肥厚型梗阻性心肌病室间隔消融术后左室心肌功能改变的临床研究  

Evaluation of left ventricular segmental and global myocardial systolic function after trans-coronary alcohol septal ablation for hypertrophic obstructive cardiomyopathy by 2D speckle tracking imaging： long-term followupstudy

作　　者：张家芬[1] 段福建[1] 陈石[1] 乔树宾[1] 王浩[1] 吕秀章[2] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院超声科,北京100037 [2]首都医科大学附属北京朝阳医院心脏中心心脏超声科

出　　处：《中华超声影像学杂志》2012年第12期1013-1016,共4页Chinese Journal of Ultrasonography

基　　金：中国医学科学院北京协和医学院中央级公益性科研院所基本科研项目（2010-F21）

摘　　要：目的研究肥厚型梗阻性心肌病患者经冠状动脉室间隔酒精消融术后左室心肌整体及节段收缩功能的变化。方法26例行室间隔酒精消融术的肥厚型梗阻性心肌病患者，应用二维斑点追踪显像评价其术前、术后1周及术后1年的左室整体及节段心肌的收缩期应变峰值。结果术前患者的整体及节段纵向收缩期应变峰值较健康人群减低。术后1周左室流出道峰值压差、左室整体及消融节段的纵向收缩期应变较术前明显减低。术后1年患者的NYHA心功能分级、左室流出道压差和室间隔厚度较术前显著减低（P〈0．001），左室整体纵向应变较术前显著改善[（-14．7±2．0）％对（-13．6±1．6）％，P〈0．01]，左室圆周应变以及消融室间隔的平均纵向应变较术前无明显改变，而长轴的侧壁节段、短轴基底段和中段的平均纵向应变则有明显改善。左室流出道压差的减低与左室整体及基底段纵向收缩期应变的改善相关（r=0．58，P〈0．01；r=0．54，P〈0．01）。结论经皮室间隔酒精消融术能显著降低肥厚型梗阻性心肌病患者左室流出道压差，改善患者左室心肌整体及节段纵向收缩功能。Objective To evaluate the left ventricular segmental and global systolic myocardial function of the hypertrophic obstructive cardiomyopathy （HOCM） before and after transcoronary ablation of septal hypertrophy （TASH）. Methods Twenty-six consecutive patients with HOCM were analysed by two-dimensional speckle tracking imaging （STI） before and after TASH. The left ventricular global and segmental systolic longitudinal strains and circumferential strain were measured. Results In the HOCM patients, the global and segmental longitudinal strains were lower than the healthy population before TASH. One week after TASH,a significant reduction of left ventricular outflow tract （LVOT） gradients occurred （P G 0. 001 ）. The global and the alcohol-treated septal segmental longitudinal strains also decreased significantly [（- 12.5 ± 1.7）% vs （-13.6±1.6）%, PG0.01;（-11.2±2.8）% vs （-12.6±3.1）%, P G 0.00l]. During 1 year follow-up after TASH,the mean NYHA function class improved after TASH （P G 0. 001） and the left ventrieular outflow tract （LVOT） gradients and septal thickness decreased （ P G 0. 001 ）. The left ventricular global longitudinal systolic strain was increased [（ - 14. 7 ± 2.0） % vs （ - 13.6 ± 1.6） %, P G0.01],and this was correlated with the decrease of the LVOT gradients （ r = 0. 579, P G 0.01 ）. The alcohol-treated septal segments showed unchanged average longitudinal strain over time, while in the anterolateral and the anterior segments, the average longitudinal systolic strain increased （ P G0.05）. The basal and medial segments also showed increased average longitudinal systolic stain. However, the left ventricular circumferential strain had no changes after TASH. Conclusions TASH can significantly decreasethe LVOT gradients and improve NYHA functional class with the increase of the left ventricular global and segmental longitudinal systolic function.

关 键 词：超声心动描记术 心肌病 肥厚性 心室功能 左 斑点追踪成像 

分 类 号：R542.2[医药卫生—心血管疾病]