组织多普勒评价化学消融术对肥厚型梗阻性心肌病心房电机械传导参数变化的价值  

Assessment of changes of atrial electromechanical conducton in patients with hypertrophic obstructive cardiomyopathy by percutaneous transluminal septal myocardial ablation using tissue doppler imaging

作　　者：王淑珍[1] 熊峰[1] 张丽娟[1] 冯坤[1] 刘春霞[1] 

机构地区：[1]四川省成都市第三人民医院心研所彩超室,四川成都610031

出　　处：《医学影像学杂志》2015年第2期218-221,共4页Journal of Medical Imaging

基　　金：四川省卫生厅科研基金课题(项目编号:120538)

摘　　要：目的探讨肥厚型梗阻性心肌病(HOCM)患者心房电-机械传导异常的严重程度及经皮室间隔化学消融术(PTSMA)对患者电-机械传导异常改善的有效性。方法选择成功进行PTSMA术并术后6个月进行随访的HOCM组25例和正常对照组26例。测量心动图P波起始点至心尖四腔观二尖瓣环左室侧壁、后间隔及三尖瓣环右室侧壁位点处组织多普勒曲线上a波起始点的时间(P-LA、P-IVS、P-RA),计算左心房内不同步性(P-LA与P-IVS差值T1)、左右心房间不同步性(P-LA与P-RA的差值T2)。结果与正常对照组相比,HOCM患者手术前、后P-LA、P-IVS、P-RA均明显延长(P<0.05),T1、T2值明显增大(P<0.05);与HOCM患者术前相比,术后P-LA、P-IVS、P-RA均显著缩短(P<0.05),T1、T2值明显减小(P<0.05)。结论 HOCM患者存在心房电-机械传导间期延长、左心房内及左右心房间不同步运动,而PTSMA术使患者这种心房电-机械活动异常及心房不同步运动得到显著改善。Objective To investigate the severities of the atrial electrophysiological abnormalities in patients with hypertrophic obstructive cardiomyopathy（HOCM）compared with healthy controls and to evaluate the effects of percutaneous transluminal septal myocardial ablation（PTSMA）on the atrial electrophysiological conduction parameters.Methods We selectd 25 HOCM patients before and 6 months after septal ablation procedures and 26 healthy controls,all of whom received conventional echocardiography and tissue Doppler imaging.The intervals from the initiation of the P wave on the electrocardiogram（ECG）to the onsets of TDI-derived late diastolic velocity at the lateral mitral annulus（P-LA）,anterior mitral annulus（P-IVS）and tricuspid annulus（P-RA）were measured.The intratrial asynchrony was defined as the difference between P-LA and P-IVS（T1）,while,the interatrial asynchrony as the difference between P-LA and P-RA（T2）.Results Compared with healthy controls,P-LA,P-IVS,P-RA and T1,T2 were significantly prolonged in HOCM patients.Moreover,at 6 months after PTSMA,the P-LA,P-IVS,P-RA and T1,T2 were significantly decreased in HOCM patients.Conclusion Left atrial electromechanical conduction time,left intratrial and interatrial asynchrony were significantly prolonged in HOCM patients.PTSMA can improve the prolonged conduction time and asynchrony for HOCM patients.

关 键 词：组织多普勒成像 肥厚型梗阻性心肌病 室间隔化学消融术 心房电机械传导 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]