家自然科学基金青年项目(81900382); 扬帆计划临床技术创新项目(XMLX201827)

Evaluation of myocardial stiffness by intrinsic cardiac elastography in hypertensivepatients with different types of left ventricular remodeling

Liqun Wei¹, Yidan Li¹, Xueyan Ding¹, Weiwei Zhu¹, juan Wang², Jiangtao Wang³, Xiuzhang Lyu¹^,^†()

^1. Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
^2. Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
^3. GE Medical Cardiovascular Ultrasound Clinical Research Department, Beijing 100020, China

Received:2020-05-31 Published:2021-02-01
Corresponding author: Xiuzhang Lyu

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引用本文：

魏丽群, 李一丹, 丁雪晏, 朱维维, 王娟, 王江涛, 吕秀章. 心肌弹性成像对高血压左心室不同构型患者心肌僵硬度的评价[J/OL]. 中华医学超声杂志（电子版）, 2021, 18(02): 128-134.

Liqun Wei, Yidan Li, Xueyan Ding, Weiwei Zhu, juan Wang, Jiangtao Wang, Xiuzhang Lyu. Evaluation of myocardial stiffness by intrinsic cardiac elastography in hypertensivepatients with different types of left ventricular remodeling[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(02): 128-134.

目的

探讨高频组织多普勒超声心动图弹性成像技术测量舒张末期左心室心肌拉伸的固有波传播速度（IVP），评价高血压左心室不同构型患者心肌僵硬度的可行性和临床价值。

方法

前瞻性纳入2019年9月至2020年3月在北京朝阳医院治疗的90例高血压患者（左心室正常构型组22例、向心性重构组30例及向心性肥厚组38例）和同期门诊年龄、性别匹配的30例健康者为对照组，均接受包括斑点追踪测量左心室整体纵向应变（GLS）的全面超声心动图检查，采用弹性成像技术定量检测心肌弹性的直接测量指标——心肌拉伸的IVP。比较各组之间IVP是否存在差异，IVP与常用超声心动图参数和GLS的相关性，受试者工作特征（ROC）曲线分析IVP预测左心室向心性肥厚的敏感度和特异度。

结果

高血压患者IVP高于健康对照组，向心性肥厚组IVP显著高于健康对照组、左心室重构组及正常构型组（均P＜0.05）。IVP与左心室后壁厚度（LVPWT）、左心室质量指数（LVMI）、室间隔厚度（IVS）、相对室壁厚度（RWT）、收缩压（SBP）及E/e'呈显著正相关（r=0.732、0.695、0.670、0.652、0.626、0.625，均P＜0.01），与GLS、e' average呈负相关（r=-0.593、-0.445，均P＜0.001）。ROC曲线分析显示，IVP＞179.84 cm/s是预测高血压患者左心室向心性肥厚构型的最佳阈值（敏感度92%，特异度61%）。

结论

IVP是无创定量评估高血压左心室重构患者左心室心肌僵硬度的新参数，值得进一步研究应用。

关键词: 超声心动描记术, 高血压, 心肌僵硬度, 弹性, 心脏重构

Objective

To explore the feasibility and clinical value of end-diastolic left ventricular intrinsic velocity propagation (IVP) of myocardial stretch measured by high-frame rate tissue Doppler echocardiography forevaluating myocardial stiffness in hypertensive patients with different types of left ventricular remodeling.

Methods

A total of 90 hypertensive patients with different types of left ventricular remodeling (22 patients with normal geometry, 30 with concentric remodeling, and 38 with concentric hypertrophy) and 30 healthy controls were prospectively included in this study. All subjects underwent comprehensive echocardiographic examination including speckle tracking and measurement of global longitudinal strain (GLS) of the left ventricle, and IVP of myocardial stretch,which is a direct and quantitative measurement index of myocardial elasticity. The differences of IVP among the groups were compared.The correlations between IVP and common echocardiographic parameters or GLS were analyzed. The sensitivity and specificity of IVP in predicting left ventricular concentric hypertrophy were analyzed by receiver operating characteristic (ROC) curve analysis.

Results

IVP in hypertensive patients was higher than that of healthy controls, and IVP in the concentric hypertrophy subgroup was significantly higher than that of the other two left ventricular remodeling subgroups(P<0.05). IVP was significantly positively correlated with left ventricular posterior wall thickness, left ventricular mass index, thickness of interventricular septum, relative wall thickness, systolic blood pressure, and E/e'(r=0.732, 0.695, 0.670, 0.652, 0.626, and 0.625, respectively; P<0.001 for all), and negatively correlated with GLS and e'average (r=-0.593 and -0.445, respectively). ROC curve analysis showed that IVP>179.84 cm/s was the best threshold for predicting left ventricular concentric hypertrophy in hypertensive patients (sensitivity 92%, specificity 61%). Condusion IVP is a new parameter for noninvasive and quantitative evaluation of left ventricular myocardial stiffness in hypertensive patients with left ventricular remodeling, which is worthy of further study and application.

Key words: Echocardiography, Arterial hypertension, Myocardial stiffness, Elasticity, Cardiacremodeling

图1 健康者与高血压患者左心室舒张末期心肌拉伸的固有波传播速度（IVP)测量，IVP为舒张末期开始时等速波阵从基底部向心尖部传播的速度(红色箭头直线的斜率)。图a示健康者IVP为133 cm/s；图b示高血压患者IVP为323 cm/s

表1 高血压各组与对照组一般临床资料比较(

x ˉ

±s)

参数	对照组(n=30)	高血压组			F/χ²值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F/χ²值	P值
年龄	55±14	55±14	60±13	59±13	1.102	0.352
男性(%)	19(63.3)	11(50.0)	19(63.3)	26(68.4)	2.053	0.562
高血压病程(年)	-	8.6±5.0	10.6±8.5	14.0±11.6	2.593^d	0.081^d
BMI(kg/m²)	23.8±3.2	27.0±4.8	29.0±7.3^a	27.0±5.8	4.423	0.006
BSA(m²)	1.75±0.12	1.91±0.16^a	1.91±0.16^a	1.93±0.28^a	5.564	0.001
HR(次/min)	74.1±13.3	79.1±16.0	70.2±10.7	74.3±12.0	2.041	0.112
SBP(mmHg)	113.0±11.2	144.6±20.2^a	146.7±19.7^a	162.7±20.7^abc	39.462	＜0.001
DBP(mmHg)	73.4±11.1	82.0±15.8	83.1±17.5	90.0±18.8^a	5.589	0.001

表1 高血压各组与对照组一般临床资料比较(

x ˉ

±s)

参数	对照组(n=30)	高血压组			F/χ²值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F/χ²值	P值
年龄	55±14	55±14	60±13	59±13	1.102	0.352
男性(%)	19(63.3)	11(50.0)	19(63.3)	26(68.4)	2.053	0.562
高血压病程(年)	-	8.6±5.0	10.6±8.5	14.0±11.6	2.593^d	0.081^d
BMI(kg/m²)	23.8±3.2	27.0±4.8	29.0±7.3^a	27.0±5.8	4.423	0.006
BSA(m²)	1.75±0.12	1.91±0.16^a	1.91±0.16^a	1.93±0.28^a	5.564	0.001
HR(次/min)	74.1±13.3	79.1±16.0	70.2±10.7	74.3±12.0	2.041	0.112
SBP(mmHg)	113.0±11.2	144.6±20.2^a	146.7±19.7^a	162.7±20.7^abc	39.462	＜0.001
DBP(mmHg)	73.4±11.1	82.0±15.8	83.1±17.5	90.0±18.8^a	5.589	0.001

表2 高血压各组与对照组超声心动图参数比较(

x ˉ

±s)

参数	对照组(n=30)	高血压组			F值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F值	P值
IVS(mm)	9.4±0.9	10.5±0.9^a	12.0±1.3^ab	13.5±1.3^abc	80.882	＜0.001
PWT(mm)	9.0±0.8	9.5±0.6	11.2±1.0^ab	13.1±1.3^abc	112.868	＜0.001
LVEDD(mm)	46.4±3.2	46.7±2.2	43.5±2.9^ab	47.3±3.6^c	9.319	＜0.001
RWT	0.39±0.03	0.41±0.02	0.52±0.06^ab	0.56±0.08^abc	66.938	＜0.001
LVMI(g/m²)	83.0±13.9	85.8±11.1	94.1±8.9^a	130.2±19.1^abc	78.625	＜0.001
LVEF(%)	67.0±3.8	66.9±3.8	67.2±3.7	66.0±3.4	0.717	0.544
GLS	20.8±1.8	19.5±2.3	18.9±2.0^a	16.8±1.6^abc	25.879	＜0.001
E(cm/s)	77.2±21.8	68.5±24.3	70.5±17.7	75.9±26.3	0.928	0.429
A(cm/s)	69.9±14.8	81.7±17.5	83.4±22.4^a	79.9±19.5	3.039	0.032
e' average	10.1±2.7	8.2±2.4^a	6.7±1.5^a	6.4±1.7^ab	21.477	＜0.001
E/e'average	7.9±2.1	8.4±2.2	11.0±3.4^ab	12.3±4.2^ab	13.297	＜0.001
LAV(ml)	45.4±9.9	50.1±13.2	60.9±16.7^a	75.7±25.1^abc	18.22	＜0.001
LAVI(ml/m²)	25.9±5.4	26.4±7.3	31.7±8.0	39.5±13.4^abc	14.499	＜0.001
IVP(cm/s)	132.1±21.0	156.1±28.0	173.9±31.2^a	224.1±41.7^abc	49.176	＜0.001

表2 高血压各组与对照组超声心动图参数比较(

x ˉ

±s)

参数	对照组(n=30)	高血压组			F值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F值	P值
IVS(mm)	9.4±0.9	10.5±0.9^a	12.0±1.3^ab	13.5±1.3^abc	80.882	＜0.001
PWT(mm)	9.0±0.8	9.5±0.6	11.2±1.0^ab	13.1±1.3^abc	112.868	＜0.001
LVEDD(mm)	46.4±3.2	46.7±2.2	43.5±2.9^ab	47.3±3.6^c	9.319	＜0.001
RWT	0.39±0.03	0.41±0.02	0.52±0.06^ab	0.56±0.08^abc	66.938	＜0.001
LVMI(g/m²)	83.0±13.9	85.8±11.1	94.1±8.9^a	130.2±19.1^abc	78.625	＜0.001
LVEF(%)	67.0±3.8	66.9±3.8	67.2±3.7	66.0±3.4	0.717	0.544
GLS	20.8±1.8	19.5±2.3	18.9±2.0^a	16.8±1.6^abc	25.879	＜0.001
E(cm/s)	77.2±21.8	68.5±24.3	70.5±17.7	75.9±26.3	0.928	0.429
A(cm/s)	69.9±14.8	81.7±17.5	83.4±22.4^a	79.9±19.5	3.039	0.032
e' average	10.1±2.7	8.2±2.4^a	6.7±1.5^a	6.4±1.7^ab	21.477	＜0.001
E/e'average	7.9±2.1	8.4±2.2	11.0±3.4^ab	12.3±4.2^ab	13.297	＜0.001
LAV(ml)	45.4±9.9	50.1±13.2	60.9±16.7^a	75.7±25.1^abc	18.22	＜0.001
LAVI(ml/m²)	25.9±5.4	26.4±7.3	31.7±8.0	39.5±13.4^abc	14.499	＜0.001
IVP(cm/s)	132.1±21.0	156.1±28.0	173.9±31.2^a	224.1±41.7^abc	49.176	＜0.001

图2 舒张末期心肌拉伸的固有波速度（IVP）预测左心室舒张功能减低的受试者工作特征（ROC）曲线

图3 舒张末期心肌拉伸的固有波速度（IVP）预测左心室向心性肥厚构型的受试者工作特征（ROC）曲线

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Evaluation of myocardial stiffness by intrinsic cardiac elastography in hypertensivepatients with different types of left ventricular remodeling

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Evaluation of myocardial stiffness by intrinsic cardiac elastography in hypertensivepatients with different types of left ventricular remodeling