二维斑点追踪技术评价慢性肾病患者左心室扭转运动

目的运用二维斑点追踪技术（2D-STI）评价慢性肾病（CKD）患者的左心室旋转及扭转运动特征，并探讨左心室射血分数（LVEF）与左心室扭转运动的关系。 方法选取2013年9月至2014年3月华中科技大学同济医学院附属同济医院住院部CKD患者46例；同时选取经临床及超声检查证实无心肺疾病的健康志愿者30名为对照组。应用二维超声测量常规超声参数，Simpson双平面法测量左心室收缩末期容积（LVESV）、舒张末期容积（LVEDV）及LVEF，应用二维斑点追踪技术测量左心室旋转及扭转运动参数。采用Pearson相关法分析CKD患者左心室旋转、扭转运动参数与LVEF之间的相关性。 结果与健康对照组比较，CKD组患者左心室扭转角度峰值、心尖部旋转角度峰值降低，差异具有统计学意义（t=0.002、0.020，P均<0.05）。与对照组比较，CKD组基底部旋转角度峰值降低不明显，仅下壁、后间隔差异有统计学意义（t=0.044、0.041，P均<0.05）。Pearson相关分析表明CKD患者左心室整体扭转角度峰值与心尖部旋转角度峰值、LVEF之间具有良好的相关性（r=0.824，0.447，P均<0.01）。 结论2D-STI可分析左心室扭转运动特征，评价CKD患者左心收缩功能受损。

Assessment of left ventricular twist in patients with chronic kidney disease by two-dimensional speckle tracking echocardiography

ObjectiveTo analyze the characteristics of left ventricular (LV) twist and discuss the relationship between LV ejection fraction (LVEF) and LV twist in patients with chronic kidney disease (CKD) by two-dimensional speckle tracking imaging (2D-STI). MethodsForty-six patients with CKD and 30 healthy controls were enrolled in this study. After conventional echocardiography, LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) were measured by Biplane Simpson method and the LVEF was calculated. And relevant parameters of LV rotation and twist were measured by speckle tracking imaging. Correlation analysis of LVEDV, LVESV and LV peak rotation and twist were analyzed respectively. ResultsCompared with the control group, LV peak twist and the apical rotation were decreased in CKD patients, which was statistically significant (t=0.002 and 0.020, both P<0.05). The inferior wall and posterior intermediate septum of basal segment were significantly decreased (t=0.044 and 0.041, both P<0.05). Pearson correlation analysis revealed LV apical peak rotation had a relationship with LVEDV and LVESV (r= 0.355 and 0.409, both P<0.01). Conclusion2D-STI is an practical noninvasive method which can analyze LV twist accurately and recognize LV systolic dysfunction of CKD patients sensitively.