南方医科大学学报

南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (01): 8-.

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实时三维超声评价肥厚型心肌病舒张失同步性及舒张功能

赵蓓，李娟，朱伟红，徐勇，周肖，智光   

  • 出版日期:2013-01-20 发布日期:2013-01-20

Real-time three-dimensional echocardiographic assessment of left ventricular diastolic dyssynchrony and dysfunction in hypertrophic cardiomyopathy

  • Online:2013-01-20 Published:2013-01-20

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摘要： 目的运用单心动周期实时三维超声评价肥厚型心肌病左室局部心肌的同步性及舒张功能。方法收集69例窦性心律且
左室射血分数≥45%的肥厚型心肌病患者及50例正常对照人群，应用二维及三维超声评估舒张功能。实时三维超声的主要评
估参数包括：舒张末球形指数（EDSI），舒张失同步指数（DDI），舒张离散差（DISPED）包括舒张晚期失同步指数（DDI-晚期），舒
张早期失同步指数（DDI-早期），舒张早期离散差（DISPED-早期），舒张晚期离散差（DISPED-晚期）。将患者按传统二维超声舒
张功能的分级标准分为3组：舒张功能轻度受损（23例）、舒张功能假性正常（37例）和舒张功能限制性充盈（9例）。结果DDI和
DISPED会随着舒张功能不全等级的升高而增加。在舒张晚期，DDI-晚期和DISPED-晚期在舒张功能严重不全（限制性充盈）
中才表现出异常升高（7.95±2.75，26.76±17.19，P<0.0001），而在轻度（轻度受损）及中度（假性正常）组中均与正常对照组无差
异。但在舒张早期，DDI-早期和DISPED-早期在轻度（8.57±2.24，25.44±6.31）及中度舒张功能不全（9.56±4.66，35.42±14.19）中
均已明显高于正常组（P<0.0001）。结论肥厚型心肌病舒张早期的失同步性比晚期更为明显，并且与整体舒张功能不全的关系
更为密切。这种早期的临床损伤可以通过实时三维超声来评估。

Abstract: Objective To assess left ventricular (LV) regional diastolic function in patients with hypertrophic cardiomyopathy
(HCM) using single-beat real-time three-dimensional echocardiography (RT-3DE). Methods Sixty-nine patients with HCM (LV
ejection fraction≥45%) and 50 normal control subjects underwent examinations by two-dimensional echocardiography (2DE)
and RT-3DE. The parameters analyzed by RT-3DE included the end diastolic sphericity index (EDSI), diastolic dyssynchrony
index (DDI), dispersion end diastole [DISPED, including late (DDI-late) and early (DDI-early) diastole, dispersion end diastole
(DISPED-late), and dispersion early diastole (DISPED-early)]. The patients were divided into 3 groups with impaired
relaxation (n=23), pseudonormal filling (n=37), and restrictive filling (n=9). Results DDI and DISPED increased with the
severity of diastolic dysfunction. In end diastole, DDI-late and DISPED-late were abnormal in cases with severe diastolic
dysfunction (7.95±2.75 and 26.76±17.19, respectively, P<0.0001) but normal in cases with mild diastolic dysfunction. In early
diastole, DDI-early and DISPED-early both increased in cases of mild (8.57±2.24 and 25.44±6.31, respectively, P<0.0001) and
moderate (9.56 ± 4.66 and 35.42 ± 14.19, respectively, P<0.0001) diastolic dysfunction. Conclusion In patients with HCM,
dyssynchrony in early diastole is more obvious than that in late diastole and shows also a stronger correlation with diastolic
dysfunction. This preclinical lesion can be detected by single-beat RT-3DE.