目的:探讨优秀女子冰球运动员左心室(left ventricular，LV)心腔内的节段性血流动力学特征。方法:以53名女子冰球运动员(27名优秀运动员、26名普通运动员)和24名健康对照受试者为研究对象，应用基于超声心动图的血流向量成像技术无创测量LV二维结构、LV心尖二/三/四腔心切面室内相对压力差(intraventricular pressure differ-ence，IVPD)和各节段壁面剪切应力(wall shear stress，WSS)，分析快速射血期、收缩末期和快速充盈期IVPD峰值时相下WSS的组间差异，统计组间差异显著的WSS与LV结构参数和训练水平的相关性，探讨优秀女子冰球运动员心脏结构适应长期高水平训练的LV心腔内节段性血流动力学特征。结果:1)优秀女子冰球运动员左心室质量指数(LV mass index，LVMi)、左心室舒张末期容积指数(LV end diastolic volume index，LVEDVi)和左心室收缩末期容积指数(LV end systolic volume index，LVESVi)显著高于健康对照组，相对室壁厚度指数(relative wall thickness index，RWTi)显著低于健康对照组;2)在快速射血期，优秀女子冰球运动员下侧壁心尖段(apical lateral，ApL)的WSS显著高于普通运动员(P=0。029);在收缩末期，优秀女子冰球运动员ApL(P=0。005)和下侧壁中间段(mid inferolateral，MIL;P=0。008)的WSS显著低于普通运动员，后间壁中间段(mid inferoseptal，MIS)的WSS显著低于普通运动员(P=0。027)和健康对照组(P=0。046);3)快速射血期ApL的 WSS与RWTi显著负相关，与训练水平显著正相关;收缩末期ApL和MIL的WSS与LVMi、LVEDVi和LVESVi显著负相关，MIL和MIS的WSS与训练水平显著负相关。结论:1)优秀女子冰球运动员LV结构呈生理性增大，心腔内血流动力在收缩期呈节段性优化;2)运动员在长期专业训练中通过心腔内节段性血流动力的优化促进其心脏结构的生理性适应。研究结果可为运动员心脏形成的血流动力学机制提供理论依据，并为预防运动员心脏病理性重构的发展提供参考。
Characteristics of Left Ventricular Segmental Hemodynamics Evaluated by Wall Shear Stress in Elite Female Ice Hockey Athletes
Objective:To investigate the intraventricular segmental hemodynamics of the left ventricle in elite female ice hockey athletes.Methods:53 female ice hockey athletes(27 elite athletes and 26 low-level athletes)and 24 healthy subjects were recruited in this study.The two-dimensional structure of the left ventricle(LV),intraventricular relative pressure difference(IVPD)and segmental wall shear stress(WSS)in LV apical two-,three-,and four-chamber view were noninvasively measured by using vector flow mapping based on echocardiography.The differences of WSS at the time phase of peak IVPD during the rapid ejection,late systole and rapid filling among groups,and the correlations between WSS,training level,and LV structural parameters were analyzed.Results:1)The LV mass index(LVMi),LV end diastolic volume index(LVEDVi)and LV end systolic volume index(LVESVi)in elite female ice hockey athletes were significantly higher than that of controls,but the relative wall thickness index(RWTi)was significantly lower in elite female ice hockey athletes compared with control group.2)During the rapid ejection phase,the WSS of apical lateral(ApL)segment was significantly higher in elite female athletes than that of low-level athletes(P=0.029).During the late systole phase,WSS of ApL segment(P=0.005)and mid inferolateral(MIL P=0.008)segment were significantly lower in elite female athletes than those of low-level athletes;in addition,the WSS in the mid inferoseptal(MIS)segment was significantly lower in elite female athlete than that of low-level athletes(P=0.027)and controls(P=0.046).3)The WSS of ApL segment during rapid ejection was negatively correlated with RWTi,and positively correlated with training level.The WSS of ApL and MIL segments during late systole phase appeared negatively correlated with LVMi,LVEDVi and LVESVi;the WSS of MIL and MIS segments during late systole phase were negatively correlated with training level.Conclusions:1)The LV structure of elite female ice hockey athletes is physiologically enlarged,and the intraventricular hemodynamics were optimized segmentally during systole;2)long-term professional training promotes the physiological adaptation of athletes'heart structure through segmental hemodynamics.The results can provide theoretical basis for the hemodynamic mechanism of the formation of athlete's heart,and provides references for the prevention of the development of pathological remodeling in athletes'heart.
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