应用实时三维超声心动图技术评价经皮室间隔化学消融术对肥厚型梗阻性心肌病患者左心室舒张功能的影响  被引量:9

Effect of Percutaneous Transluminal Septal Myocardial Ablation on Diastolic Dysfunction in Patients With Hypertrophic Obstructive Cardiomyopathy by Real-time Three-dimensional Echocardiography

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作  者:段福建[1] 李慧[1] 高一鸣[1] 王剑鹏[1] 乔树宾[2] 袁建松[2] 崔锦钢[2] 王浩[1] 

机构地区:[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院超声科,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心内科,北京市100037

出  处:《中国循环杂志》2015年第6期516-519,共4页Chinese Circulation Journal

摘  要:目的:应用实时三维超声心动图技术评价肥厚型梗阻性心肌病(HOCM)患者经皮室间隔化学消融术(PTSMA)前及治疗后中远期左心室各节段舒张功能,探讨PTSMA对左心室舒张功能的影响。方法:46例HOCM患者于PTSMA术前及术后中远期(平均18.8个月),分别进行两次全面的超声心动图检查,测量二尖瓣口舒张早期血流速度峰值(E峰)/二尖瓣口舒张晚期血流速度峰值(A峰)比值(E/A比值),E峰/二尖瓣环舒张早期血流速度峰值(Ea峰)比值(E/Ea比值)。并进行实时三维超声心动图图像采集,获得17节段容积—时间曲线,计算左心室各节段的舒张末期容积(r EDV)、收缩末期容积(r ESV),容积变化(r SV)及充盈率(r PFR)。结果:46例患者术后随访E/Ea比值较术前明显降低(12.04±3.29 vs 15.70±5.68,P<0.001),左心室前壁中间段及前间隔中间段的r SV较术前减低[前壁中间段:(1.13±1.60)ml vs(4.38±0.66)ml;前间隔中间段:(3.14±1.04)ml vs(5.61±2.15)ml,P<O.05],前间隔中间段、后间隔中间段及间隔心尖段的r PFR较术前升高[前间隔中间段:(15.94±3.09)ml/s vs(12.07±2.91)ml/s;后间隔中间段:(10.15±1.91)ml/s vs(5.57±1.81)ml/s;间隔心尖段:(17.42±6.50)ml/s vs(9.29±2.25)ml/s,P<O.05]。结论:PTSMA后,患者左心室局部舒张功能得到改善,实时三维超声心动图可能为定量评价左心室节段舒张功能提供了新的方法和视角。Objective: To assess the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on mid- to long-term left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) by real-time three-dimensional echocardiography (RT-3DE). Methods: A total of 46 HOCM patients who received 2DE and RT-3DE examination before and after (with the mean of 18.8 months) PTSMA were studied. The ratios of E/A and E/Ea were analyzed, RT-3DE was conducted to collect the images, to obtain 17-segmant volume-time curve and to calculate the parameters of rEDV, rESV, rSV and rPFR respectively. Results: The follow-up echocardiography in all 46 patients indicated that the ratio of E/Ea decreased after the operation (12.04 ± 3.29) vs (15.70 ± 5.68),P〈0.001, the rSV of left ventricular anterior wall middle segment and anterior septal middle segment decreased after the operation,P〈0.05, while the rPFR of anterior septal middle segment, rear septal middle segment and apical segment increased,P〈0.05. Conclusion: PTSMA may improve local left ventricular diastolic function in HOCM patients, RT-3DE provides a new method and viewing angle for HOCM evaluation.

关 键 词:肥厚型梗阻性心肌病 经皮室间隔化学消融术 实时三维超声心动图 

分 类 号:R54[医药卫生—心血管疾病]

 

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