二维斑点追踪技术评价心脏移植患者左室重构对左室整体收缩功能的影响  

Evaluation of the effect of left ventricular remodeling on left ventricular global systolic function with heart transplantation by 2-dimensional speckle tracking echocardiography imaging

作　　者：覃小娟[1] 谢明星[1] 李贺[1] 吕清[1] 张菁[2] 尤君[1] 武彧[1] 邓尧[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院超声科心血管病研究所湖北省分子影像重点实验室,武汉430022 [2]华中科技大学同济医学院附属协和医院心血管外科心血管病研究所

出　　处：《临床心血管病杂志》2015年第3期292-295,共4页Journal of Clinical Cardiology

摘　　要：目的:左室重构是心脏移植患者常见现象,本研究旨在应用二维斑点追踪技术评价心脏移植患者左室重构对左室整体纵向、环向、径向收缩功能的影响。方法:选取健康志愿者30例及心脏移植术后时间≥1年的患者24例。其中心脏移植患者根据相对室壁厚度及左室质量指数分为HT-左室构型正常组(11例)和HT-左室重构组(13例)。采集所有患者左室心尖四腔观及左室乳头肌水平短轴观动态图像,二维应变技术测量左室整体径向应变(GRS)与应变率(GRSr)、整体环向应变(GCS)与应变率(GCSr)、整体纵向应变(GLS)与应变率(GLSr),比较这些参数指标在正常对照组、HT-左室构型正常组与HT-左室重构组之间的差别,探讨心脏移植后左室重构对心肌功能的影响。结果:与正常对照组比较,移植后2组GCS、GCSr、GRS、GRSr、GLS、GLSr均减低,差异均有统计学意义(均P<0.05),且HT-左室重构组GCS、GCSr、GRS、GRSr、GLS、GLSr较HT-左室构型正常组进一步减低,差异均有统计学意义(P<0.05)。GCS、GCSr、GRS、GRSr、GLS、GLSr指标参数具有较高的可重复性。结论:心脏移植患者左室整体纵向、环向及径向收缩功能均减低,发生左室重构患者更为明显,提示左室重构影响移植心脏左室心肌收缩功能,有效预防左室重构有利于维持术后左室心肌收缩功能。Objective：Left ventricular（LV）remodeling often occurs in heart transplant（HT）patients.This study aims to evaluate the LV longitudinal,circumferential and radial systolic function of transplantation heart with LV remodeling by two-dimensional speckle tracking.Method：Twenty-four patients surviving more than one year after HT and 30 healthy volunteers were divided into three groups：control group（healthy volunteers,n=30）,HT patients with normal LV geometry（n=11）and HT patients with LV remodeling（n=13）.The short axis view of the LV on the level of papillary muscle and the apical four-chamber view were acquired and stored in dynamic mode,and then analyzed off-line in Qlab Analysis 7.1.We compared the global LV longitudinal strain（GLS）,global circumferential strain（GCS）,global radial strain（GRS）,GLS rate（GLSr）,GCS strain（GCSr）and GRS strain（GRSr）among the three groups,and analyzed the possible factors.Result：Compared with the control group,GCS,GLS,GRS,GCSr,GLSr,GRSr were significant lower in both HT groups（P〈0.05）.And GCS,GLS,GRS,GCSr,GLSr,GRSr in the HT group with LV remodeling were lower than in the HT group with normal LV geometry（all P〈0.05）.There were high repeatability and consistency of these parameters：GCS,GLS,GRS,GCSr,GLSr and GRSr.Conclusion：LV global longitudinal,circumferential and radial systolic functions decrease in HT patients,especially in patients with LV remodeling,which implies LV remodeling after heart transplantation influences LV systolic function.Prevention of LV remodeling or hypertrophy can help to maintain postoperative LV systolic function.

关 键 词：超声心动图描记术 心脏移植 心室功能 左 二维斑点追踪技术 

分 类 号：R654.2[医药卫生—外科学]