【摘要】：目的·探討梗阻性與非梗阻性肥厚型心肌病(HCM)患者左心室應(yīng)變力的改變及其差異。方法·序貫入組48例左心室射血分?jǐn)?shù)保留(LVEF50%)的HCM(梗阻性18例、非梗阻性30例)和25例健康人,采用心臟磁共振成像(MRI)掃描,測(cè)量并比較左心室整體縱向應(yīng)變(GLS)、徑向應(yīng)變(GRS)與周向應(yīng)變(GCS),以及LVEF、左室舒張末容積(LVEDV)、左室心肌質(zhì)量(LVM)、左室舒張末容積指數(shù)(LVEDVI)、左室心肌質(zhì)量指數(shù)(LVMI)。依據(jù)美國(guó)心臟協(xié)會(huì)17節(jié)段法則測(cè)量左心室中段徑向應(yīng)變(m RS)、周向應(yīng)變(m CS)及徑向最大位移。結(jié)果·(1)梗阻性HCM患者LVEF顯著高于非梗阻性及正常組(P0.05),2組HCM患者LVM及LVMI均顯著高于正常組(均P0.01)。(2)與梗阻性HCM患者相比,非梗阻性HCM患者的左心室整體應(yīng)變參數(shù)(GLS、GRS、GCS)均明顯降低(均P0.05),且2組均低于正常組,差異具有統(tǒng)計(jì)學(xué)意義(均P0.05)。(3)與梗阻性HCM患者相比,非梗阻性HCM患者的左心室節(jié)段性心肌應(yīng)變力,即左心室m CS及m RS顯著降低(均P0.05),且2組均低于正常組(均P0.05)。非梗阻性HCM患者左心室中段心肌徑向最大位移顯著低于梗阻性HCM患者及正常組(均P0.05),梗阻性HCM患者與正常組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論·在LVEF保留情況下,非梗阻性HCM患者左心室壁應(yīng)變力較梗阻性HCM患者顯著降低,可能是導(dǎo)致2種類型HCM患者臨床預(yù)后不同的原因,提示在評(píng)價(jià)HCM心肌做功方面,心室室壁應(yīng)變力較射血分?jǐn)?shù)更敏感。
[Abstract]:Objective to investigate the changes and differences of left ventricular strain in patients with obstructive and non obstructive hypertrophic cardiomyopathy (HCM). Methods the left ventricular ejection fraction (LVEF50%) HCM (18 obstructive, 30 non-obstructive) and 25 normal controls were examined by (MRI) scanning with cardiac magnetic resonance imaging (MRI) in 48 patients with sequential left ventricular ejection fraction retention (LVEF50%). Measurement and comparison of left ventricular global longitudinal strain (GLS), radial strain (GRS) and circumferential strain (GCS), and LVEF, left ventricular end-diastolic volume (LVEDV), left ventricular mass (LVM), left ventricular end-diastolic volume index (LVEDVI), Left ventricular mass index (LVMI).) Radial strain (m RS), circumferential strain (m CS) and radial maximum displacement were measured according to the American Heart Association 17 segment rule. Results (1) the LVEF of obstructive HCM patients was significantly higher than that of non-obstructive HCM patients and normal controls (P0.05). The LVM and LVMI of HCM patients in both groups were significantly higher than those in normal controls (P0.01). (2), and those in obstructive HCM patients were significantly higher than those in obstructive HCM patients. The global strain parameters (GLS,GRS,GCS) of left ventricle in patients with non-obstructive HCM were significantly decreased (P0.05), and the two groups were lower than the normal group (P0.05). (3). The left ventricular segmental strain, that is, left ventricular m CS and m RS in patients with non-obstructive HCM was significantly decreased (P0.05), and both groups were lower than normal group (P0.05). The maximum radial displacement of left ventricular myocardium in patients with non-obstructive HCM was significantly lower than that in patients with obstructive HCM and normal controls (P0.05), but there was no significant difference between patients with obstructive HCM and normal controls (P0.05). Conclusion under the condition of LVEF retention, left ventricular wall strain in patients with non-obstructive HCM is significantly lower than that in patients with obstructive HCM, which may be the cause of the difference in clinical prognosis between the two types of HCM patients. Ventricular wall strain is more sensitive than ejection fraction.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院;上海交通大學(xué)附屬第六人民醫(yī)院心臟中心;
【基金】：上海市衛(wèi)生局科研課題計(jì)劃項(xiàng)目(20134105)~~
【分類號(hào)】：R542.2

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