三维斑点追踪技术评价梗阻性肥厚型心肌病患者行改良扩大Morrow手术治疗后的双心室重构  

Assessment of bi-ventricular remodeling in patients with hypertrophic cardiomyopathy after modified Morrow surgery by three-dimensional speckle tracking echocardiography

作　　者：刘芳 付建莉[1,3] 张展 胡芮[1] 周梦垚[1] 张军 刘丽文 Liu Fang;Fu Jianli;Zhang Zhan;Hu Rui;Zhou Mengyao;Zhang Jun;Liu Liwen(Department of Ultrasonography,Xijing Hospital,Air Force Medical University,Xi′an 710032,China;Department of Ultrasound,Affiliate Children′s Hospital of Xi′an Jiaotong University,Xi′an 710002,China;Department of Ultrasound,Shaanxi Province People′s Hospital,Xi′an 710068,China)

机构地区：[1]空军军医大学西京医院超声医学科,西安710032 [2]西安市儿童医院超声科,710002 [3]陕西省人民医院超声科,西安710068

出　　处：《中华超声影像学杂志》2020年第1期19-24,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金面上项目(81671693);陕西省社会发展领域重点项目(2017ZDXM-SF-058)。

摘　　要：目的应用三维斑点追踪(3D-STE)技术评价梗阻性肥厚型心肌病(HOCM)患者行改良扩大Morrow手术治疗后双心室重构及功能改变。方法收集2013年8月至2016年9月西京医院实施改良扩大Morrow手术治疗的HOCM患者28例,随访12~24个月。术前及术后均采集常规及全容积超声图像,图像输入TomTec分析软件,计算左室及右室舒张末期容积(EDV)、收缩末期容积(ESV)、每搏量(SV)及射血分数(EF),左室16节段纵向应变(LS)、圆周应变(CS)、径向应变(RS),左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房每搏量(LASV)、左房射血分数(LAEF),室间隔右室侧纵向应变[RVLS(S)]、右室游离壁纵向应变[RVLS(FW)]、三尖瓣环位移(TAPSE)、右室面积变化分数(RVFAC)。结果术后室间隔厚度较术前明显变薄,左室流出道压差减低,左室流出道内径增加,差异有统计学意义(均P<0.05);术后左室基底部的前壁及侧壁LS较术前增加(均P<0.05);术后基底部及中部左室侧壁CS较术前增加(均P<0.05);左室基底部的前壁、侧壁及后壁,中部的前壁及侧壁RS较术前增加(均P<0.05)。术后左房LAVmax、LAVmin、LASV较术前减低,LAEF较术前增加(均P<0.05)。术后右室RVLS(FW)及TAPSE较术前增高(均P<0.05)。结论改良扩大Morrow手术治疗HOCM患者后,可同时改善左室、左房及右室心肌运动能力,导致其形态学重构;3D-STE技术在评估改良扩大Morrow术后疗效方面具有较高的临床应用价值。Objective To assess the bi-ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy(HOCM)after modified Morrow surgery by three-dimensional speckle tracking echocardiography(3D-STE).Methods Twenty-eight patients with HOCM who underwent modified Morrow surgery from August 2013 to September 2016 in Xijing Hospital were consecutively included in this study.Routine and full-volume echocardiographic images were collected before and after surgery,3D-STE echocardiographic data were analyzed by TomTec software to calculate left and right ventricular end-diastolic volume(EDV),end-systolic volume(ESV),stroke volume(SV)and ejection fraction(EF),as well as the longitudinal strain(LS),circumferential strain(CS),radial strain(RS)of the 16 segments of left ventricle.The left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),left atrial stroke volume(LASV),left atrial ejection fraction(LAEF)were obtained,as well as right ventricular longitudinal strain of septum[RVLS(S)],right ventricular longitudinal strain of free wall[RVLS(FW)],tricuspid annular planesystolic excursion(TAPSE),right ventricular fractional area change(RVFAC).Results Compared with baseline,the IVS thickness were significantly reduced,LVOT pressure gradient were significantly decreased,LVOT diameter were increased significantly(all P<0.05).The LS in the basal part of anterior and lateral wall were increased significantly(all P<0.05).The CS in basal and middle part of lateral wall were increased significantly(all P<0.05).The RS in basal part of anterior,lateral and posterior wall,as well as in the middle part of anterior and lateral wall were increased significantly(all P<0.05).The LAVmax,LAVmin and LASV were decreased,and the LAEF was increased(all P<0.05).The RVLS(FW)and the TAPSE were increased significantly(all P<0.05).Conclusions After modified Morrow surgery in HOCM patients,the morphological remodeling of left ventricle,left atrium and right ventricle are improved,accompanied by the improvement of the function.3D-STE is

关 键 词：超声心动描记术 斑点追踪显像 三维 心肌病 肥厚型 心室功能 

分 类 号：R542[医药卫生—心血管疾病]