超声斑点追踪技术评价心脏移植患者左心房功能  

Evaluation of left atrial function in patients with heart transplantation by speckle tracking echocardiography

作　　者：姜辛 曹省[1] 谭团团[1] 蔡迪 姚雪[1] 郭瑞强[1] JIANG Xin;CAO Sheng;TAN Tuan-tuan;CAI Di;YAO Xue;GUO Rui-qiang(Department of Ultrasound,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院超声影像科,湖北武汉430060

出　　处：《生物医学工程与临床》2022年第3期307-313,共7页Biomedical Engineering and Clinical Medicine

基　　金：湖北省青年基金资助项目(ZRMS2019000321)。

摘　　要：目的通过超声斑点追踪技术(STE)获取心脏移植(HT)患者左心房应变/应变率参数和左心房不同时态射血分数,评价其左心房功能随术后时间改变情况。方法选择在武汉大学人民医院行HT术的患者25例(HT组),其中男性18例,女性7例;年龄26~68岁,平均年龄48.60岁。分别在术后1个月、6个月、12个月和24个月来院复查时采集超声心动图数据。同期体检正常的健康人群25例(对照组),其中男性17例,女性8例;年龄28~65岁,平均年龄49.00岁。采用STE测量左心房应变及应变率参数,包括左心室收缩期左心房峰值应变值(LAS-S)、左心房收缩期应变值(LAS-A)、左心室收缩期左心房平均峰值应变率(mSRs)、左心室舒张早期左心房平均峰值应变率(mSRe)、左心室舒张晚期左心房平均峰值应变率(mSRa),容量参数包括左心房最大容积(LAVmax)、左心房收缩前容积(LAVp)、左心房最小容积(LAVmin),并计算左心房总射血分数(LAtEF)、左心房被动射血分数(LApEF)和左心房主动射血分数(LAaEF)。结果与对照组常规超声指标相比,HT组心率增加(P<0.01),左心房前后径(LAD)增大(P<0.05),术后早期明显下降的左心室射血分数(LVEF)和三尖瓣环收缩期位移(TAPSE)分别于术后6个月、12个月时恢复至正常水平,与对照组相比,差异无统计学意义(P>0.05);与对照组左心房参数比较,Ht组早期各项功能均显著下降,随访至术后24个月时仍有LAS-S、LAS-A减低[(27.58±6.12)%vs(21.47±6.11)%、(13.20±4.37)%vs(8.17±3.98)%],LAVmin增大[(16.72±4.78)mL vs(23.39±9.53)mL],LAtEF及LApEF减低[(60.93±7.19)%vs(53.07±9.55)%、(29.68±5.43)%vs(23.44±5.94)%](P<0.05);HT组间各时间点比较,左心房心肌应变和射血分数随术后时间呈递增趋势,12个月组LAS-S、mSRs、LAtEF、LAaEF较1个月组增加[(15.57±3.56)%vs(9.38±2.86)%、(1.09±0.26)s^(-1)vs(0.83±0.25)s^(-1)、(48.56±7.66)%vs(41.90±7.76)%.(32.89±8.09)%vs(25.44±7.77)%],24个月组mSRs、mSRe、mSRaObjective To obtain left atrial strain/strain rate parameters and left atrial ejection fraction in different time points of heart transplantation(HT)patients who performed ultrasound speckle tracking technology(STE),and evaluate the function changes of left atrial with postoperative time.Methods A total of 25 HT patients(HT group)were enrolled,which included 18 males and 7 females,aged 26-68 years old with mean age of 48.60 years old.The echocardiographic data were collected 1-month,6-month,12-month,and 24-month after HT operation.Meanwhile,25 healthy with normal physical examination were set as control group,which included 17 males and 8 females,aged 28-65 years old with mean age of 49.00 years old.The left atrial strain and strain rate parameters were measured by STE,which included left atrial peak strain-during left ventricular systole(LAS-S),left atrial systolic strain value left atrial peak strain-during left atrial systole(LAS-A),mean peak strain rate of left atrium-during left ventricular systole(mSRs),left atrial mean peak strain rate in early diastole mean peak strain rate of left atrium-during left ventricular early diastole(mSRe),mean peak strain rate of left atrium-during left ventricular advanced diastole(mSRa),volume parameters included the maximum volume of left atrium(LAVmax),presystolic volume of left atrium(LAVp),the minimum volume of left atrium(LA Vmin).The left atrial total ejection fraction(LAtEF),left atrial passive ejection fraction(LApEF)and left atrial active ejection fraction(LAaEF)were calculated.Results Compared with conventional ultrasound indicators in control group,the heart rate(P<0.01)and left atrial anteroposterior diameter(LAD)(P<0.01)significantly increased in HT group,left ventricular ejection fraction(LVEF)and tricuspid annular plane systolic excursion(TAPSE)decreased significantly in the early postoperative period,but returned to normal levels 6-month and 12-month after operation,respectively,which was no significant difference between 2 groups(P>0.05);Compared with left at

关 键 词：斑点追踪 心脏移植 心功能 左心房 超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R654.2[医药卫生—诊断学]