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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2021, Vol. 18 ›› Issue (03) : 250 -257. doi: 10.3877/cma.j.issn.1672-6448.2021.03.003

所属专题： 文献；

心血管超声影像学

三维斑点追踪技术评价肥厚型心肌病患者左心室心肌力学特点
黎梦1, 章子铭1, 吕清1, 汪雨珊1, 王书媛1, 李贺1, 谢明星1, 张丽1,†()   
  1. 1. 434000　武汉，华中科技大学同济医学院附属协和医院超声影像科，分子影像湖北省重点实验室
  • 收稿日期:2020-06-02 出版日期:2021-03-01
  • 通信作者: 张丽
  • 基金资助:
    国家自然科学基金(81922033，81671705)

Investigation of left ventricular myocardial mechanics in patients with hypertrophic cardiomyopathy by three-dimensional speckle tracking echocardiography

Meng Li1, Ziming Zhang1, Qing Lv1, Yushan Wang1, Shuyuan Wang1, He Li1, Mingxing Xie1, Li Zhang1,†()   

  1. 1. Department of Ultrasound, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 434000, China
  • Received:2020-06-02 Published:2021-03-01
  • Corresponding author: Li Zhang
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引用本文：

黎梦, 章子铭, 吕清, 汪雨珊, 王书媛, 李贺, 谢明星, 张丽. 三维斑点追踪技术评价肥厚型心肌病患者左心室心肌力学特点[J]. 中华医学超声杂志（电子版）, 2021, 18(03): 250-257.

Meng Li, Ziming Zhang, Qing Lv, Yushan Wang, Shuyuan Wang, He Li, Mingxing Xie, Li Zhang. Investigation of left ventricular myocardial mechanics in patients with hypertrophic cardiomyopathy by three-dimensional speckle tracking echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(03): 250-257.

目的

应用三维斑点追踪技术（3D-STI）评价不同程度室壁肥厚对肥厚型心肌病（HCM）患者左心室整体及局部心肌力学的影响。

方法

纳入2016年4月至2017年12月于华中科技大学同济医学院附属协和医院确诊为HCM患者30例，同时纳入此时间段在该院行常规体检的正常对照组30例。根据左心室16节段的室壁厚度将HCM组分为4个亚组（HCM 1组，室壁厚度<1.1 cm；HCM 2组，室壁厚度≥1.1 cm且<1.5 cm；HCM 3组，室壁厚度≥1.5 cm且<2.0 cm；HCM 4组，室壁厚度≥2.0 cm）。研究对象均行常规超声及三维超声心动图检查。获取左心室整体纵向应变（GLS）、圆周应变（GCS）及径向应变（GRS），各节段纵向应变（SLS）、圆周应变（SCS）及径向应变（SRS），左心室质量（LVM）与左心室射血分数（LVEF）。采用独立样本t检验比较HCM组与对照组各指标的差异；采用单因素方差分析比较HCM各亚组间应变参数；采用Pearson或Spearman相关分析分析LVEF和室壁肥厚程度与左心室整体应变间的相关性。

结果

与对照组比较，HCM组标化后LVM增加[（122.3±29.7）g/m2 vs （77.3±11.3）g/m2]，GLS、GRS减低[（-14.7±3.6）% vs （-24.7±2.7）%，（36.2±8.3）% vs （47.7±3.0）%]，差异具有统计学意义（t=-7.761、-12.229、7.161，P均<0.001）；2组间LVEF、GCS比较，差异无统计学意义（P>0.05）；HCM组LVEF与GLS、GCS及GRS均存在相关性（r=-0.41，-0.88，0.66，P均<0.05）。HCM组GLS与标化后LVM呈线性相关（r=0.42，P<0.05）；HCM组GCS与最大室壁厚度、室壁厚度≥1.5 cm的节段数呈线性相关（r=0.35、0.48，P均<0.05）；GRS与最大室壁厚度、室壁厚度≥1.5 cm的节段数呈负相关（r=-0.55、-0.52，P均<0.05）。

结论

HCM患者左心室整体与各节段心肌收缩功能损伤随室壁肥厚加重而加重。环向应变在HCM患者维持左心室收缩功能正常中可能起着重要的作用。

关键词: 肥厚型心肌病, 三维斑点追踪技术, 室壁厚度, 左心室, 收缩性
Objective

To investigate the impact of wall thickness on global and segmental myocardial systolic function in patients with hypertrophic cardiomyopathy (HCM) by three-dimensional speckle tracking imaging (3D-STI).

Methods

Thirty patients with HCM diagnosed at Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were included in this study from April 2016 to December 2017, and 30 cases of normal controls who underwent routine physical examination during the same period were also included. According to the wall thickness, the HCM group was further divided into four subgroups (HCM 1, <1.1 cm; HCM 2, ≥1.1 cm to <1.5 cm; HCM 3, ≥1.5 cm to <2.0 cm; HCM 4, ≥2.0 cm). All subjects underwent conventional and three-dimensional echocardiography. The following parameters were obtained: left ventricular (LV) global longitudinal strain (GLS), circumferential strain (GCS) and radial strain (GRS), segmental longitudinal strain (SLS), circumferential strain (SCS) and radial strain (SRS), LV mass (LVM), and LV ejection fraction (LVEF). Independent sample t-test was used to compare the differences of each parameter between the HCM group and control group; one-way ANOVA was used to compare the strain parameters among HCM subgroups; Pearson or Spearman correlation was used to analyze the correlation between LVEF, ventricular wall thickness, and LV global strain.

Results

Compared with the normal control group, indexed LVM increased, and GLS and GRS decreased in the HCM group [(122.3±29.7) g/m2 vs (77.3±11.3) g/m2, (-14.7±3.6)% vs (-24.7±2.7)%, (36.2±8.3)% vs (47.7±3.0)%; t=-7.761, -12.229, and 7.161, P<0.001 for all], while LVEF and GCS showed no significant difference (P>0.05). In the HCM group, LVEF was correlated with GLS, GCS, and GRS (r=-0.41, -0.88, 0.66; P<0.05 for all). There was a correlation between GLS and indexed LVM (r=0.42, P<0.05). GCS was correlated with the maximum wall thickness and number of segments with wall thickness≥1.5 cm (r=0.35, 0.48; P<0.05 for both). GRS were negatively correlated with the maximum wall thickness and number of segments with wall thickness≥1.5 cm (r=-0.55, -0.52; P<0.05 for both).

Conclusion

LV global and regional myocardial systolic dysfunction in patients with HCM aggravates as the degree of hypertrophy increases. GCS may play an important role in the maintenance of normal LVEF in HCM.

Key words: Hypertrophic cardiomyopathy, Three-dimensional speckle tracking imaging, Wall thickness, Left ventricular systolic function, Systolic
图1 肥厚型心肌病（HCM）组与对照组患者整体与节段三维应变指标。图a、b为HCM组与对照组左心室整体应变参数；图c、d为HCM组与对照组左心室16节段各室壁节段纵向应变（SLS）；图e、f为HCM组与对照组左心室16节段各室壁节段圆周应变（SCS）；图g、h为HCM组与对照组左心室16节段各室壁节段径向应变（SRS）
表1 HCM组与对照组一般情况及超声心动图常规参数比较
组别 例数 男/女（例） 年龄（岁，±s） 体表面积（m2，±s） 收缩压（mmHg，±s） 舒张压（mmHg，±s） 心率（次/min，±s） LAD（cm，±s） LVEDD（cm，±s） E/A（±s） E/e（±s）
HCM组 30 23/7 51.3±10.5 1.8±0.2 125.4±15.3 76.7±9.8 69.9±9.7 3.9±0.6 4.6±0.5 0.9±0.4 17.8±4.9
对照组 30 21/9 46.3±10.9 1.7±0.2 121.2±6.9 78.6±5.1 73.1±5.8 3.1±0.3 4.5±0.3 1.25±0.33 8.5±2.2
统计值   χ2=0.341 t=-1.791 t=-0.796 t=-1.489 t=0.942 t=1.537 t=-7.557 t=-0.840 t=3.328 t=-9.290
P值   0.567 0.078 0.564 0.173 0.350 0.130 <0.001 0.404 0.002 <0.001
图2 肥厚型心肌病（HCM）组LVEF与左心室三维整体应变参数相关性分析。图a为GLS与LVEF相关性分析图；图b为GCS与LVEF相关性分析图；图c为GRS与LVEF相关性分析图
表2 HCM组与对照组左心室三维容积与整体应变参数比较（±s）
组别 例数 标化后EDV（ml/m2） 标化后ESV（ml/m2） 标化后SV（ml/m2） 标化后LVM（g/m2） LVEF（%） GLS（%） GCS（%） GRS（%）
HCM组 30 48.9±11.4 18.3±5.9 30.6±7.9 122.3±29.7 62.7±7.3 -14.7±3.6 -32.6±6.2 36.2±8.3
对照组 30 50.7±8.8 17.5±3.4 33.3±5.79 77.3±11.3 65.3±1.8 -24.7±2.7 -33.9±1.7 47.7±3.0
t值   0.693 -0.646 1.483 -7.761 1.896 -12.229 -1.017 7.161
P值   0.491 0.521 0.143 <0.001 0.063 <0.001 0.313 <0.001
图3 肥厚型心肌病（HCM）组左心室整体应变与左心室质量、最大室壁厚度及室壁厚度≥1.5 cm节段数相关性分析
图4 肥厚型心肌病（HCM）各亚组间三维应变参数比较图。图a为HCM各亚组间SLS比较；图b为HCM各亚组间SCS比较；图c为HCM各亚组间SRS比较
表3 肥厚型心肌病患者左心室三维容积及整体应变参数观察者内一致性分析
参数 同类相关系数 95%可信区间 一致性界限
观察者内      
  EDV 0.979 （0.948~0.991） （-11.1，10.1）
  ESV 0.916 （0.804~0.966） （-9.1，7.2）
  GLS 0.925 （0.825~0.970） （-3.8，2.9）
  GCS 0.903 （0.753~0.929） （-5.4，3.5）
  GRS 0.885 （0.737~0.953） （-5.6，7.8）
观察者间      
  EDV 0.979 （0.947~0.992） （-14.7，13.1）
  ESV 0.955 （0.886~0.982） （-9.1，6.7）
  GLS 0.962 （0.904~0.985） （-3.6，3.7）
  GCS 0.905 （0.760~0.926） （-4.6，4.8）
  GRS 0.951 （0.875~0.980） （-4.9，6.7）
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