二维斑点追踪成像技术评价舒张性心力衰竭患者左心室局部收缩功能

目的应用二维斑点追踪成像技术评价舒张性心力衰竭患者左心室局部心肌收缩功能.资料与方法应用二维超声心动图分别对临床确诊的射血分数正常的32例舒张性心力衰竭患者、20例收缩性心力衰竭患者及32名正常受检者进行检查,存储胸骨旁左心室短轴二尖瓣水平、乳头肌水平及心尖水平连续3个心动周期的二维灰阶图像进行斑点追踪分析,记录左心室上述3个短轴切面共18个节段径向收缩期峰值应变率.结果左心室舒张性心力衰竭及收缩性心力衰竭患者各节段径向应变率曲线形态与正常受检者相似,且舒张性心力衰竭患者同一水平不同节段间径向收缩期峰值应变率差异无统计学意义(P>0.05).但舒张性心力衰竭患者所有节段径向收缩期峰值应变率均较正常受检者相应室壁节段减低,其中部分节段差异有统计学意义(P<0.05).而收缩性心力衰竭患者所有节段径向收缩期峰值应变率均显著低于正常受检者及舒张性心力衰竭患者(P<0.05).结论左心室舒张性心力衰竭患者存在节段性室壁径向应变率减低,提示射血分数正常的舒张性心力衰竭患者存在局部收缩功能受损.

Evaluation of Left Ventricular Regional Systolic Function in Diastolic Heart Failure Patients by Two-dimensional Speckle Tracking Imaging

Purpose To observe the left ventricular (LV) twist and segment peak systolic radial strain rate (SRr) by two-dimensional speckle tracking imaging (2D-STI), and to evaluate the systolic function in diastolic heart failure (DHF) patients with a normal left ventricular ejection fraction. Materials and Methods Eighty-four consecutive clinically stable patients were enrolled in this study (32 healthy controls, 32 patients with diastolic heart failure, and 20 patients with systolic heart failure). High frame rate dynamic two-dimensional images were obtained from the left ventricular short-axis views, including basal, papillary muscle and apical planes. Segmental SRr was measured. Results ① The curve character of SRr of all the patients was similar to that of the healthy controls. ② There was no significant difference in SRr between different segments at the same level in both DHF patients and healthy subjects. ③ All segments SRr were lower in both heart failure groups than in controls. Several segments SRr were decreased to a larger extent in DHF patients, and all segments SRr of SHF patients were reduced significantly than that of DHF patients. Conclusion All segments SRr are reduced in SHF patients. Segmental LV SRr is reduced in the DHF patients, even in the patients with normal ejection fraction, which means the systolic function of DHF patients is impaired.