Liu Wen, Zhang Yanfen, Liu Yan, Ma Chunyan, Yang Jun, Sun Dandan
Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang, 110001, China.
Int J Cardiovasc Imaging. 2020 Nov;36(11):2129-2137. doi: 10.1007/s10554-020-01921-6. Epub 2020 Jun 29.
We conducted this study to investigate left ventricle (LV) systolic function in endocardial, mid-myocardial, and epicardial layers by two-dimensional (2D) speckle tracking echocardiography (STE) in hypertrophic cardiomyopathy (HCM) patients with myocardial injury indexed by elevated serum cardiac troponin I (cTnI). Twenty-nine HCM patients with myocardial injury, thirty-five HCM patients without myocardial injury, and ninty-one healthy controls were enrolled in this study. Serum cTnI > 0.026 ng/mL was defined as myocardial injury. LV longitudinal and circumferential strain (LS and CS) were assessed in endocardial, mid-myocardial and epicardial layers. Layer-specific LS and CS differed significantly (all P < 0.001) among all three groups in all three layers, in a descending order from healthy controls to HCM patients without myocardial injury to HCM patients with myocardial injury. Layer-specific LS and CS were decreased the most in HCM patients with myocardial injury indexed by elevated seum cTnI (all P < 0.05). In HCM patients with myocardial injury, layer-specific LS and CS were significantly lower in the segments with greater hypertrophy (segmental thickness ≥ 15 mm) (all P < 0.001) except for endocardial CS (P > 0.05). Layer-specific evaluation of LV strain may improve understanding of impaired LV systolic function in HCM patients with myocardial injury, thus preventing further damage.
我们开展这项研究，旨在通过二维（2D）斑点追踪超声心动图（STE），对血清心肌肌钙蛋白I（cTnI）升高所指示的心肌损伤的肥厚型心肌病（HCM）患者的心内膜、心肌中层和心外膜层的左心室（LV）收缩功能进行研究。本研究纳入了29例有心肌损伤的HCM患者、35例无心肌损伤的HCM患者和91例健康对照者。血清cTnI > 0.026 ng/mL被定义为心肌损伤。在心内膜、心肌中层和心外膜层评估左心室纵向和圆周应变（LS和CS）。在所有三层中，所有三组之间的层特异性LS和CS均存在显著差异（均P < 0.001），从健康对照者到无心肌损伤的HCM患者再到有心肌损伤的HCM患者，呈递减顺序。血清cTnI升高所指示的有心肌损伤的HCM患者的层特异性LS和CS下降最为明显（均P < 0.05）。在有心肌损伤的HCM患者中，除心内膜CS外（P > 0.05），肥厚程度较高（节段厚度≥15 mm）的节段的层特异性LS和CS显著较低（均P < 0.001）。对左心室应变进行层特异性评估可能有助于更好地理解有心肌损伤的HCM患者左心室收缩功能受损情况，从而预防进一步损伤。
