| Background:HCM is a autosomal dominant inherited disease which is caused by the genic mutation of ten proteinum encoding the cadiocyte sarcomere.The myocardium pachynsis happens without the obvious increasing of volume load and pressure load,and its manifestation is apopsychia,chest distress,chest pain,arrhythmia and sudden death.But some patients may have the serious consequence without the clinical symptom,the pristine diagnosis is very important.The traditional ultrasonic cardiogram can offer the morphologic and hemodynamic information to diagnose HCM,the most common manifestation is the inhomogeneous pachynsis of interventricular septum and left ventricular wall.Hypertensive left ventricular hypertrophy(H-LVH)has a history of hypertension,and its main manifestation is the homogeneous pachynsis of left ventricular wall,so it is not too difficult to diagnose the typical cases.But some literatures pointed that thirteen to thirty-one percents patients of HCM have the manifestation of the homogeneous pachynsis of the left ventricular wall,and four to tourty-seven percents patients of H-LVH have the manifestation of the inhomogeneous pachynsis of the left ventricular wall.So the appreciation of the HCM and H-LVH is always the hot spot and the difficult spot in this sphere. Betaloc is the most common drug for HCM,but it can not reverse the myocardial pachynsis in macroscopy,and the traditional ultrasonic cardiogram can not evaluate the therapeutic effectively,it does not have a certain effective power.So it is necessary to carry out a systematic research for the alteration of the left ventricular function in these diseases. The technique of straining/strain rate image formation,which is developed recently is about organizational Doppler,has a high timeresolution, and it can quantitive analyze the movement of multi-segmented myocardium simultaneouly.Many researches have confirmed that this technique can investigate the contractile function and the diastolic function of the partial left ventricular myocardium quantitatively,and the movement of the myocardium which is determined by that technique can reflect the contractile character and the diastolic character of the myocardium without the influence of the peripheral organizational attraction.Purpose:In this research,we use the technique of straining/strain rate image formation to study the alteration of the left ventricular function in the patients of HCM and H-LVH in order to discuss these problems:(1) The alteration of the contractile function and the diastolic function in the patients of HCM;(2)to evaluate the value of the technique of straining/strain rate image formation in studying the left ventricular function in the patients who have the pachyntic left ventricle;(3)to evaluate the disparity of the alteration of the contractile function and the diastolic function in all kinds of the HCM patients;(4)to evaluate the value of the straining/strain rate image formation to analyze the APH;(5) the correlation between the alteration of the contractile function and the diastolic function in the patients of the partial myocardium and the thickness of the ventricular wall;(6)using the technique of straining/strain rate image formation to evaluate the therapeutic effect of Betaloc to patients with HCM.Subjects and methods:1 A total of 130 consecutive subjects were separated into 3 groups:(1)The control group consisted of 27 subjects(16 males and 11 females, age 24-62 years,averaged 44±12 years)without hypertrophic cardiomyopathy,coronary artery disease,nephrosis,hypertension,or diabetes mellitus who had no abnormal findings on physical/blood-biochemistry examination or abnormalities on electrocardiographic or conventional echocardiographic examinations.All subjects of this group do not have the history of heart failure or the history of hypertension.(2)A total of 69 patients(48 males and 21 females,age 14-63 years, average 41±12 years,case history 0-96 months)whose the cardiac muscle thickness met the criteria for the diagnosis of hypertrophic cardiomyopathy established by WHO/IFS were admitted to the hypertrophic cardiomyopathy group,hypertrophic cardiomyopathy was defined as the thickness of middle and superior parts of interventricular septum＞15mm measured by two dimensional echocardiography; posterior wall,inferior wall,anterior wall and lateral wall of left ventricle are thickening lightly or no thickening;the ratio of the thickness of interventricular septum:the thickness of posterior left ventricular wall＞1.3:1;the one which had apical hypertrophy appearance merely was defined as apical hypertrophy cardiomyopathy.According to different study objectives,the subjects of this group were divided with different standards:According to pressure gradient of left ventricle outflow tract, this group was divided into obstructive hypertrophic cardiomyopathy group and non-obstructive hypertrophic cardiomyopathy group:①Obstructive hypertrophic cardiomyopathy group:left ventricle outflow tract pressure≥20mmHg.23 subjects totally in this group,16 males and 7 females,age25-57 years,average 40±11years,case history0-60 months;②Non-obstructive hypertrophic cardiomyopathy group:left ventricle outflow tract pressure＜20mmHg.35 subjects totally in this group, 24 males and 11 females,age 14-63 years,average 43±17 years, case history 0-96months;③Apical hypertrophy cardiomyopathy group:The apical hypertrophy is limited under the level of the left ventricular columna papillares.11 subjects totally in this group,8 males and 3 females,age 22-61 years,average 41±14 years,case history 3-84 months;In order to estimate the curative effect of Betaloc,21 HCM patients whose heart rate is above 60pm/min,are chosen and offered Betaloc and followed up one month.(3)A total of 34 patients(21 males and 13 females,age 31-67 years, average44±13years,case history 0-156months)whose blood pressure met the criteria for the diagnosis of hypertension established by WHO/ISH were admitted to the hypertension group.Hypertension was defined as a blood pressure of at least 140/90mmHg or the use of anti-hypertension medications.Patients with secondary hypertension were excluded by physical and laboratory examinations.2.Methods:inter-and intra-group comparisons were performed with a one-way ANOVA test and post-hoc LSD-t test respectively.Univariate correlation was assessed by Pearson correlation coefficient.Significantly correlated parameters were subjected to linear regression ananlysis.For all statistical procedures,SPSS statistical analysis software was used.A p value＜0.05 was considered statistically significant.Results:1.Compared with the control group about the left ventricular structure and function,the numerical values of the left ventricular inner diameter,the thickness of the interventricular septum and the left ventricular posterior wall,the EF of the left ventricle,the weight of the left ventricle of the HCM group are more than those in the control group significantly (P＜0.01),and the numerical values of the E/A,S/D are less than those in the control group significantly(P＜0.01);the numerical values of the left ventricular inner diameter,the thickness of the interventricular septum and the left ventricular posterior wall of the hypertension group are more than those in the control group significantly(P＜0.01),the numerical values of the weight of the left ventricle are more than those in the control group(P＜0.05),and the numerical values of the E/A,S/D are less than those in the control group significantly(P＜0.01);the numerical values of the left ventricular inner diameter,the thickness of the interventricular septum and the left ventricular posterior wall,the EF of the left ventricle,the weight of the left ventricle of the HCM group are more than those in the hypertension group significantly(P＜0.01);2.The result of the comparison about the left ventricular structure and function among the different HCM groups is that,the numerical values of the thickness of the interventricular septum,the weight of the left ventricle,the blood flow rate of the debouch of the aortic valve of the HCM group with obstruction are more than the HCM group without obstruction significantly(P＜0.01),and the thickness of the left ventricular posterior wall are bigger(P＜0.05);the numerical values of the thickness of the interventricular septum,the weight of the left ventricle,the blood flow rate of the debouch of the aortic valve of the HCM group which has the apical hypertrophy are less than the HCM group with obstruction significantly(P＜0.01),and the numerical values of the thickness of the left ventricular posterior wall are less than that(P＜0.05);all the other indexes of the HCM group which has the apical hypertrophy and the HCM group with obstruction have no statistical variance;3.Compared with the control group about the left ventricular structure and function,the numerical values of the left ventricular inner diameter,the thickness of the interventricular septum and the left ventricular posterior wall,the EF of the left ventricle,the weight of the left ventricle of the apical hypertrophic cardiomyopathy are more than those in the control group significantly(P＜0.05),and the numerical values of the E/A,S/D are less than those in the control group significantly(P＜0.05);4.Compared with the control group about the straining/strain rate,the numerical values of all segmentedεet,SRs,SRe,Sra of the HCM group are less than those in the control group significantly(P＜0.05or P＜0.01);the numerical values of all segmentedεet,SRe of basilar part,intermediate part and Apex of heart are less than those in the control group significantly(P＜0.05or P＜0.01),the SRa of Apex of heart is higher than those in the control group(P＜0.05),and the others have no statistical variance;the numerical values of all segmentedεet,SRs,SRe,Sra of the HCM group are less than those in the hypertension group significantly(P＜0.05or P＜0.01);5.The variance of indexes about the straining/strain rate among the different groups:the numerical values ofεet,SRs,SRe of the basilar part and intermediate part of the HCM group with obstruction or not are less than the HCM group which have the apical hypertrophy significantly(P＜0.05or P＜0.01),SRa is lower but it has no statistical variance;εet of the HCM group with obstruction or not is higher than the HCM group which has the apical hypertrophy significantly(P＜0.01),the numerical values of SRs,SRe,SRa are more than the HCM group which has the apical hypertrophy but they have no statistical variance;the comparison of all segemented straining/strain rate between the HCM group with obstruction and the group without obstruction has no statistical variance(P＞0.05);6.Compared with the control group about the straining/strain rate,the numerical values ofεet,SRs of the intermediate and apex part are lower than those in the control group(P＜0.05),the numerical values of all segmented SRe,Sra of the HCM group are less than those in the control group significantly(P＜0.05or P＜0.01);7.The correlation between the thickness of the ventricular wall and the straining of the systolic peak:the correlation coefficient of the the thickness of the ventricular wall and the straining of the systolic peak(absolute value)r=-0.783,presenting a high negative correlation.8.The alteration of the indexes about the function of the left ventricle and the straining/strain rate in the HCM patients between pre-treatment and after one-month-treatment:no significant alteration of the indexes about the left ventricular structure and function,the increasing ofεet after-treatment is statistical singificant(P＜0.05), the increasing of SRs,SRe,SRa is not statistical significant.Conclusions:1.The technique of straining/strain rate image formation can detect the abnormality of the contractile function and the diastolic function by the the aspect of left ventriculate image formatr long axis sensitively,it can be the first choice to estimate the pristine myocardial pathological change and the disfunction.2.The technique of straining/strain rate image formation can discriminate the HCM patients and the HP patients great to give the early diagnosis exactly. 3.The technique of straining/strain rate image formation can be used to diagnose the apical hypertrophic cardiomyopathy.4.The decrease of the left ventricular contractile function are relative to the thickness of the myocardial hypertrophy.5.The contractile function and the diastolic function of the left ventricle are depressing in the HCM patients,but the diastolic function can be improved after the treatment of Betaloc.6.The technique of straining/strain rate image formation is not effected by the motivation of the ventricular obstruction,and it is not effected by the integrity movement and the partial tensile force relatively.It has a wide perspective of clinical application in evaluating the function of the partial myocardium.
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