右心室流出道起源室性早搏患者左心室扭转运动分析  

Study of left ventricular torsional mechanics in patients with premature ventricular complexes from right ventricular outflow tract

作　　者：陈燕[1] 许迪[1] 张艳娟[1] 唐欢[1] 葛贝贝 钱丽君 王信淳 沈艳[1] 姚静[1] Chen Yan;Xu Di;Zhang Yanjuan;Tang Huan;Ge Beibei;Qian Lijun;Wang Xinchun;Shen Yan;Yao Jing(Department of Cardiology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心脏科,210029

出　　处：《中华超声影像学杂志》2019年第1期12-16,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81571691,81771844).

摘　　要：目的探讨正常人及右心室流出道(right ventricular outflow tract,RVOT)起源室性早搏(premature ventricular contraction,PVC)患者左心室扭转运动模式的改变。方法应用二维斑点追踪成像(two-dimensional speckle tracking imaging,2D-STI)技术分析30例RVOT-PVC患者以及31例健康志愿者左室整体扭转角度峰值、左室基底部及心尖部旋转角度峰值,以及上述参数达峰时间。RVOT-PVC患者同时留取其窦性心搏(PVC-S)及室性早搏(PVC-V)时各项参数。结果与对照组比较,PVC-S组左室射血分数(left ventricular ejection fraction,LVEF)差异无统计学意义(P>0.05),而左室心尖部旋转角度峰值[(8.47±3.54)°对(9.50±3.21)°,P=0.042]及左室整体扭转角度峰值[(11.25±6.31)°对(14.00±4.07)°,P=0.046]降低。与对照组比较,PVC-V组与左室心尖部旋转角度峰值[(3.93±7.23)°对(9.50±3.21)°,P=0.000]、左室整体扭转角度峰值均降低[(4.35±9.62)°对(14.00±4.07)°,P=0.000],同时出现左室基底部旋转角度达峰时间提前[(40.5±18.6)%对(48.0±9.1)%,P=0.05]且峰值显著降低[(-0.57±4.44)°对(-5.26±3.84)°,P=0.000]。PVC-V组与PVC-S组相比左室基底部旋转角度达峰时间提前[(40.5±18.6)%对(48.1±12.6)%,P=0.018]且峰值降低[(-0.57±4.44)°对(-4.57±4.57)°,P=0.000],同时左室整体扭转角度达峰时间提前[(39.3±15.4)%对(46.7±13.8)%,P=0.007]且峰值降低[(4.35±9.62)°对(11.25±6.31)°,P=0.001]。结论RVOT-PVC患者PVC-S时LVEF尚在正常范围之内,左室心肌扭转运动已发生改变,主要表现为左室心尖部旋转角度及左室整体扭转角度的降低;而其PVC-V时上述改变更加明显,且出现旋转/扭转时序的改变,并伴LVEF下降。Objective To assess alternations in left ventricular(LV) torsion parameters in healthy subjects and patients with premature ventricular complexes (PVCs) from the right ventricular outflow tract (RVOT). Methods Thirty patients with PVCs from RVOT and 31 healthy subjects were included.Two-dimensional speckle tracking imaging(2D-STI) was applied to evaluate LV torsion parameters,including LV rotational degrees in basal and apical levels respectively,LV total torsional degrees,and time to peak rotational and torsional degrees.All values of patients with PVCs were recorded during both sinus beats (PVC-S) and premature ventricular beats (PVC-V). Results No significant difference was observed in left ventricular ejection fraction(LVEF) between PVC-S group and control subjects(P>0.05),while LV rotational degrees in apical levels[(8.47±3.54)° vs (9.50±3.21)°,P=0.042] and LV total torsional degrees [(11.25±6.31)° vs (14.00±4.07)°,P=0.046] were significantly reduced in PVC-S group.In addition to the reduction of LV rotational degrees in apical levels[(3.93±7.23)° vs (9.50±3.21)°,P=0.000] and LV total torsional degrees[ (4.35±9.62)° vs (14.00±4.07)°,P=0.000],lower apical levels [(-0.57±4.44)° vs (-5.26±3.84)°,P=0.000] and advanced LV rotational degrees [(40.5±18.6)% vs (48.0±9.1)%,P=0.05] in basal levels were observed in PVC-V group in comparison with the control subjects.Compared with the PVC-S group,PVC-V group showed lower LV rotational degrees in basal levels [(-0.57±4.44)° vs (-4.57±4.57)°,P=0.000] and advanced time to peak rotational degrees [(40.5±18.6)% vs (48.1±12.6)%,P=0.018],as well as advanced time to peak and lower LV total torsional degrees [(39.3±15.4)% vs (46.7±13.8)%,P=0.007;(4.35±9.62)° vs (11.25±6.31)°,P=0.001]. Conclusions As to RVOT-PVC patients,LV myocardial torsional motion has changed in PVC-S mainly manifested as a decrease of rotation degrees in apical levels even if the LVEF is still in the normal range.During PVC-V the rotation and twist degree is further reduced,

关 键 词：超声心动描记术 室性早搏复合征 心室功能 左 扭转 

分 类 号：R541.7[医药卫生—心血管疾病] R540.45[医药卫生—内科学]