肥厚型心肌病左房收缩和舒张功能的组织速度成像研究

目的：应用超声组织速度显像（TVI）技术对肥厚型心肌病患者左房的局部收缩和舒张功能变化进行初步探讨。方法：选择25例肥厚型心肌病患者（HCM组）与30例正常对照者（Nor组），应用TVI技术分别测量长轴方向左房各壁基段、中段和尖段的收缩期峰值速度（Vs）、舒张期峰值速度（Va）。同时测量左房前后径（LAD）、室间隔（IVS）、左室后壁（LVPW）、二尖瓣口舒张早期峰值流速（E）、舒张晚期峰值流速（A）、肺静脉收缩期峰值流速（S）、舒张期峰值流速（D）和心房收缩期肺静脉反向血流速度（AR）及其持续时间。启动定量分析软件程序，用Simpson法测量左房射血分数（LAEF）。结果：HCM组室间隔明显厚于Nor组（P〈0．05），左房前后径明显大于Nor组（P〈0．05），LAEF较Nor组降低（P〈0．05）；HCM组左房各壁各节段心肌的Vs和Vd均低于Nor组（P〈0．05）；HCM组肺静脉频谱S和D峰值血流速度均大于Nor组（P〈0．05），S和D峰值持续时间长于Nor组（P〈0．05），AR峰值血流速度和持续时间与Nor组相应测值无明显差异；HCM组左房中段Vd与S峰值血流速度呈直线负相关（r=-0．88，P〈0．001），与S峰持续时间呈直线正相关（r=0．86，P〈0．000）。结论：肥厚型心肌病患者左房长轴方向上舒缩功能均受损，且左房舒缩功能受损可导致肺静脉收缩和舒张峰流速和持续时间的改变。

Evaluation left atrial systolic and diastolic function of hypertrophic cardiomyopathy by tissue velocity imaging

Objective: To evaluate left atrial systolic and diastolic function of hypertrophic cardiomyopathy by tissue velocity imaging(TVI).Methods: TVI data were recorded in twenty five HCM patients and thirty healthy subjects in long axis for the basic,middle,apical segment of lateral, anterior and inferior LA walls.The TVI during the contractile and diastolic LA phases were measured.To measure left atrial dimension(LAD),interventricular septum(IVS),posterior wall of left ventricular(LVPW),peak velocity ratio of the early filling wave(E),atrial contraction wave(A),pulmonary venous systolic flow(S),pulmonary venous diastolic flow(D),reversal pulmonary venous flow at atrial contraction(AR) and the duration time.Results: The IVS was thicker in HCM patients than in Nor group(P<0.05),LAD was larger in HCM patients than in Nor group(P<0.05),LAEF was lower in HCM patients than in Nor group(P<0.05).The TVI data during contractile and diastolic phases in basic,middle,apical segment of lateral,anterior and inferior LA wall were lower in HCM patients than those in Nor group(P<0.05).The peak velocity of S,D was higher in HCM patients than that in Nor group(P<0.05).The duration of S,D was longer in HCM patients than that in Nor group(P<0.05).The peak velocity and duration of AR in HCM as well as in Nor group were similar.The LA wall TVI data of diastolic period in HCM showed negative correlation with peak velocity of S(r=-0.88,P<0.000),showed positive correlation with duration of S(r=0.86,P<0.000).Conclusions: Our data suggest that systolic as well as diastolic dysfunction in HCM patients,the dysfunction in HCM patients can also change peak velocity and duration of systolic,diastolic and pulmonary venous flow.