STI评价原发性高血压与尿毒症左室壁增厚患者的左室纵行心肌应变

目的:应用斑点追踪技术成像(speckle tracking imaging,STI)评价原发性高血压与尿毒症左室壁增厚患者的左室纵行心肌应变。方法:正常对照组20例,原发性高血压组40例,尿毒症组30例。常规心脏数据测量后,连接胸导联心电图,分别采集心尖位3个长轴切面的二维灰阶动态图,取3个连续稳定心动周期,脱机分析18个节段收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变,记录并比较各参数测值。结果:正常对照组左室各壁收缩期峰值应变自基底段至心尖段逐渐增加;同一室壁各节段心肌收缩期峰值应变达峰时间基本一致。原发性高血压组左室前间隔中间段、心尖段与后壁中间段、心尖段,后间隔基底段收缩期峰值应变降低,与正常对照组差异有统计学意义,余室壁收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变与正常对照组差异无统计学意义;同一室壁各节段心肌应变曲线紊乱,收缩期峰值应变达峰时间一致性差。尿毒症组左室各壁收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变明显降低,与另外2组相比差异均有统计学意义;同一室壁各节段心肌应变曲线紊乱,收缩期峰值应变达峰时间一致性差。结论:STI能准确、快速地测定原发性高血压和尿毒症左室壁增厚患者左室局部心肌收缩期峰值应变的减低,提示患者左室整体收缩功能正常情况下存在节段性收缩功能降低。

Evaluation of left ventricular longitudinal two-dimensional strain in patients with essential hypertension and uremia measured by speckle tracking echocardiography

Objeetive..To investigate the value of STI in quantifying regional myocardial strain in normal group,essential hypertension group and uremia group. Methods：Group A included twenty normal subjects, group B included thirty patients with essential hypertension,and group C included thirty patients with uremia.High frame rate two-dimensional images were recorded from the apical two-chamber view, three-chamber view and four-chamber view of the left ventricle （LV）. Peak systolic strain and global peak systolic strain of each view of eighteen segment were measured by automated functional imaging （AFI） software of 2-DSE. Compare all parameters. Results： Left ventricular two-dimensional longitudinal strain gradually increased from the base to apex in group A,S-Peak of every segments was consistent. Strains of middle and apical segments of anterior septum and posterior wall, strains of basal segment of posteriorseptum were lower in group B than those in group A,there were statistically differences （P〈0. 05） ;strains of other parameters, the average strain of the apical two-chamber view,the average strain of the apical three-chamber view, the average strain of the apical four-chamber view and the average strain of all apical view were lower in group B than those in group A,there were no statistically differences （P〉0.05）;S-Peak of every segments was not consistent;strains of all parameters,the average strain of the apical two-chamber view, the average strain of the apical three-chamber view,the average strain of the apical, four-chamber view and the average strain of all apical view were lower in group C than those in group A and group B. There were statistically differences （P〈0.05） ; S-Peak of every segment was not consistent. Conclusions： The early reduce of left ventricular regional myocardial strain could be detected rapidly and precisely by STI in essential hypertension group and uremia group.