To evaluate the effect of left ventricular hypertrophy and deformation on cardiac function in patients with uremic cardiomyopathy (UCM) by using the technology of two dimensional speckle tracking imaging (2D-STI). Methods: A total of 67 UCM patients were randomly divided into the normal cardiac function group (subgroup A, 32 cases) and the abnormal cardiac function group (subgroup B, 35 cases) according to the New York Heart Association points (NYHA-P). A total of 30 healthy subjetcs served as the control group. Parameters including left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular spherical index (LVSI), left ventricular myocardial mean radial strain (MRS), mean radial strain rate (MRSR), mean longitudinal strain (MLS), local systolic twist angle (STA), and mitral annulus maximum displacement (TMAD) were detected. Results: MLS, MRS, MRSR, LVSI, STA and TMAD in the Group A and Group B were lower than that in the control group (P<0.05), and LVMI in the Group A and Group B was increased than those in the control group (P<0.05); LVEF, MLS, MRS, MRSR, LVSI and STA in the Group B was decreased than that in the Group A (P<0.05). MLS in the Group A and B were positively correlated with LVEF and LVSI, but negatively correlated with LVMI. Using the point of 14.10% for MLS to evaluate UCM patients with NYHA-P>4 points, the sensitivity, the specificity and Yuedden index were 90.5%, 71% and 0.585, respectively. STA in UCM patients were lower than that in the control (P<0.05). Conclusion: 2D-STI possesses a unique advantage in detecting left ventricular strain and strain rate on left ventricular regional function in UCM with left ventricular hypertrophy and ventricular deformation. There is no direct correlation between the left ventricular hypertrophy and ventricular deformation, but the ventricular hypertrophy and deformation are correlated with regional cardiac function and clinical cardiac function. Left ventricular regional dysfunction may occur before cardiac hypertrophy and deformation.
目的：应用二维斑点追踪技术(two dimensional speckle tracking imaging，2D-STI)检测尿毒症心肌病(uremic cardiomyopathy，UCM)患者心肌生物力学参数，评价左室肥厚及左室形变对心功能的影响。方法：随机将67例UCM患者分为临床心功能正常组(A亚组，32例)及心功能异常组(B亚组，35例)，另选30例作为正常对照组。比较受检者临床心功能分级积分NYHA-P、左室射血分数(left ventricular ejection fraction，LVEF)、左室重量指数(left ventricular mass index，LVMI)、左室球形指数(left ventricular spherical index，LVSI)以及心肌生物力学参数即左室平均径向应变(mean radial strain，MRS)、平均径向应变率(mean radial strain rate，MRSR)、平均纵向应变(mean longitudinal strain，MLS)、组织运动瓣环位移(tissue motion annular displacement，TMAD)、左室心肌收缩期扭转角度(systolic twist angle，STA)。结果：UCM组LVMI增大，而STA，MLS，MRS，MRSR，TMAD，LVSI减低(P<0.05)。UCM组中B亚组与A亚组比较：LVMI差异无统计学意义(P>0.05)，MLS，MRS，MRSR，STA，TMAD，LVSI减低(P<0.05)。正常对照组和UCM组MLS绝对值与LVEF均呈正相关；UCM患者MLS绝对值与LVSI呈正相关，与LVMI呈负相关。以MLS –14.10%为截断点判定患者NYHA-P>4分灵敏度为90.5%，特异度为71%，Yuedden指数最高0.585。UCM患者心肌收缩期STA较对照组减低(P<0.05)。结论：用2D-STI技术检测心肌生物力学参数来评价UCM患者左室局部功能具有独特的优越性，左室肥厚与心室形变无直接相关，临床心功能分级与左室肥厚及心室形变相关，与局部心功能参数相关性更明显，局部心肌力学参数改变存在于心功能分级尚好及心室重构程度较轻的患者，局部心肌力学参数下降预示心功能向异常化发展。.