组织速度成像与应变率成像技术评价尿毒症患者左室舒张功能

目的:运用定量组织速度成像(QTVI)和应变率成像(SRI)技术定量分析尿毒症患者左室舒张功能,探讨两种技术在评价尿毒症患者心脏舒张功能中的价值及其左室舒张功能受损的可能机制。方法:尿毒症患者35例,对照组20例分别行常规超声心动图与彩色组织速度成像(TVI)检查。获取心尖四腔、两腔TVI图像,存盘,脱机分析左室后室间隔、侧壁、前壁、下壁基底部及中部心内膜下心肌节段QTVI及SRI曲线。QTVI测量参数:①舒张早期峰值速度(Ve);②舒张晚期峰值速度(Va);计算Ve/Va。SRI测量参数:①舒张早期峰值应变(SRe);②舒张晚期峰值应变(SRa);计算SRe/SRa。结果:根据常规超声心动图测得左室射血分数(EF),将尿毒症患者分为EF正常组与EF降低组;与对照组比较,尿毒症EF正常组及EF降低组左室壁Ve、Ve/Va及SRe、SRe/SRa均显著降低;尿毒症组左室壁Ve、SRe与收缩压、血浆甲状旁腺素(PTH)水平呈显著负相关。结论:QTVI和SRI技术可有效评价尿毒症患者舒张功能;尿毒症患者左室舒张功能异常可能与其血压增高及高血浆PTH水平有关。

Evaluation of Left Ventricular Diastolic Function in Patients with Uremia by Tissue Velocity Imaging and Strain Rate Imaging

Objective: To analyze left ventricular function in patients with uremia quantitatively by quantitative tissue velocity imaging (QTVI) and strain rate imaging (SRI). Methods: Conventional echocardiography and color tissue velocity imaging were performed in 35 patients with uremia and 20 controls. Four-chamber and 2-chamber apical views of TVI were stored. QTVI and SRI curves in basal and middle segments of post interventricular septal, laterior, anterior and inferior wall were analyzed. QTVI indices included: ① peak velocity in early diastole (Ve); ② peak velocity in late diastole (Va); ③ Ve/Va. SRI indices included: ① peak strain rate in early diastole (SRe); ② peak strain rate in late diastole (SRa); ③ SRe/SRa. Results: According to ejection fraction (EF) by conventional echocardiography, patients with uremia were divided into normal EF and decreased EF group. Compared with controls, Ve,Ve/Va and SRe,SRe/SRa of normal EF group and decreased EF group decreased significantly; Ve and SRe negatively correlated with systolic blood pressure (SBP) and plasma levels of parathyroid hormone (PTH). Conclusion: QTVI and SRI can evaluate left ventricular function in diastole of patients with uremia effectively. The abnomal left ventricular function in diastole maybe correlate with high SBP and PTH.