实时心肌造影评价肥厚型心肌病患者心内膜下及心外膜下心肌灌注

目的应用实时心肌超声造影分析肥厚型心肌病（HCM）患者心内膜下及心外膜下心肌灌注状况，及其与室壁肥厚程度的关系，以评价肥厚型心肌病患者心肌微循环障碍。方法HCM患者26例，正常对照组20例，实时心肌超声造影观察心尖四腔、两腔、左心长轴切面实时动态图像，应用时间～强度曲线分析造影图像。结果HCM患者左室肥厚节段及非肥厚心肌节段的心内膜下及心外膜下心肌的A及A×k值低于对照组（P〈0．05），k值高于对照组（P〈0．001）。HCM患者左室肥厚节段心内膜下及心外膜下心肌的的A及A×k值低于非肥厚心肌节段（P〈0．05），k值高于非肥厚心肌节段（P〈0．05）。HCM患者心内膜下A、及A×k值低于下心外膜下（P〈0．001）。HCM患者肥厚节段心内膜下及心外膜下心肌A×k值与肥厚节段室壁厚度均呈负相关（r=-0．785，P〈0．001；r=-0．461，P〈0．05）。结论HCM患者肥厚节段与非肥厚节段的心内膜下及心外膜下心肌均存在微循环障碍，且以心内膜下心肌微循环损伤更为显著，同时，随着室壁厚度的增加，心肌血流灌注显著减少。实时心肌超声造影是评价HCM患者心肌微循环障碍的有效方法。

Evaluation of epicardial and endocardial myocardial perfusion in patients with hypertrophic cardiomyopathy by real-time myocardial contrast echocardiography

Objective To analyze the epicardial and endocardial myocardial perfusion in patients with hypertrophic cardiomyopathy （HCM） by real -time myocardial contrast echocardiography （MCE）, and to evaluate their myocardial microcirculation disturbance. Methods Twenty-six patients with HCM and 20 contrast subjects were enrolled in this study. Real time MCE was performed by SonovVue injection via ulnar vein. The real time dynamic images of apical four-chamber, two-chamber and left ventricnlar long-axis views in 5 cardiac cycles before flash and 15 cardiac cycles after flash were recorded, the results were analyzed by time-intensity curves. Results A and A x K of epieardial and endocardial myocardium in HCN patients with left ventricular hypertrophic segments or without hypertrophic myocardial segments were obviously lower than those in control group （ P 〈 0.05 ） , k of epicardial and endocardial myocardinm in HCN patients with left ventricular hypertrophic segments or without hypertrophic myocardial segments was obviously higher than that in control group （ P 〈 0. 001 ）. A and A x K of epicardial and endoeardial myocardium in HCN patients with left ventrieular hypertrophic segments were obviously lower than those in non - hypertrophic myocardial segments （P 〈 0.05）. K of epicardial and endocardial myoeardium in HCN patients with left ventricular hypertrophic segments was obviously higher than that in non - hypertrophic myocardial segments （ P 〈 0.05 ）. A and A x k of epicardium in HCM patients were obviously lower than those of endocardium （ P 〈 0. 001 ）. There was negative correlation between A and A x K of epieardial and endocardial myocardium and ventricular wall thickness of hypertrophic segments in HCM patients （ r = - 0.451 ,P 〈 0.05 ; r = - 0.785, P 〈 0. 001 ）. Conclusion Microcirculation disturbance exists in epicardial and eudocardial myocardium of hypertrophic segments and non-hypertrophic segments in HCM patients, and with the development of ventrieular thickness, my