斑点追踪显像技术评价生理性和病理性左室心肌肥厚的左心室功能

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[摘要] 目的 应用二维斑点追踪显像（2DSTI）技术评价生理性和病理性左心室心肌肥厚的左心室功能。 方法 高心组（50例），运动员组（25例）和对照组（25例）。应用STI技术测定左心室各壁基底段、中间段和心尖段收缩期峰值应变（Ss）和收缩期峰值应变率（SRs），并对结果进行分析。 结果 与对照组和运动员组比较，高心组Ss和SRs均显著降低（均P < 0.05），对照组和运动员组比较无显著性差异（P > 0.05）。 结论 STI技术可实时、准确地反映心肌收缩功能状况，并可对生理性肥厚心肌和高血压左心室肥厚进行鉴别。

[关键词] 二维斑点追踪；高血压；心肌肥厚；长轴应变；运动员心脏

[中图分类号] R540.45 [文献标识码] B [文章编号] 1673-7210（2012）08（b）-0102-03

Evaluationg of left ventricular function in physiological and pathological left ventricular myocardial hypertrophy by Speckle tracking imaging

TAN Wei1 DING Yan2 WANG Zhibin3 SUN Pin3 LE Jiafang1

1.Department of Ultrasound, Qingdao Municipal Hospital Affiliated to Medical College of Qingdao University, Shandong Province, Qingdao 266000, China; 2.Department of Ultrasound, Maternity and Child Health Care Institute of the North District in Qingdao, Shandong Province, Qingdao 266000, China; 3.Department of Cardiac Ultrasound, Affiliated Hospital of Medical College of Qingdao University, Shandong Province, Qingdao 266003, China

[Abstract] Objective To evaluate the left ventricular function of pathologic and physiologic left ventricular hypertrophy using two-dimensional speckle tracking imaging. Methods 50 cases of hypertension heart group, 25 cases of athlete group and 25 cases of the control group were selected, systolic peak strain (Ss), systolic peak strain rate (SRs) were measured at basal, middle and apical segments, and the results were analyzed. Results The Ss and SRs in hypertension heart group were all significantly lower than those of control group and athlete group (all P < 0.05). The difference of Ss and SRs between athlete group and control group was not statistically significant (P > 0.05). Conclusion STI can not only distinguish left ventricular hypertrophy in hypertension patients and physiologic hypertrophy in athletes but also assess the function of the left ventricle accurately.

[Key words] Speckle tracking imaging; Hypertension; Myocardial hypertrophy; Longitudinal strain; Athlete's heart

近年来，运动员猝死事件时有发生，数据显示，长期剧烈运动致心脏室壁增厚，即心肌生理性肥厚，是心肌的一种适应性表现；病理性左心室心肌肥厚是高血压病的并发症之一，并非有益的代偿机制，而可能是一种增加心血管意外发病率和死亡率的独立危险因子。二维斑点追踪显像（2DSTI）技术是在高帧频条件下识别和追踪心肌内部声学斑点，自动跟踪测量心肌的运动速度与应变。本研究通过比较高血压肥厚心肌与生理性肥厚心肌的长轴收缩期峰值应变（Ss）及应变率（SRs）的不同，对两者做出鉴别，现报道如下：

1 资料与方法

1.1 一般资料

健康志愿者（对照组）25例，男20例，女5例，年龄30～60岁，平均（48±8）岁。心肌肥厚的职业运动员（运动员组）25例，全部为男性，年龄25～40岁，平均（31±6）岁，平均职业运动年限7年，左室质量指数（LVMI）大于134 g/m2，排除有家族性高血压及肥厚型心肌病家族史。高血压左心室肥厚患者（高心组）为2009年10月～2012年3月住院或门诊患者，共50例，男28例，女22例，年龄33～48岁，平均（38±5）岁。病例入选标准：①高血压诊断按照1999年WHO/ISH标准；②无严重的心律失常，瓣膜疾病、扩张型心肌病、肥厚型心肌病及心力衰竭；③入选患者均停用降压药物至少2周，且心脏超声检查计算LVMI，男性＞ 134 g/m2，女性＞ 110 g/m2[1]。三组一般资料比较，差异无统计学意义（P > 0.05），具有可比性。