二维斑点追踪成像评价心脏移植术后左室收缩同步性的价值探讨  

Two-dimensional speckle tracking echocardiography in evaluating left ventricular systolic synchronization after heart transplantation

作　　者：易仁凤 周燕翔 宋宏宁[1] 姜楠[1] 蔡迪 郭瑞强[1] YI Renfeng;ZHOU Yanxiang;SONG Hongning;JIANG Nan;CAI Di;GUO Ruiqiang(Department of Ultrasonography,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科

出　　处：《临床超声医学杂志》2020年第2期108-112,共5页Journal of Clinical Ultrasound in Medicine

基　　金：武汉大学自主科研资助项目(2042019kf0089)

摘　　要：目的应用二维斑点追踪成像评价临床状态稳定的心脏移植患者术后左室收缩同步性。方法选取20例心脏移植后无并发症且临床状态稳定的患者(心脏移植组),于移植术后3 d、1个月、3个月、6个月和1年行超声心动图检查;另选20例正常成人(对照组)。应用二维斑点追踪成像技术获取左室各节段纵向应变、径向应变及圆周应变达峰时间(Tls、Trs、Tcs),计算左室整体收缩期纵向应变、径向应变、环向应变达峰时间标准差(Tls-SD、Trs-SD、Tcs-SD)及达峰时间最大差值(Tls-dif、Trs-dif、Tcs-dif),并计算纵向应变延迟指数(LSDI),同时应用改良Simpson双平面法测量左室射血分数(LVEF)。比较心脏移植组各时间段与对照组间、心脏移植组各时点间上述参数的差异。结果心脏移植组术后3 d各应变参数均较对照组显著增高,差异均有统计学意义(均P<0.05);术后1个月Tls-SD与对照组比较差异有统计学意义(P<0.05)。心脏移植组术后LSDI、Tls-SD、Tls-dif呈逐渐降低趋势,且术后3 d与术后3个月、6个月、1年比较,差异均有统计学意义(均P<0.05);术后1个月Tls-SD与术后1年比较差异有统计学意义(P<0.05)。术后各时间段LSDI、Tls-SD和Tls-dif与LVEF均呈负相关(r=-0.523、-0.434、-0.401,均P<0.01),其中LSDI相关系数最高。结论临床状态稳定的心脏移植术后患者左室收缩功能存在不同步性,以术后3 d最为显著,在术后3个月左室收缩同步性得以恢复,并趋向正常。二维斑点追踪成像测得的LSDI、Tls-SD、Tls-dif可以客观评价心脏移植术后左室收缩同步性的变化,且以上参数与LVEF显著相关。Objective To evaluate left ventricular systolic synchronization in the patients with stable clinical stateafter heart transplantation in by two-dimensional speckle tracking technique(2D-STE).MethodsA total of 20 patients with stable clinical status after heart transplantation were selected(heart transplantation group).Echocardiography was performed at3 d,1 month,3 months,6 months and 1 year after heart transplantation,and 20 normal subjects were collected as control group.The longitudinal strain,radial strain and circumferential strain at peak time(Tls,Trs,Tcs)of each segment of left ventricle wereobtained by 2 D-STE.The standard deviations(Tls-SD,Trs-SD,Tcs-SD)and the maximum difference of peak time(Tls-dif,Trs-dif,Tcs-dif)of longitudinal strain、radial strain and circumferential strain at peak time of left ventricle were calculated.Thelongitudinal strain delay index(LSDI)was calculated,and the left ventricular ejection fraction(LVEF)was measured by modifiedSimpson biplane method.ResultsThe strain parameters of heart transplantation group were significantly higher than those ofcontrol group at 3 d after heart transplantation(all P<0.05).There was significant difference in Tls-SD between 1 month heartafter transplantation and control group(P<0.05).In the heart transplantation group,the LSDI,Tls-SD,Tls-dif decreasedgradually after operation,and there were significant differences between the 3 d and 3 months,6 months,1 year aftertransplantation(all P<0.05).There was significant difference in Tls-SD between 1 month and 1 year after sransplantation(P<0.05).In the transplantation group,there were significant negative correlations between LSDI,Tls-SD Tls-dif and LVEF(r=-0.523,-0.434,-0.401,all P<0.01),and the correlation coefficient of LSDI was the highest.Conclusion The left ventricular systolic function of patients with stable clinical state after heart transplantation is not synchronous,the mostsignificant is the 3 d after transplantion.After 3 months of transplantation,the synchronization of left ventricular systo

关 键 词：斑点追踪成像 二维 心脏移植 同步性 心室 左 

分 类 号：R540.45[医药卫生—心血管疾病] R617[医药卫生—内科学]