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目的探讨应用定量组织速度成像技术(QTVI)评价肥厚型心肌病(HCM)患者左心室非同步舒张运动的意义。方法获取15例非梗阻性HCM(HCM)患者、12例梗阻性HCM(HOCM)患者及14例正常人的标准心尖部左室长轴、两腔和四腔观组织速度图像,离线分析左心室6个壁基底段、中间段和心尖段共18个位点及左心室各壁二尖瓣环的组织速度曲线,测量心电图QRS波起始点至各位点心肌舒张早期峰值速度(Ea)的时限(TQ-E)。计算同一节段6个壁间TQ-E的最大差值(Inter-ΔTQ-E)、同一壁内3个节段间TQ-E的最大差值(Intra-ΔTQ-E)及左心室18个位点间TQ-E的最大差值(Max-ΔTQ-E)。计算左心室各壁二尖瓣环Ea与舒张晚期峰值速度(Aa)比值的平均值(Ea/Aa′)。并测定室间隔基底段厚度(IVSTh)与左心室流出道压力阶差(LVOTPG)。结果与正常人相比,HCM和HOCM患者的Inter-ΔTQ-E、Intra-ΔTQ-E、Max-ΔTQ-E均明显延长,Ea/Aa′明显降低;而HCM和HOCM患者之间Inter-ΔTQ-E、Intra-ΔTQ-E、Max-ΔTQ-E、Ea/Aa′无明显不同。IVSTh、LVOTPG在正常人、HCM和HOCM患者中依次递增。HCM和HOCM患者中,Max-ΔTQ-E与Ea/Aa′均呈显著负相关。HCM患者IVSTh、LVOTPG与Ea/Aa′未见明显相关,而HOCM患者IVSTh、LVOTPG与Ea/Aa′呈中度负相关。结论HCM患者左心室同一节段、同一壁内均存在非同步舒张运动,并且其是导致左心室舒张功能不全的必要因素,而IVSTh、LVOTPG则不是导致HCM患者左心室舒张功能不全的必要因素;HCM患者左心室不同步舒张运动可能在一定程度上反映了其心肌病变。
Objective To evaluate the value of quantitative tissue velocity imaging (QTVI) in the assessment of left ventricular nonsynchronized diastolic motion in patients with hypertrophic cardiomyopathy (HCM). Methods Standard apical left ventricular long axis, two-chamber and four-chamber view tissue velocity images were obtained from 15 patients with non-obstructive HCM (HCM), 12 patients with obstructive HCM (HOCM) and 14 normal controls. Left ventricular 6 basal segment, middle segment and apical segment of 18 sites and mitral annular tissue velocity curve of the left ventricular wall to measure the ECG QRS start point to each point of myocardial early diastolic peak velocity (Ea) of the time ( TQ-E). The maximum difference of TQ-E (Inter-ΔTQ-E), the maximum difference of TQ-E (Intra-ΔTQ-E) among the three segments in the same wall and the number of left ventricular Maximum difference between sites TQ-E (Max-ΔTQ-E). The mean (Ea / Aa ’) ratio of mitral annulus Ea to late diastolic peak velocity (Aa) was calculated for each wall of the left ventricle. The basal segment thickness of the interventricular septum (IVSTh) and left ventricular outflow tract pressure gradient (LVOTPG) were measured. Results Inter-ΔTQ-E, Intra-ΔTQ-E and Max-ΔTQ-E in HCM and HOCM patients were significantly prolonged and Ea / Aa ’significantly decreased compared with those in normal subjects. Inter-ΔTQ -E, Intra-ΔTQ-E, Max-ΔTQ-E, Ea / Aa ’are not significantly different. IVSTh, LVOTPG in normal, HCM and HOCM patients in increasing order. In HCM and HOCM patients, Max-ΔTQ-E and Ea / Aa ’showed significant negative correlation. No significant correlation was found between IVSTh, LVOTPG and Ea / Aa ’in HCM patients, while there was a moderate negative correlation between IVSTh, LVOTPG and Ea / Aa’ in HOCM patients. CONCLUSIONS: Non-synchronous diastolic motion is present in the same segment of the left ventricle and in the same wall in HCM patients, and is a necessary factor leading to left ventricular diastolic dysfunction. However, IVSTh and LVOTPG are not essential for left ventricular diastolic dysfunction in HCM patients. Left ventricular dyssynchrony in HCM patients may reflect its cardiomyopathy to a certain extent.