使用组织多普勒成像检测肥厚型心肌病患者左心室局部舒张异常和不同步性。

Detection of left ventricular regional relaxation abnormalities and asynchrony in patients with hypertrophic cardiomyopathy with the use of tissue Doppler imaging.

作者信息

Oki T, Mishiro Y, Yamada H, Onose Y, Matsuoka M, Wakatsuki T, Tabata T, Ito S

机构信息

Second Department of Internal Medicine, School of Medicine, the University of Tokushima, Japan.

出版信息

Am Heart J. 2000 Mar;139(3):497-502. doi: 10.1016/s0002-8703(00)90094-2.

DOI:10.1016/s0002-8703(00)90094-2

PMID:10689265

Abstract

BACKGROUND

It is well known that the distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with hypertrophic cardiomyopathy (HCM), which results in regional heterogeneity of LV early diastolic function. The advent of tissue Doppler imaging (TDI) has allowed the noninvasive evaluation of regional LV wall motion velocities. The aim of this study was to evaluate regional LV relaxation abnormalities and asynchrony noninvasively in patients with HCM by using pulsed and color-coded TDI.

METHODS AND RESULTS

We studied 20 patients with asymmetric septal hypertrophy (HCM group) and 18 age-matched normal patients (control group). The peak early diastolic motion velocity (Ew) and time from the aortic component of the second heart sound to the peak of the Ew (II(A)-Ew) were measured by pulsed TDI. The myocardial velocity gradient during early diastole (MVG-Ew) also was measured by color-coded TDI. Mean values for these parameters were determined on the basis of measurements made at 2 sites of the ventricular septum or posterior wall at the levels of chordae tendineae and papillary muscles. The mean Ew and mean MVG-Ew for the ventricular septum and posterior wall were significantly lower, and mean II(A)-Ew was significantly prolonged in the HCM group compared with the control group. This difference was most pronounced in the hypertrophied ventricular septum of the HCM group. The standard deviations of II(A)-Ew for the ventricular septum and posterior wall were significantly greater in the HCM group than in the control group. The time constant of LV pressure decay during isovolumic diastole (tau) correlated inversely with Ew and MVG-Ew and correlated directly with II(A)-Ew. Furthermore, tau correlated directly with the standard deviation of the II(A)-Ew.

CONCLUSIONS

LV early diastolic function in patients with HCM may be mediated by an augmentation of regional LV relaxation abnormalities and asynchrony.

摘要

背景

众所周知，肥厚型心肌病（HCM）患者左心室（LV）肥厚的分布和程度并不均匀，这导致左心室舒张早期功能存在区域异质性。组织多普勒成像（TDI）的出现使得对左心室壁区域运动速度进行无创评估成为可能。本研究的目的是通过使用脉冲和彩色编码TDI对HCM患者左心室舒张异常和不同步性进行无创评估。

方法与结果

我们研究了20例不对称性室间隔肥厚患者（HCM组）和18例年龄匹配的正常患者（对照组）。通过脉冲TDI测量舒张早期峰值运动速度（Ew）以及从第二心音主动脉成分到Ew峰值的时间（II(A)-Ew）。舒张早期心肌速度梯度（MVG-Ew）也通过彩色编码TDI进行测量。这些参数的平均值是根据在腱索和乳头肌水平的室间隔或后壁两个部位的测量值确定的。与对照组相比，HCM组室间隔和后壁的平均Ew和平均MVG-Ew显著降低，平均II(A)-Ew显著延长。这种差异在HCM组肥厚的室间隔中最为明显。HCM组室间隔和后壁II(A)-Ew的标准差显著大于对照组。等容舒张期左心室压力衰减的时间常数（tau）与Ew和MVG-Ew呈负相关，与II(A)-Ew呈正相关。此外，tau与II(A)-Ew的标准差呈正相关。