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目的应用超声二维应变成像技术评价孤立性左心室心肌致密化不全心肌病(IVNC)患者左心室局部心肌收缩功能。方法选择IVNC患者54例,根据患者左心室射血分数(LVEF)将其分为LVEF降低组(LVEF<50%,34例),LVEF正常组(LVEF≥50%,20例)。选择28名健康志愿者作为健康对照组。获取受试者左心室短轴二尖瓣、乳头肌及心尖水平及心尖位左心室长轴、心尖四腔、心尖两腔观二维图像,应用超声二维应变成像技术测量并记录各节段的圆周收缩期应变峰值(Sc)、径向收缩期应变峰值(Sr)及纵向收缩期应变峰值(ε)。结果 (1)健康对照组二尖瓣水平Sc、Sr及ε分别为-(18.11±6.02)%、(20.43±10.72)%、-(16.12±8.01)%,乳头肌水平分别为-(17.82±5.50)%、(25.33±11.32)%、-(17.41±6.52)%,心尖水平分别为-(18.33±5.61)%、(21.11±8.92)%、-(19.33±4.81)%;LVEF降低组IVNC患者二尖瓣水平Sc、Sr及ε分别为-(8.12±4.63)%、(6.81±4.90)%、-(7.10±4.72)%,乳头肌水平分别为-(6.72±4.11)%、(6.14±4.21)%、-(6.40±4.31)%,心尖水平分别为-(6.62±5.13)%、(5.61±3.92)%、-(7.22±4.93)%;LVEF值正常组IVNC患者二尖瓣水平Sc、Sr及ε分别为-(16.72±7.41)%、(19.41±8.32)%、(-14.33±6.21)%,乳头肌水平分别为-(15.31±4.42)%、(16.61±6.82)%、-(12.91±7.42)%,心尖水平分别为-(15.51±7.22)%、(12.03±8.81)%、-(13.71±6.81)%。LVEF降低组IVNC患者二尖瓣、乳头肌、心尖水平Sc、Sr及ε均较LVEF值正常组IVNC患者降低,且差异均有统计学意义(二尖瓣水平:q值分别为7.24、9.18、6.63,P均<0.05;乳头肌水平:q值分别为5.51、9.82、11.30,P均<0.05;心尖水平:q值分别为8.17、9.85、10.33,P均<0.05);LVEF降低组IVNC患者二尖瓣、乳头肌、心尖水平Sc、Sr及ε也均较健康对照组降低,差异也均有统计学意义(二尖瓣水平:q值分别为9.02、8.57、9.83,P均<0.05;乳头肌水平:q值分别为9.31、11.76、10.30,P均<0.05;心尖水平:q值分别为8.86、10.65、9.45,P均<0.05)。LVEF值正常组IVNC患者一般临床资料和常规超声心动图参数与健康对照组比较差异无统计学意义,但乳头肌、心尖水平Sr、Sc、ε均较健康对照组降低,差异均有统计学意义(乳头肌水平:q值分别为10.01、8.67、7.84,P均<0.05;q值分别为9.58、9.25、10.62,P均<0.05)。IVNC患者左心室受累节段数与LVEF呈负相关(r=-0.48,P<0.05),与左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)呈正相关(r值均为0.50,P均<0.05)。结论 IVNC部分患者虽然左心室整体收缩功能正常,但局部心肌收缩功能已发生改变,超声二维应变成像技术能敏感、准确地发现IVNC患者早期左心室心肌收缩功能受损。
Objective To evaluate the systolic function of left ventricular myocardium in patients with isolated left ventricular myocardium (IVNC) by two-dimensional ultrasound imaging. Methods Fifty-four patients with IVNC were selected and divided into LVEF (LVEF <50%, 34 cases) and normal LVEF group (LVEF≥50%, 20 cases) according to left ventricular ejection fraction (LVEF). 28 healthy volunteers were selected as healthy control group. Obtain the left ventricular short axis mitral valve, papillary muscle and apical level and apical long axis of the left ventricle, apical four-chamber, apical two-chamber view of two-dimensional images, the application of two-dimensional ultrasound imaging technology to measure and record the various segments (Sc), radial peak systolic strain (Sr) and longitudinal systolic peak strain (ε) were measured. Results The mitral levels Sc, Sr and ε were (18.11 ± 6.02)%, (20.43 ± 10.72)% and (16.12 ± 8.01)% respectively in the healthy control group and 17.82 ± (25.33 ± 11.32)% and (17.41 ± 6.52)%, respectively. The apex levels were (18.33 ± 5.61)%, (21.11 ± 8.92)%, and (19.33 ± 4.81)%, respectively The levels of mitral stenosis Sc, Sr and ε were - (8.12 ± 4.63)%, (6.81 ± 4.90)% and (7.10 ± 4.72)%, respectively. The levels of papillary muscles were (6.72 ± 4.11)% and (6.62 ± 5.13)%, (5.61 ± 3.92)% and (7.22 ± 4.93)%, respectively. The mitral valve levels in patients with normal LVEF Sc, Sr and ε were - (16.72 ± 7.41)%, (19.41 ± 8.32)% and (- 14.33 ± 6.21)%, respectively. The papillary muscle levels were (15.31 ± 4.42)% and (16.61 ± 6.82)%, - (12.91 ± 7.42)% and apex (-15.51 ± 7.22)%, (12.03 ± 8.81)% and (-13.71 ± 6.81)%, respectively. Mitochondria, papillary muscle and apical level of Sc, Sr and ε in IVC patients with LVEF decrease were lower than IVVC patients with normal LVEF, and the difference was statistically significant (mitral valve level: q = 7.24,9.18, 6.63, P <0.05; papillary muscle: q values were 5.51,9.82,11.30, P <0.05; apex level: q values were 8.17,9.85,10.33, P < Mitral valve, papillary muscle and apical level of Sc, Sr and ε also decreased compared with healthy control group, and the differences were also statistically significant (mitral valve level: q values were 9.02,8.57,9.83, P <0.05; Papillary muscle level: q values were 9.31,11.76,10.30, P <0.05; apical level: q values were 8.86,10.65,9.45, P <0.05). The normal clinical data and routine echocardiographic parameters of IVNC patients with normal LVEF value had no significant difference compared with healthy control group, but the papillary muscle and apical level of Sr, Sc, εwere lower than that of healthy control group, the differences were statistically significant (Papillary muscle: q values were 10.01,8.67,7.84, P <0.05; q values were 9.58,9.25,10.62, P <0.05). The number of left ventricular involvement in IVNC patients was negatively correlated with LVEF (r = -0.48, P <0.05), positively correlated with left ventricular end diastolic volume (EDV) and left ventricular end systolic volume (ESV) P <0.05). Conclusion Some patients with IVNC have normal left ventricular systolic function, but local myocardial systolic function has been changed. Ultrasound two-dimensional strain imaging can detect left ventricular systolic dysfunction in IVNC patients sensitively and accurately.