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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (04) : 417 -423. doi: 10.3877/cma.j.issn.1672-6448.2023.04.007

心血管超声影像学

二维斑点追踪成像技术对肥厚型心肌病患者右心室功能的评价
陈丹丹, 马小静(), 夏娟, 余正春, 谢姝瑞, 程冠, 吴梅   
  1. 430022 武汉科技大学附属武汉亚洲心脏病医院超声科 武汉市心血管影像临床医学研究中心;430065 武汉科技大学医学院
    430022 武汉科技大学附属武汉亚洲心脏病医院超声科 武汉市心血管影像临床医学研究中心
  • 收稿日期:2021-10-14 出版日期:2023-04-01
  • 通信作者: 马小静
  • 基金资助:
    湖北省武汉市科技局项目(2019020701011422)

Evaluation of right ventricular function in patients with hypertrophic cardiomyopathy by two-dimensional speckle tracking imaging

Dandan Chen, Xiaojing Ma(), Juan Xia   

  • Received:2021-10-14 Published:2023-04-01
  • Corresponding author: Xiaojing Ma
引用本文:

陈丹丹, 马小静, 夏娟, 余正春, 谢姝瑞, 程冠, 吴梅. 二维斑点追踪成像技术对肥厚型心肌病患者右心室功能的评价[J/OL]. 中华医学超声杂志(电子版), 2023, 20(04): 417-423.

Dandan Chen, Xiaojing Ma, Juan Xia. Evaluation of right ventricular function in patients with hypertrophic cardiomyopathy by two-dimensional speckle tracking imaging[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(04): 417-423.

目的

应用二维斑点追踪成像(2D-STI)技术评价肥厚型心肌病(HCM)患者右心室功能,并探讨左心室流出道梗阻对HCM患者右心室功能的影响,以及HCM患者右心室功能与室间隔厚度的相关性。

方法

这是一项回顾性研究。选取2020年4月至2021年6月在武汉亚洲心脏病医院就诊的60例单纯左心室壁肥厚的HCM患者,将其分为非梗阻性肥厚型心肌病(HNCM)组29例和梗阻性肥厚型心肌病(HOCM)组31例;另选取健康志愿者40例作为对照组。分析比较3组的常规超声心动图参数和2D-STI应变参数,并分析HCM患者的右心室功能与室间隔厚度以及左心室流出道压差的相关性。

结果

与对照组相比较,HNCM组和HOCM组的舒张末期室间隔厚度、左心室后壁厚度及左心室流出道压差均增加,而右心室面积变化率、三尖瓣环收缩期位移均减低,差异均具有统计学意义(P均<0.05)。与HNCM组相比,HOCM组的左心室流出道压差增加,差异具有统计学差异(P<0.05)。HNCM组和HOCM组的右心室心内膜、心肌整体纵向峰值应变、整体径向峰值应变绝对值均低于对照组;除右心室游离壁基底段径向峰值应变外,HNCM组和HOCM组的右心室各节段应变(纵向峰值应变和径向峰值应变)绝对值均低于对照组,差异均具有统计学意义(P均<0.05)。与对照组比较,HNCM组和HOCM组的右心室各节段纵向峰值应变率、右心室游离壁心尖段径向峰值应变率、室间隔(基底段和中间段)径向峰值应变率绝对值均减低,差异均有统计学意义(P均<0.05)。HNCM组和HOCM组的应变参数差异无统计学意义(P均<0.05)。HCM患者的右心室心内膜、心肌整体纵向峰值应变的绝对值及右心室整体径向峰值应变与室间隔厚度均呈负相关(相关系数分别为-0.655、-0.539、-0.511,P<0.05),而与左心室流出道压差没有相关性(相关系数分别为0.000、0.162、0.016,P>0.05)。

结论

HCM患者的右心室功能减低,且不受左心室流出道梗阻的影响;2D-STI技术的应变和应变率作为新的功能指标,对HCM患者的右心室功能的评估具有良好的应用价值。

Objective

To evaluate right ventricular function in patients with hypertrophic cardiomyopathy (HCM) by two-dimensional speckle tracking imaging (2D-STI), investigate the influence of left ventricular outflow tract obstruction on right ventricular function in HCM patients, and analyze the correlation between right ventricular function and interventricular septal thickness.

Methods

This was a retrospective observational study in which 60 HCM patients with simple left ventricular wall hypertrophy admitted to Wuhan Asian Heart Hospital from April 2020 to June 2021 were included. The patients were divided into either a hypertrophic non-obstructive cardiomyopathy (HNCM) group (29 patients) or a hypertrophic obstructive cardiomyopathy (HOCM) group (31 patients). Forty healthy volunteers were also included as a control group. Conventional echocardiographic parameters and 2D-STI strain parameters of the three groups were analyzed and compared, and the correlation between right ventricular function and ventricular septal thickness and left ventricular outflow tract pressure in HCM patients was analyzed.

Results

Compared with the control group, the interventricular septal thickness at end diastole, left ventricular posterior wall thickness at end diastole, and left ventricular outflow tract pressure gradient in the HNCM and HOCM groups were increased, while right ventricular fractional area change and tricuspid annular plane systolic excursion were reduced (P<0.05 for all). The left ventricular outflow tract pressure gradient of the HOCM group was significantly higher that of the HNCM group (P<0.05). Compared with the control group, right ventricular endocardium, global longitudinal strain, and global radial strain in the HNCM group and HOCM group were decreased. Except the basal radial strain of the right ventricle, right ventricular segmental strain (global longitudinal and radial strain) in the HNCM group and HOCM group was significantly lower than that of the control group (P<0.05 for all). Compared with the control group, right ventricular segmental global longitudinal strain rate, right ventricular free wall apical radial strain rate, and interventricular septal (basal segment and medium segment) radial strain rate in the HNCM group and HOCM group were decreased (P<0.05 for all). Strain parameters were not significantly different between the HNCM group and HOCM group (P>0.05 for all). Right ventricular endocardium, global longitudinal strain, and global radial strain in HCM patients were negatively correlated with interventricular septal thickness (r=-0.655, -0.539, and -0.511, respectively, P<0.05 for all), but not with the left ventricular outflow tract pressure gradient (r=0.000, 0.162, and 0.016, respectively, P>0.05 for all).

Conclusion

Right ventricular global and regional functions are impaired in patients with HCM, and right ventricular function is not affected by left ventricular outflow tract obstruction in HCM patients. As new functional indexes, strain and strain rate of 2D-STI technique have good value in the evaluation of right ventricular function in patients with HCM.

表1 对照组与HNCM组、HOCM组间一般资料比较(
x¯
±s
表2 对照组与HNCM组、HOCM组常规超声心动图参数比较(
x¯
±s
表3 对照组与HNCM组、HOCM组二维应变参数比较
x¯
±s)
组别 例数 Free-wall basal-LS(%)

Free-wall med-LS

(%)

Free-wall apical- LS(%) Septum basal -LS(%)

Septum med-LS

(%)

Septum apical-LS

(%)

对照组 40 -32.38±4.46 -26.75±5.11 -21.86±4.69 -21.10±4.79 -19.34±3.65 -21.03±4.65
HNCM组 29 -24.19±3.28a -18.07±4.69a -12.34±4.86a -16.05±3.75a -15.24±2.56a -15.58±3.01a
HOCM组 31 -24.14±1.96a -15.83±4.63a -13.87±4.06a -14.61±2.81a -14.58±2.89a -15.14±2.34a
F 65.853 51.034 44.963 26.576 24.374 29.841
P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
组别 例数 Septum basal-RS(%) Septum med-RS(%) Septum apical -RS(%)
对照组 40 49.98±13.72 43.22±11.69 48.41±8.69
HNCM组 29 35.43±13.60a 26.55±8.72a 44.67±5.96a
HOCM组 31 33.55±9.15a 23.35±7.40a 43.60±4.26a
F 18.825 43.739 4.979
P <0.001 <0.001 0.009
组别 例数 Free-wall basal- RSR(s-1

Free-wall med- RSR

(s-1

Free-wall apical -RSR(s-1 Septum basal-RSR(s-1

Septum med -RSR

(s-1

Septum apical -RSR(s-1
对照组 40 3.35±1.27 3.24±0.99 2.50±0.98 2.70±0.70 2.28±0.68 1.76±0.44
HNCM组 29 3.51±1.45 2.92±0.62 2.00±0.76a 2.05±0.68a 1.65±0.62a 1.57±0.41
HOCM组 31 3.57±1.56 3.11±0.69 1.94±0.91a 2.12±0.88a 1.68±0.71a 1.55±0.59
F 0.242 1.278 4.261 8.004 10.192 2.117
P 0.785 0.283 0.017 0.001 <0.001 0.126
组别 例数 GLS endo(%)

GLS myo

(%)

GRS

(%)

Free-wall basal-RS(%)

Free-wall med -RS

(%)

Free-wall apical -RS(%)
对照组 40 -22.66±3.96 -18.72±3.00 52.29±14.22 69.33±17.88 66.24±14.37 60.44±13.34
HNCM组 29 -13.42±1.93a -12.46±2.06a 36.60±13.87a 64.52±9.49 54.82±13.69a 43.71±7.28a
HOCM组 31 -12.83±3.53a -11.33±2.34b 36.04±11.54a 64.36±7.78 56.10±12.24a 42.39±6.53a
F 97.721 87.500 17.070 1.654 7.630 36.498
P <0.001 <0.001 <0.001 0.197 <0.001 <0.001
组别 例数 Free-wall basal -LSR(s-1

Free-wall med -LSR

(s-1

Free-wall apical LSR(s-1

Septum basal-LSR

(s-1

Septum med -LSR(s-1 Septum apical -LSR(s-1
对照组 40 -2.02±0.72 -1.73±0.44 -1.44±0.62 -1.21±0.26 -1.11±0.24 -1.33±0.35
HNCM组 29 -1.53±0.83a -1.31±0.62a -1.15±0.34a -0.92±0.32a -0.88±0.36a -1.03±0.40a
HOCM组 31 -1.58±0.67a -1.36±0.53a -1.00±0.36a -0.85±0.24a -0.75±0.26a -1.02±0.30a
F 4.593 6.894 7.920 17.170 14.535 8.841
P 0.012 0.002 0.001 <0.001 <0.001 <0.001
图1 二维斑点追踪成像各节段纵向峰值应变和径向峰值应变图。图a为健康者各节段纵向峰值应变和径向峰值应变图;图b为非梗阻性肥厚型心肌病患者各节段纵向峰值应变和径向峰值应变;图c为梗阻性肥厚型心肌病患者各节段纵向峰值应变和径向峰值应变
图2 肥厚型心肌病患者右心室纵向峰值应变绝对值与室间隔厚度的相关性分析散点图。图a,b,c分别为右心室心内膜整体纵向峰值应变绝对值、右心室心肌整体纵向峰值应变绝对值、右心室整体径向峰值应变与室间隔厚度的相关性分析散点图注:GLS endo为右心室心内膜整体纵向峰值应变;GLS myo为右心室心肌整体纵向峰值应变;GRS为右心室整体径向峰值应变;IVSD为舒张末期室间隔厚度
图3 肥厚型心肌病患者右心室纵向峰值应变绝对值与左心室流出道压差的相关性分析散点图。图a,b,c分别为右心室心内膜整体纵向峰值应变绝对值、右心室心肌整体纵向峰值应变绝对值、右心室整体径向峰值应变与左心室流出道压差的相关性分析散点图注:GLS endo为右心室心内膜整体纵向峰值应变;GLS myo为右心室心肌整体纵向峰值应变;GRS为右心室整体径向峰值应变;LVOT-PG为左心室流出道压差
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