上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (07): 929-935.doi: 10.3969/j.issn.1674-8115.2020.07.011

• 论著·临床研究 • 上一篇    下一篇

儿童肥厚型心肌病患者左心室扭转功能及收缩同步性的变化

姜逊渭，孙兴华，张 晗，肖婷婷，张永为，谢利剑   

  1. 上海交通大学附属儿童医院心内科，上海 200062
  • 出版日期:2020-07-28 发布日期:2020-09-23
  • 通讯作者: 谢利剑，电子信箱：naijileix@aliyun.com。
  • 作者简介:姜逊渭（1987—），男，主治医师，硕士生；电子信箱：jiangxw@shchildren.com.cn。
  • 基金资助:
    上海交通大学医工交叉重点项目（YG2016ZD05，ZH2018ZDA26）；上海市科学技术委员会医学引导类科技支撑项目（18411965800）；上海交通大学医学院转化医学协同创新中心合作研究项目（TM201922）。

Change of left ventricular torsion function and systolic synchronization in children with hypertrophic cardiomyopathy

JIANG Xun-wei, SUN Xing-hua, ZHANG Han, XIAO Ting-ting, ZHANG Yong-wei, XIE Li-jian   

  1. Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
  • Online:2020-07-28 Published:2020-09-23
  • Supported by:
    Medical Engineering Cross Project of Shanghai Jiao Tong University (YG2016ZD05, ZH2018ZDA26); Science and Technology Support Project for Medical Guidance of Shanghai Science and Technology Commission (18411965800); Cooperative Research Project of Transformation Medicine Collaborative Innovation Center of Shanghai Jiao Tong University School of Medicine (TM201922).

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摘要： 目的·通过二维斑点追踪超声心动图技术（two-dimension speckle tracking image echocardiography，2D-STI）评价儿童肥厚型心肌病（hypertrophic cardiomyopathy，HCM）患者左心室扭转功能及收缩同步性，为临床早期患儿心功能评估提供理论基础。方法·选取上海交通大学附属儿童医院2018年10月—2019年3月确诊的29例HCM患儿，根据有无症状分为无症状组（17例）和有症状组（12例），同时选取30名正常儿童作为正常对照组。所有对象均行超声心动图检查，运用2D-STI采集左心室不同切面、节段及左心室整体扭转和收缩同步性的相关数据。结果·左心室应变分析显示，有症状组和无症状组的左心室纵向应变率较正常对照组显著下降（均P<0.05），径向及圆周应变率显著升高（均P<0.05）；有症状组6个切面的达峰时间最大差值显著高于正常对照组（P=0.000），而无症状组与正常对照组间差异无统计学意义。左心室扭转功能分析提示，与正常对照组相比，有症状组和无症状组左心室整体扭转角度峰值和扭转速度正向峰值显著升高（均P<0.05），标化达峰时间显著延长（均P<0.05），扭转速度负向峰值和解旋率显著降低（均P<0.05）。结论·儿童HCM患者的左心室扭转功能增强、舒张功能减弱，有症状患儿的左心室收缩同步性较差。

关键词: 肥厚型心肌病, 儿童, 二维斑点追踪超声心动图, 收缩同步性, 扭转功能

Abstract:

Objective · To assess left ventricular torsion function and systolic synchronization in children with hypertrophic cardiomyopathy (HCM) by using two-dimensional speckle tracking echocardiography (2D-STI), so as to provide theoretical basis for early clinical evaluation of cardiac function in children. Methods · Twenty-nine children with HCM in Shanghai Children’s Hospital, Shanghai Jiao Tong University from October 2018 to March 2019 were divided into two groups according to whether having clinical symptoms, i.e., asymptomatic HCM group (n=17) and symptomatic HCM group (n=12). Thirty normal children were also enrolled in the normal control group. All subjects underwent echocardiography, and the torsion-and strain-related data of the whole and different myocardial segments in the cardiac sections of left ventricle were obtained by 2D-STI. Results · Left ventricular strain analysis showed that the left ventricular longitudinal strains of both HCM groups decreased significantly compared with the normal control group (P<0.05), while the radial and circumferential strains increased significantly (P<0.05). The maximum difference of peak time in different segments on six cardiac sections in the symptomatic HCM group was significantly higher than that in the normal control group (P=0.000), while the difference between the asymptomatic HCM group and the normal control group was not significant. Left ventricular torsion function analysis showed that the global peak twists of left ventricle and positive peaks of rotation velocity in both HCM groups were significantly higher compared with the normal control group (P<0.05), standardized times to peak were longer (P<0.05), and negative peaks of rotation velocity and the untwisting rates were lower (P<0.05). Conclusion · In the children with HCM, the left ventricular torsion function is enhanced and diastolic function is weakened. In the symptomatic children, the left ventricular systolic synchrony is poor.

Key words: hypertrophic cardiomyopathy (HCM), children, two-dimensional speckle tracking echocardiography (2D-STI), systolic synchrony, torsional function

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