Doppler tissue imaging: Regional myocardial function in hypertrophic cardiomyopathy and in athlete's heart
Doppler tissue imaging: Regional myocardial function in hypertrophic cardiomyopathy and in athlete's heart
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DOI：
10.1067/mje.2003.13
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发表时间：
2003-03-01
影响因子：
6.5
通讯作者：
Correia, JM
中科院分区：
文献类型：
--
作者：
Cardim, N;Oliveira, AG;Correia, JM
背景资料：肥厚型心肌病（HCM）与运动员心脏（AT）的鉴别是临床上的重要问题，多普勒组织成像技术对心肌局部功能的分析有助于两者的鉴别诊断。我们的目的是比较多普勒组织成像评估赛艇运动员和一组HCM患者的局部功能。应用脉冲多普勒组织成像技术对24例非梗阻性肥厚型心肌病患者和20例年龄、血压、心率相似的赛艇运动员的左心室（LV）纵向（心尖切面8个节段）和径向（短轴切面2个节段）的局部功能（速度、时间间期、异质性指数、舒张压梯度）进行分析。与AT相比，HCM患者显示：（1）收缩功能;（a）纵向：速度和跨瓣压差较低;预收缩期（PCP）较长; PCP/LV收缩时间较高;（B）径向：速度和跨瓣压差较低; PCP较长; PCP/LV收缩时间较高;（2）舒张功能;（a）对数：较低的E（舒张早期）、A（舒张晚期）和E/A速度;以及较长的预松弛时间和达到峰值C的时间。HCM组e/a < 1的节段百分比为25%，AT心脏组为0%;（B）桡动脉：较低的e速度和梯度;较低的e/a梯度;较长的内侧预松弛和基础时间达到峰值e。大部分这些差异也发生在非肥厚的下壁HCM患者。结论：有竞争性赛艇运动员和HCM患者的局部左室功能之间存在显着差异。这些差异（1）发生在收缩期和舒张期;（2）影响速度和时间间隔;（3）在长轴上更引人注目，但也见于短轴;（4）也发生在非肥大节段，表明该技术在两种情况之间的鉴别诊断中的有用性，即在Maron的“灰色地带”中的个体。
Background: The distinction between hypertrophic cardiomyopathy (HCM) and the athlete's (AT) heart is an important clinical problem, and the analysis of regional myocardial function with Doppler tissue imaging may be useful in the differential diagnosis.Objective. Our aim was to compare regional function assessed by Doppler tissue imaging in rowers and in a group of patients with HCM.Methods. In 24 patients with nonobstructive HCM and in 20 competitive rowers with similar age, blood pressure, and heart rate, we analyzed with pulsed Doppler tissue imaging left ventricular (LV) regional function (velocities, time intervals, heterogeneity and asynchrony indices, and meridional gradient) in the longitudinal (8 segments, apical views) and in the radial (2 segments, short-axis view) axis.Results. Compared with AT, patients with HCM showed: (1) systolic function; (a) longitudinal: lower velocities and meridional gradient; longer precontraction period (PCP); and higher PCP/LV contraction time; (b) radial: lower velocities and gradient; longer PCP; and higher PCP/LV contraction time; (2) diastolic function; (a) logitudinal: lower e (early diastolic), a (late diastolic), and e/a velocities; and longer prerelaxation time and time to peak c. The percentage of segments with e/a < 1 was 25% in the HCM group and 0% in the AT heart group; (b) radial: lower e velocity and gradient; lower e/a gradient; and longer medial prerelaxation and basal time to peak e. Most of these differences also occurred in the nonhypertrophied inferior wall of patients with HCM.Conclusions: There are significant differences between regional LV function of competitive rowers and patients with HCM. These differences (1) occur in systole and diastole; (2) affect velocities and time intervals; (3) are more striking in the long axis, but are also seen in the short axis, and (4) also occur in nonhypertrophied segments, suggesting the usefulness of the technique in the differential diagnosis between the 2 situations, namely in individuals that fall in Maron's "grey zone".