超声心动图评价肥胖患者左心室收缩及舒张功能

目的应用超声心动图技术评价肥胖患者左心室收缩及舒张功能的改变，为临床及时诊治肥胖患者的心脏疾病提供帮助。方法应用常规超声心动图、组织多普勒以及三维斑点追踪技术（3D—STI）分别测量本院2012年3月-2013年7月132例肥胖患者（左心室射血分数≥50％）的左心室舒张、收缩功能，并进行比较分析。结果与对照组相比，肥胖组的左心房指数、左心室舒张末期内径指数、左心室收缩末期内径指数、二尖瓣口舒张晚期灌注峰值流速（A）、组织多普勒二尖瓣环舒张晚期峰值速度（A’）值升高；肥胖组的肺静脉收缩期峰值速度（S）、二尖瓣口舒张早期灌注峰值流速与二尖瓣口舒张晚期灌注峰值流速比值（E／A）、组织多普勒二尖瓣环舒张早期峰值速度与二尖瓣环舒张晚期峰值速度比值（E’／A’）降低；三维整体应变参数中，肥胖组的左心室质量、左心室整体径向收缩期峰值应变（global radial strain，GRS）升高，左心室整体圆周收缩期峰值应变（global circumferential strain，GCS）、左心室整体纵向收缩期峰值应变（global longitudinal strain，GLS）以及左心室整体面积收缩期峰值应变（global area strain，GAS）减低，两组间差异均有统计学意义（P〈0．001）；单变量线性回归分析，肥胖组S、GLS、GCS、GRS以及GAS与体质量指数（body mass index，BMI）有较好的相关性；Stepwise逐步回归分析发现GCS（P=0．002）与BMI相关性最强。结论3D—STI为临床评估肥胖患者左心室收缩功能提供新的敏感指标。

Echocardiography in assessment of left ventricular systolic and diastolic function in obesity patients

Objective To provide the evidence for the clinical diagnosis and treatment of heart disease in obesity patients by assessing their left ventricular systolic and diastolic function with echocardiography. Methods The left ventricle diastolic and systolic function in 132 obesity patients admitted to our hospital from March 2012 to July 2013 with their LVEF ≥ 50% measured by conventional echocardiography, tissue Doppler imaging and 3-dimensional speckle tracking imaging （3D-STI） were comparatively analyzed. Results The left atrium index（LAI）, left ventriclar end-diastolic diameter（LVEDd）, left ventriclar end-systolic diameter（LVESd）, peak perfusion velocity of mitral valve at late diastolic phase （A）, peak perfusion velocity of mitral annulus at late diastolic phase（A＇）, left ventricular mass （LVM） and global radial strain （GRS） were significantly higher, whereas the peak perfusion velocity of pulmonary vein at systolic phase （S）, the ratio of peak perfusion velocity in mitral valve at early and late diastolic phase （E/A）, the ratio of peak perfusion velocity in mitral annulus at early and late diastolic phase （E＇/A＇）, global circumferential strain （GCS）, global longitudinal strain （GLS） and global area strain （GAS） were significantly lower in obesity patients than in controls （P 〈 0.001）. Univariate linear regression analysis showed that S, GLS, GCS, GRS and GAS were related with BMI in obesity patients. Stepwise regression analysis revealed that GCS was closely related with BMI （P=0.002）. Conclusion 3D-STI can provide a new sensitive indicator for the clinical assessment of left ventricular systolic function in obese patients.