心肌肥厚性疾病患者左心室扭转与心肌纤维化的相关性研究

目的应用三维超声斑点追踪成像技术分析心肌肥厚性疾病患者左心室扭转与心肌纤维化程度的相关性。 方法收集2017年7月至2019年2月在哈尔滨医科大学附属第四医院行心脏超声及心脏磁共振（CMR）检查的心肌肥厚性疾病患者31例，根据CMR钆造影剂延迟强化阳性与否诊断患者是否存在心肌纤维化，并将患者分为心肌纤维化组20例，无心肌纤维化组11例。另选取健康体检者35例作为对照组。应用三维斑点追踪成像技术测量左心室基底段、中间段、心尖段旋转角度峰值，左心室整体扭力及左心室扭转角度峰值。比较心肌肥厚性疾病患者与健康对照组的常规二维超声参数，以及心肌肥厚性疾病心肌纤维化组、无心肌纤维化组与健康对照组的左心室旋转、扭转参数。分析左心室扭转角度峰值与钆造影剂延迟强化阳性心肌/左心室心肌质量比值的相关性。 结果与健康对照组比较，心肌肥厚性疾病无心肌纤维化组及心肌纤维化组的左心室基底段、中间段、心尖段旋转角度峰值及左心室扭转角度峰值均明显升高（无心肌纤维化组：t=4.45、7.51、-5.45、-6.79，心肌纤维化组：t=-5.53、-9.84、-5.82、-9.45；P均<0.01）；心肌肥厚性疾病心肌纤维化组左心室心尖段旋转角度峰值及左心室扭转角度峰值较无心肌纤维化组明显升高（t=-2.71、2.36，P均<0.05）。心肌肥厚性疾病患者左心室扭转角度峰值与钆造影剂延迟强化阳性心肌/左心室心肌质量比值呈正相关（r=0.58，P=0.001）。 结论三维斑点追踪技术可有效评估心肌肥厚性疾病患者左心室扭转及旋转，左心室整体扭转角度峰值与左心室心肌纤维化呈正相关，三维斑点追踪技术可为临床检测心肌肥厚患者心肌纤维化提供新的方法和选择。

Relationship between left ventricular twist and myocardial fibrosis in patients with myocardial hypertrophy

ObjectiveTo analyze the relationship between left ventricular twist and myocardial fibrosis in patients with myocardial hypertrophy by three-dimensional ultrasound speckle tracking imaging. MethodsFrom July 2017 to February 2019, 31 patients with myocardial hypertrophy who underwent echocardiography and myocardial magnetic resonance (CMR) examinations at the Fourth Affiliated Hospital of Harbin Medical University were included. According to the late gadolinium enhancement (LGE) on CMR, which can be used to diagnose myocardial fibrosis, the patients were divided into a myocardial hypertrophy with myocardial fibrosis group (n=20), and a myocardial hypertrophy without myocardial fibrosis (n=11). Thirty-five healthy volunteers were also included as a control group. Three-dimensional speckle tracking imaging was used to measure the parameters of left ventricular rotation and torsion, including left ventricular peak rotation on basal plane (LV Prot-base), left ventricular peak rotation on middle plane (LV Prot-mid), left ventricular peak rotation on apical plane (LV Prot-ap), left ventricular torsion (Lvt), and left ventricular peak twist angle (LV Ptw). The conventional two-dimensional ultrasound parameters and the parameters of left ventricular rotation and torsion were compared among the three groups. The relationship between LV Ptw and LGE positive myocardium/left ventricular myocardial weight was analyzed by spearman correlation analysis. ResultsCompared with the control group, the LV Prot-base, LV Prot-mid, LV Prot-ap, and LV Ptw were significantly increased in both the myocardial hypertrophy with and without fibrosis groups (without fibrosis group: t=4.45, 7.51, -5.45, and -6.79, respectively; with fibrosis group: t=-5.53, -9.84, -5.82, and -9.45, respectively; P<0.01). The LV Prot-ap and LV Ptw in the myocardial hypertrophy with fibrosis group were significantly higher than those of the myocardial hypertrophy without fibrosis group (t=-2.71 and 2.36, respectively; P<0.05). The LV Ptw was positively correlated with LGE myocardium/left ventricular myocardial weight (r=0.58, P=0.001). ConclusionThree-dimesional speckle tracking technology can effectively evaluate left ventricular rotation and twist in patients with myocardial hypertrophy. The LV Ptw is positively correlated with the extent of myocardial fibrosis and this might provide a new method or choice for detecting myocardial fibrosis in patients with myocardial hypertrophy.