组织多普勒评价室壁肥厚与左室局部及整体舒张功能的关系

目的　应用脉冲组织多普勒( TDI)技术分析左室肥厚( L VH)患者局部室壁厚度、室壁不对称性与左室局部及整体舒张功能间的相关关系。方法　左室肥厚患者4 2例,包括肥厚型心肌病( HCM) 1 6例和高血压性心脏病( HHD)左室肥厚2 6例;正常对照( NC) 2 0例。二维超声测量并计算左室8个节段室壁厚度( r WT)、总厚度( t WT)及室壁不对称指数( CVw) ;TDI测量8个心肌节段的舒张期运动速度比( r E/ A)和等容舒张时间( r IVRT) ;另外分别应用TDI和脉冲波多普勒测量二尖瓣环和二尖瓣口的舒张期参数m E/ A、m IVRT和PVE/ PVE,IVRT作为整体舒张功能指标。结果　( 1 ) L VH者室壁总厚度及其不对称指数、局部等容舒张时间及其舒张不同步性均高于NC组;( 2 )室壁肥厚的程度及其不对称性与左室整体舒张功能相关( r值的绝对值0 .1 8～0 .4 1 ,P<0 .0 5 ) ;( 3 )局部r WT与r E/ A、r IVRT相关( r值- 0 .4 6 ,0 .4 1 ,P<0 .0 5 )。结论　肥厚型心肌病和高血压性心肌肥厚患者的局部室壁肥厚程度与左室局部舒张功能减低及等容舒张期延长有关;左室壁不对称性肥厚通过影响左室局部心肌早期舒张的速度和同步性间接导致左室整体早期充盈异常;TDI技术用于非创伤性评价左室局部及整体舒张功能有一定价值

TDI Evaluation of Regional and Global Relaxation Abnormalities in Patients with Left Ventricular Hypertrophy

Objective To evaluate the relationship between the degree and asymmetry of left ventricular myocardial hypertrophy(LVH)and regional/global diastolic abnormality in patients with left ventricular hypertrophy(LVH) by tissue Doppler imaging(TDI).Methods Totally 42 patients with LVH,including 16 with hypertrophic cardiomyopathy(HCM) and 26 with hypertensive heart disease(HHD)were studied,and 20 normal volunteers were as the control(NC).Regional wall thickness(rWT) were determined for the basal and mid ventricular segments of the left ventricle,and the total wall thickness(tWT) and asymmetry index were calculated;Regional diastolic myocardial velocity ratio(rE/A) and regional isovolumetric relaxation time (rIVRT) of each segments,and those of mitral ring were measured by TDI;PVE/PVA and IVRT of transmitral flow were also detected.Results (1) tWT and asymmetry index,rIVRT and asynchrony of left ventricle were increased in both HCM and HHD compared with those of NC.(2) Correlations were found between the tWT,asymmetry index and global relaxation parameters (r 0.18-0.41,P<0.05);(3) Correlations of rWT with decreased rE/A,and prolonged rIVRT were also found in patients with LVH (r-0.46,0.41,all P<0.05).Conclusions The rWT in LVH is associated with the decrease of regional diastolic velocity and increase of r IVRT.The asymmetry of myocardial hypertrophy is indirectly related to global early diastolic abnormality through regional asynchrony in LV relaxation.