超声斑点追踪显像评价原发性高血压患者左室扭转及解旋运动
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摘要
目的
本研究应用超声斑点追踪显像探讨原发性高血压对左室扭转与解旋运动的影响,并进一步探索不同程度左室心肌肥厚(LVH)对扭转与解旋的影响。
方法
45例按照LVH程度分为三组的原发性高血压患者与20例正常人经胸采集4个心动周期标准左室短轴基底及心尖平面二维图像并存储,运用Echo PAC超声工作站进行脱机分析,获得以上两平面旋转角度-时间、旋转速度-时间曲线以及左室整体的扭转角度-时间、扭转速度-时间曲线。
结果
1、原发性高血压组与正常组相比舒张早期解旋程度与解旋率均显著减低(P<0.01),并且均与左室质量指数的增加相平行,标化达解旋峰速时间显著延迟(P<0.01),解旋速度峰值增大(P<0.05)。
2、原发性高血压组收缩期峰值扭转增强,但在不同程度的LVH患者中无统计学差异(P>0.05)。高血压组与正常组的左室扭转角度-时间、扭转速度-时间曲线走行趋势基本一致。
3、舒张早期左室解旋程度、解旋率、标化达解旋速度峰值时间与传统评价左室舒张功能参数相比可更敏感反映左室舒张早期舒张功能变化。
结论
原发性高血压患者左室舒张功能减低可能与舒张早期左室解旋减小及延迟有关。STI技术可作为无创性定量评价左室舒张功能的新工具。
Objective
To assess the left ventricular (LV) twist and untwist changes in patients with primary hypertension using speckle tracking imaging (STI) echocardiography, also to assess the LV twist and untwist changes in patients with different degrees of left ventricular hypertrophy (LVH) furtherly.
Methods
45 primary hypertension patiens groupeded into 3 groups accroding to different degrees of LVH were included and 20 healthy subjects were on control group. Clear two-dimensional images of the left ventricular short axis views at basal and apical levels were recorded in 4 continuous cardiac cycles. The images were analyzed by 2D-speckle tracking soft in Echo PAC workstation, we acquired rotation angle-time and rotation velocity-time curves of the above two planes and global LV twist angle-time and twist velocity-time curves.
Results
1. Untwisting early in diastole and untwisting rate were significantly reduced in parallel to increasing left ventricular mass index (LVMI) (P<0.01). The duration of normalized time-to-peak untwisting velocity (TPUV) was significantly prolonged (P< 0.01) and peak untwisting velocity (PUV) increased (P<0.05).
2. The peak systolic twist increased in hypertensive patients, but no inter-group differences were noted among patients with different degrees of LVH (P>0.05).The LV twist angle-time and twist velocity-time curves in hypertensive patients performs a similar courser tendency with healthy subjects.
3. The novel diastolic parameters derivatized from STI (including untwisting or untwisting rates during early diastole, standardized TPUV) were more sensitive than traditional diastolic parameters in reflexing changes of LV relaxation fuction during early diastole.
Conclusionsns
The reduced and delayed diastolic untwisting during the isovolumic relaxation period noted in essential hypertensive patients may contribute to the LV relaxation reduced. Speckle tracking imaging echocardiography is a novel tool which can be used for the non-invasive and quantitateive assessment of LV relaxation.
本研究应用超声斑点追踪显像探讨原发性高血压对左室扭转与解旋运动的影响,并进一步探索不同程度左室心肌肥厚(LVH)对扭转与解旋的影响。
方法
45例按照LVH程度分为三组的原发性高血压患者与20例正常人经胸采集4个心动周期标准左室短轴基底及心尖平面二维图像并存储,运用Echo PAC超声工作站进行脱机分析,获得以上两平面旋转角度-时间、旋转速度-时间曲线以及左室整体的扭转角度-时间、扭转速度-时间曲线。
结果
1、原发性高血压组与正常组相比舒张早期解旋程度与解旋率均显著减低(P<0.01),并且均与左室质量指数的增加相平行,标化达解旋峰速时间显著延迟(P<0.01),解旋速度峰值增大(P<0.05)。
2、原发性高血压组收缩期峰值扭转增强,但在不同程度的LVH患者中无统计学差异(P>0.05)。高血压组与正常组的左室扭转角度-时间、扭转速度-时间曲线走行趋势基本一致。
3、舒张早期左室解旋程度、解旋率、标化达解旋速度峰值时间与传统评价左室舒张功能参数相比可更敏感反映左室舒张早期舒张功能变化。
结论
原发性高血压患者左室舒张功能减低可能与舒张早期左室解旋减小及延迟有关。STI技术可作为无创性定量评价左室舒张功能的新工具。
Objective
To assess the left ventricular (LV) twist and untwist changes in patients with primary hypertension using speckle tracking imaging (STI) echocardiography, also to assess the LV twist and untwist changes in patients with different degrees of left ventricular hypertrophy (LVH) furtherly.
Methods
45 primary hypertension patiens groupeded into 3 groups accroding to different degrees of LVH were included and 20 healthy subjects were on control group. Clear two-dimensional images of the left ventricular short axis views at basal and apical levels were recorded in 4 continuous cardiac cycles. The images were analyzed by 2D-speckle tracking soft in Echo PAC workstation, we acquired rotation angle-time and rotation velocity-time curves of the above two planes and global LV twist angle-time and twist velocity-time curves.
Results
1. Untwisting early in diastole and untwisting rate were significantly reduced in parallel to increasing left ventricular mass index (LVMI) (P<0.01). The duration of normalized time-to-peak untwisting velocity (TPUV) was significantly prolonged (P< 0.01) and peak untwisting velocity (PUV) increased (P<0.05).
2. The peak systolic twist increased in hypertensive patients, but no inter-group differences were noted among patients with different degrees of LVH (P>0.05).The LV twist angle-time and twist velocity-time curves in hypertensive patients performs a similar courser tendency with healthy subjects.
3. The novel diastolic parameters derivatized from STI (including untwisting or untwisting rates during early diastole, standardized TPUV) were more sensitive than traditional diastolic parameters in reflexing changes of LV relaxation fuction during early diastole.
Conclusionsns
The reduced and delayed diastolic untwisting during the isovolumic relaxation period noted in essential hypertensive patients may contribute to the LV relaxation reduced. Speckle tracking imaging echocardiography is a novel tool which can be used for the non-invasive and quantitateive assessment of LV relaxation.
引文
1 Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure:an epidemiologic perspective. J am Coll Cariol.1995;26:1565-1574.
2 Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional strain a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr.2004;17(10):1021-1029.
3 Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertension:comparison to necropsy findings. Am J Cardiol.1986;57:450-458.
4 Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification:a report from the American Society of Echocardiography Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr.2005; 18:1440-1463.
5 Valle TH, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation speckle tracking echocardiography. Circulation.2005; 112 (20): 3149-3156.
6 Notomi Y, Lysyansky P, Setser RM, et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardio.2005;45(12):2034-2041.
7 M.Stuber, M.B.Scheidegger, S.E.Fischer,et al. Alterations in the local myocardial motion pattern in patients suffering from pressure overlode due to aortic stenosis. Circulation.1999; 100:361-368.
8 Ling Hui, James P, Edward H, et al. The Contribution of left ventricular muscle bands to left ventricular rotation:Assessment by a 2-dimensional speckle tracking method. J Am Soc Echocardiogr.2007;20(5):486-491.
9 Detsky ME, Azevedo ER, Parker JD. Left ventricular isovolumic relaxation is a predictor of left ventricular end-diastolic pressure. Can J Cardiol.2003;19:378-382.
10 M.Stuber, M.B.Scheidegger, S.E.Fischer,et al. Alterations in the local myocardial motion pattern in patients suffering from pressure overlode due to aortic stenosis. Circulation. 1999; 100:361-368.
11 Wachtell K, Smith G, Gerdts E, et al. Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy. Am J Cardiol.2000;85(4):466-472.
12 Dong S, Hees P, Hees P, et al. MRI assessment of LV relaxation by untwisting rate:a new isovolumic phase measure of tau. Am J Physiol Heart Circ Physiol.2001; 281:H 2002-2009.
13 Maceria AM, Barba J, Varo N, et al. Ultrasonic backscattter and serum marker of cardial fibrosis in hypertensives. Hypertension.2002;9:923-928.
14 Zile MR, Gaasch WH. Mechanical loads and the isovolumic filling indices of left ventricular relaxation. Prog Cardiovasc Dis.1990;32:333-346.
15 Masaaki T, William B, Hiromi N,et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy:a study using two-dimensional speckle tracking imaging. European Heart Journal.2007;28:2756-2762.
16 Simone GD, Greco R, Mureddu G, et al. Relation of left ventricular diastolic properties to systolic function in arterial hypertension. Circulation.2000;101(2):152-156.
17 Yuming Mu, Chuan Qin, Chunmei Wang, et al. Two-dimensional ultrasound speckle tracking imaging in evaluation of early changes in left ventricular diastolic function in patients with essential hypertension. Echocardiography.2010;27:146-154.
18 Bas M van Dalen, Floris Kauer, Michelle Michels, et al. Delayed Left Ventricular Untwisting in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr.2009;22:1320-1326.
1 Harada K, Komuro I, Shiojima I, et al. Pressure overload induces cardiac hypertrophy in angiotensin Ⅱ type-A receptor knockout mice. Circulation.1998; 97:1952-1959.
2 Greenberg NL, Firstenberg MS, Castro PL, et al. Doppler derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation.2002; 105(1):99-105.
3 Heimdal A, Stoylen A, Torp H, et al. Real-time strain rate imaging of the left ventricle by ultrasound. J Am Soc Echocardiogr.1998; 11(11):1013-1019.
4 Mirsky I, Parmley WW. Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res.1973; 33:233-243.
5 Toyoda T, Baba H, Akasaka T, et al. Assessment of regional myocardial strain by a novel automated tracking system from digital image files.J Am Soc Echocardiogr, 2004,17:1234-1238
6 Serri K, Reant P, Lafitte M, et al. Global and regional myocardial function quantification by two-dimensional strain application in hypertrophic cardiomyopathy. J Am Coll Cardio.2006; 47:1175-1181.
7 Langeland S, D'hooge J, Wouters PF, et al. Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle.Circulation.2005; 112:2157-2162.
8 Valle TH, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation speckle tracking echocardiography. Circulation.2005; 112(20):3149-3156.
9 Notomi Y, Lysyansky P, Setser RM, et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardio.2005; 45(12): 2034-2041.
10 Torrent-Guasp F, Ballester M, Buckberg GD, et al. Spatial orientation of the ventricular muscle band:physiologic contribution and surgical implications. Thorac Cardiovasc Surg.2001; 122(15):389-392.
11 Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr.2004; 17(10):1021-1029.
12 Stuber M, Scheidegger MB, Fischer SE, et al. Alterations in the Local myocardial motion pattern in patients suffering from pressure overload due to aortic stenosis.Circulation.1999; 100(4):361-368.
13 Kawagishi T. Speckle tracking for assessment of cardiac motion and dyssynchrony. Echocardiography.2008; 25:1167-1171.
14 王静,谢明星,韩伟等.超声二维斑点追踪成像评价原发3级高血压患者的左室扭转重构.中
15 Takeuchi M, Nakai H, Kokumai M, et al. Left ventricular untwisting was delayed and reduced in patients with hypertensive left ventricular hypertrophy:demonstration by 2-dimensional speckle tracking imaging. J Am Coll Cardiol.2006;47(4):98-102.
16 Yuming Mu, Chuan Qin, Chunmei Wang, et al. Two-dimensional ultrasound speckle tracking imaging in evaluation of early changes in left ventricular diastolic function in patients with essential hypertension. Echocardiography.2010;27:146-154.
17 Kim HK, Sohn DW, Lee SE, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr.2007; 20: 45-53.
18 Masaaki Takeuchi, William B. Borden, Hiromi Nakai, et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy:a study using two-dimensional speckle tracking imaging. European Heart Journal.2007; 28(3): 2756-2762.
19 韩伟,谢明星,王新房等.超声斑点追踪成像技术评价高血压患者左室心肌扭转的初步研究.中华超声影像学杂志.2007；24(9)：737-741.
20 Wang J, Khoury DS, Yue Y, et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation.2007; 116:2580-2586.
21 Suffoletto MS, Dohi K, Cannesson M, et al. Novel speckle tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation.2006; 113:960-968.
22 Cho GY, Chan J, Leano R, et al. Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol.2006; 97:1661-1666.
23 D'hooge J, Heimdal A, Jamal F, et al. Regional strain and strain rate measurements by cardiac ultrasound:principles,implementation and limitations. Eur J Echocardiogr.2000; 1:154-170.
24 Sutherland GR, Di Salvo G, Claus P, et al. Strain and strain rate imaging:A new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr.2004; 17: 788-802.
2 Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional strain a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr.2004;17(10):1021-1029.
3 Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertension:comparison to necropsy findings. Am J Cardiol.1986;57:450-458.
4 Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification:a report from the American Society of Echocardiography Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr.2005; 18:1440-1463.
5 Valle TH, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation speckle tracking echocardiography. Circulation.2005; 112 (20): 3149-3156.
6 Notomi Y, Lysyansky P, Setser RM, et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardio.2005;45(12):2034-2041.
7 M.Stuber, M.B.Scheidegger, S.E.Fischer,et al. Alterations in the local myocardial motion pattern in patients suffering from pressure overlode due to aortic stenosis. Circulation.1999; 100:361-368.
8 Ling Hui, James P, Edward H, et al. The Contribution of left ventricular muscle bands to left ventricular rotation:Assessment by a 2-dimensional speckle tracking method. J Am Soc Echocardiogr.2007;20(5):486-491.
9 Detsky ME, Azevedo ER, Parker JD. Left ventricular isovolumic relaxation is a predictor of left ventricular end-diastolic pressure. Can J Cardiol.2003;19:378-382.
10 M.Stuber, M.B.Scheidegger, S.E.Fischer,et al. Alterations in the local myocardial motion pattern in patients suffering from pressure overlode due to aortic stenosis. Circulation. 1999; 100:361-368.
11 Wachtell K, Smith G, Gerdts E, et al. Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy. Am J Cardiol.2000;85(4):466-472.
12 Dong S, Hees P, Hees P, et al. MRI assessment of LV relaxation by untwisting rate:a new isovolumic phase measure of tau. Am J Physiol Heart Circ Physiol.2001; 281:H 2002-2009.
13 Maceria AM, Barba J, Varo N, et al. Ultrasonic backscattter and serum marker of cardial fibrosis in hypertensives. Hypertension.2002;9:923-928.
14 Zile MR, Gaasch WH. Mechanical loads and the isovolumic filling indices of left ventricular relaxation. Prog Cardiovasc Dis.1990;32:333-346.
15 Masaaki T, William B, Hiromi N,et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy:a study using two-dimensional speckle tracking imaging. European Heart Journal.2007;28:2756-2762.
16 Simone GD, Greco R, Mureddu G, et al. Relation of left ventricular diastolic properties to systolic function in arterial hypertension. Circulation.2000;101(2):152-156.
17 Yuming Mu, Chuan Qin, Chunmei Wang, et al. Two-dimensional ultrasound speckle tracking imaging in evaluation of early changes in left ventricular diastolic function in patients with essential hypertension. Echocardiography.2010;27:146-154.
18 Bas M van Dalen, Floris Kauer, Michelle Michels, et al. Delayed Left Ventricular Untwisting in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr.2009;22:1320-1326.
1 Harada K, Komuro I, Shiojima I, et al. Pressure overload induces cardiac hypertrophy in angiotensin Ⅱ type-A receptor knockout mice. Circulation.1998; 97:1952-1959.
2 Greenberg NL, Firstenberg MS, Castro PL, et al. Doppler derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation.2002; 105(1):99-105.
3 Heimdal A, Stoylen A, Torp H, et al. Real-time strain rate imaging of the left ventricle by ultrasound. J Am Soc Echocardiogr.1998; 11(11):1013-1019.
4 Mirsky I, Parmley WW. Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res.1973; 33:233-243.
5 Toyoda T, Baba H, Akasaka T, et al. Assessment of regional myocardial strain by a novel automated tracking system from digital image files.J Am Soc Echocardiogr, 2004,17:1234-1238
6 Serri K, Reant P, Lafitte M, et al. Global and regional myocardial function quantification by two-dimensional strain application in hypertrophic cardiomyopathy. J Am Coll Cardio.2006; 47:1175-1181.
7 Langeland S, D'hooge J, Wouters PF, et al. Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle.Circulation.2005; 112:2157-2162.
8 Valle TH, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation speckle tracking echocardiography. Circulation.2005; 112(20):3149-3156.
9 Notomi Y, Lysyansky P, Setser RM, et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardio.2005; 45(12): 2034-2041.
10 Torrent-Guasp F, Ballester M, Buckberg GD, et al. Spatial orientation of the ventricular muscle band:physiologic contribution and surgical implications. Thorac Cardiovasc Surg.2001; 122(15):389-392.
11 Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr.2004; 17(10):1021-1029.
12 Stuber M, Scheidegger MB, Fischer SE, et al. Alterations in the Local myocardial motion pattern in patients suffering from pressure overload due to aortic stenosis.Circulation.1999; 100(4):361-368.
13 Kawagishi T. Speckle tracking for assessment of cardiac motion and dyssynchrony. Echocardiography.2008; 25:1167-1171.
14 王静,谢明星,韩伟等.超声二维斑点追踪成像评价原发3级高血压患者的左室扭转重构.中
15 Takeuchi M, Nakai H, Kokumai M, et al. Left ventricular untwisting was delayed and reduced in patients with hypertensive left ventricular hypertrophy:demonstration by 2-dimensional speckle tracking imaging. J Am Coll Cardiol.2006;47(4):98-102.
16 Yuming Mu, Chuan Qin, Chunmei Wang, et al. Two-dimensional ultrasound speckle tracking imaging in evaluation of early changes in left ventricular diastolic function in patients with essential hypertension. Echocardiography.2010;27:146-154.
17 Kim HK, Sohn DW, Lee SE, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr.2007; 20: 45-53.
18 Masaaki Takeuchi, William B. Borden, Hiromi Nakai, et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy:a study using two-dimensional speckle tracking imaging. European Heart Journal.2007; 28(3): 2756-2762.
19 韩伟,谢明星,王新房等.超声斑点追踪成像技术评价高血压患者左室心肌扭转的初步研究.中华超声影像学杂志.2007；24(9)：737-741.
20 Wang J, Khoury DS, Yue Y, et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation.2007; 116:2580-2586.
21 Suffoletto MS, Dohi K, Cannesson M, et al. Novel speckle tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation.2006; 113:960-968.
22 Cho GY, Chan J, Leano R, et al. Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol.2006; 97:1661-1666.
23 D'hooge J, Heimdal A, Jamal F, et al. Regional strain and strain rate measurements by cardiac ultrasound:principles,implementation and limitations. Eur J Echocardiogr.2000; 1:154-170.
24 Sutherland GR, Di Salvo G, Claus P, et al. Strain and strain rate imaging:A new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr.2004; 17: 788-802.