吴炜,张抒扬,方理刚,陈未

• 1:中国医学科学院北京协和医学院北京协和医院心内科

摘要(Abstract)：

目的比较左心室舒张功能评价指标在原发性肥厚型心肌病(HCM)及限制型心肌病(RCM)患者中的差异。方法连续入选在北京协和医院诊治的17例HCM患者与16例RCM患者,超声心动图测定左心室舒张末内径(LVEDd)、左心室射血分数(LVEF)、E峰减速时间(EDT)、组织多普勒二尖瓣环侧壁舒张早期峰值速度(lateral E')与二尖瓣血流E峰/E'(E/E')。比较两组患者各项指标的差异,同时分别在两组患者中进行EDT与E/E'的相关性分析。结果 HCM患者与RCM患者LVEDd比较[(45.2±3.7)mm比(42.9±3.8)mm,P=0.074],差异无统计学意义;LVEF显著高于RCM组[(72.9±7.2)%比(62.3±8.0)%,P<0.001];EDT较RCM组患者显著延长[(163.3±46.8)ms比(123.4±12.4)ms,P=0.002];二尖瓣环侧壁E'显著高于RCM组[(8.4±3.3)cm/s比6.0±2.0)cm/s,P=0.015];E/E'显著低于RCM组[(10.0±4.0)比(13.3±2.9),P=0.013]。在HCM患者中,EDT与E/E'呈正相关(P=0.029),而RCM患者中EDT与E/E'呈负相关趋势,但相关性未达到统计学意义(P=0.121)。结论 HCM与RCM患者均存在明显的左心室舒张功能异常,但RCM患者的左心室舒张功能受累程度及左心室僵硬程度显著高于HCM患者,HCM患者可能以通过延长EDT的方式来改善左心室充盈。

关键词(KeyWords)： 超声心动图;肥厚型心肌病;限制型心肌病;舒张功能异常

Abstract:

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基金项目(Foundation):

作者(Author): 吴炜,张抒扬,方理刚,陈未

参考文献(References)：

• [1]Maron BJ,Towbin JA,Thiene G,et al.Contemporary definitions and classification of the cardiomyopathies:an American Heart Association Scientific Statement from the Council on Clinical Cardiology,Heart Failure and Transplantation Committee;Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups;and Council on Epidemiologyand Prevention.Circulation,2006,113:1807-1816.
• [2]Weidemann F,Niemann M,Herrmann S,et al.Assessment of diastolic heart failure.Current role of echocardiography.Herz,2013,38:18-25.
• [3]Cheitlin MD,Armstrong WF,Aurigemma GP,et al.ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography--summary article:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(ACC/AHA/ASE Committee to Update the1997 Guidelines for the Clinical Application of Echocardiography).J Am Coll Cardiol,2003,42:954-970.
• [4]Ohno M,Cheng CP,Little WC.Mechanism of altered patterns of left ventricular filling during the development of congestive heart failure.Circulation,1994,89:2241-2250.
• [5]Oh JK.Seward JB,Tajik AJ.The Echo Manual(3rd edition).2007,Lippincott Williams&Wilkins.
• [6]Ommen SR,Nishimura RA,Appleton CP,et al.Clinical utility of Dopplerechocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures:A comparative simultaneous Doppler-catheterization study.Circulation,2000,102:1788-1794.
• [7]Meric M,Yesildag O,Yuksel S,et al.Tissue doppler myocardial performance index in patients with heart failure and its relationship with haemodynamic parameters.Int J Cardiovasc Imaging,2014,30:1057-1064.
• [8]Rivas-Gotz C,Manolios M,Thohan V,et al.Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity.Am J Cardiol,2003,91:780-784.
• [9]李成洋,李占全,石蕴琦,等.18岁以下肥厚型梗阻性心肌病患者化学消融的近期疗效与安全性探讨.中国介入心脏病学杂志,2013,21:97-99.
• [10]Nagueh SF,Appleton CP,Gillebert TC,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography.Eur J Echocardiogr,2009,10:165-193.