Frielingsdorf J, Franke A, Kühl H P, Rijcken E, Krebs W, Hess O M, Flachskampf F A, Hanrath P
Medical Clinic I, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany.
J Am Soc Echocardiogr. 1998 Aug;11(8):778-86. doi: 10.1016/s0894-7317(98)70052-5.
Assessment of regional left ventricular (LV) function in patients with asymmetric LV hypertrophy is difficult with two-dimensional echocardiography mainly because of factors such as LV geometry, structure, regional wall stress, and ischemia. Multiplane transesophageal echocardiography with three-dimensional reconstruction of cross-sectional images was used for quantitative evaluation of regional wall thickness and fractional thickening. Fifteen patients (56 +/- 13 years old) with hypertrophic cardiomyopathy (LV ejection fraction 71% +/- 4%), 15 (62 +/- 13 years) with hypertensive heart disease (ejection fraction 66% +/- 8%) and 15 (53 +/- 11 years) healthy control subjects (ejection fraction 61% +/- 5%) were included in the analysis. Regional function was studied in four parallel equidistant short-axis cross sections from base to apex of the reconstructed left ventricle. In 15 degree intervals, 24 wall thickness measurements in each cross section were made at end-diastole and end-systole after endocardial and epicardial border tracing. A total of 192 measurements were obtained in each patient, and absolute wall thickening and fractional thickening were calculated. Absolute and fractional wall thickening showed a significant inverse relation to end-diastolic wall thickness in all heart conditions (r = 0.71, p < 0.0001). Regions of normal wall thickness in diseased patients were not hyperdynamic when compared with normal control subjects. Significant impairment in fractional thickening at identical end-diastolic thickness was observed in the septum compared with the lateral free wall in both hypertrophic cardiomyopathy and hypertensive heart disease. Thus regional systolic function is inversely related to end-diastolic wall thickness. The decrease in regional systolic function with increasing LV hypertrophy was similar in idiopathic and hypertensive cardiomyopathy. In both types of hypertrophy, significant differences in systolic function were observed in septal and lateral wall segments of similar wall thickness. This indicates that factors other than end-diastolic wall thickness influence myocardial thickening in patients with hypertrophy and preserved global function.
对于非对称性左心室肥厚患者，二维超声心动图评估局部左心室（LV）功能存在困难，主要原因是左心室几何形态、结构、局部壁应力和缺血等因素。采用多平面经食管超声心动图结合横截面图像的三维重建技术对局部壁厚度和增厚分数进行定量评估。分析纳入了15例肥厚型心肌病患者（年龄56±13岁，左心室射血分数71%±4%）、15例高血压性心脏病患者（年龄62±13岁，射血分数66%±8%）和15例健康对照者（年龄53±11岁，射血分数61%±5%）。在重建左心室从心底到心尖的四个平行等距短轴横截面上研究局部功能。在心内膜和心外膜边界追踪后，在舒张末期和收缩末期以15度间隔在每个横截面上进行24次壁厚度测量。每位患者共获得192次测量值，并计算绝对壁增厚和增厚分数。在所有心脏状况下，绝对壁增厚和增厚分数与舒张末期壁厚度均呈显著负相关（r = 0.71，p < 0.0001）。与正常对照者相比，患病患者中壁厚度正常的区域并无高动力表现。在肥厚型心肌病和高血压性心脏病中，与外侧游离壁相比，在相同舒张末期厚度时，室间隔的增厚分数均出现显著受损。因此，局部收缩功能与舒张末期壁厚度呈负相关。特发性和高血压性心肌病中，随着左心室肥厚增加，局部收缩功能的降低情况相似。在两种类型的肥厚中，在壁厚度相似的室间隔和侧壁节段观察到收缩功能存在显著差异。这表明，在肥厚且整体功能保留的患者中，除舒张末期壁厚度外，其他因素也会影响心肌增厚。
