超声心动图右心室整体长轴应变在右心室压力负荷增加的实验乳猪右心室纤维化中的动态变化  

Dynamic Changes of Right Ventricular Global Longitudinal Strain on Echocardiography in the Development of Right Ventricular Fibrosis of Experimental Piglets With Right Ventricular Pressure Overload

作　　者：万琳媛 孟红 齐红霞 王婧金 段雪晶 孟庆龙 孙晓露 胡文文 WAN Linyuan;MENG Hong;QI Hongxia;WANG Jingjin;DUAN Xuejing;MENG Qinglong;SUN Xiaolu;HU Wenwen(Ultrasound Imaging Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Clinical Pathology,Experimental Diagnosis Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

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、阜外医院超声影像中心,北京100037 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院、实验诊断中心、临床病理科,北京100037

出　　处：《中国循环杂志》2024年第12期1217-1222,共6页Chinese Circulation Journal

基　　金：中国医学科学院临床与转化医学研究专项基金(2022-I2M-C&T-B-051)。

摘　　要：目的:评估超声心动图右心室整体长轴应变(RVGLS)在右心室压力负荷增加的实验乳猪右心室纤维化中的动态变化。方法:实验乳猪5只,环缩主肺动脉,测压针确保右心室压与左心室压比值>60%,构建右心室后负荷增加的实验动物模型。术前、术后即刻、术后3周、7周、14周(实验结束前)均进行超声心动图检查。实验结束时对右心室的多处心肌组织进行组织病理检测。结果:在手术进行实验动物模型建立过程中,2只实验乳猪因失血性休克死亡,3只实验乳猪存活并纳入分析。与术前比,术后即刻右心室收缩压、肺动脉收缩压、肺动脉平均压与术前相比均明显增高,术后14周右心室平均压及肺动脉平均压与术前相比均明显增高(P均<0.05)。三尖瓣环收缩期位移和三尖瓣环侧壁组织舒张早期峰值流速(TV e’)术后即刻开始减低(P均<0.05),术后3周后逐渐恢复至术前水平。与术前比,内膜、中层、外膜RVGLS在肺动脉环缩术后即刻均明显减低,术后3周内膜层RVGLS开始恢复,术后7周中层、外膜RVGLS开始恢复,但差异均无统计学意义(P均>0.05)。术后各层RVGLS达峰时间均较术前延长,直到术后14周(实验结束前)均未能恢复至术前水平(P均<0.05)。实验结束时,动物心肌组织病理检查发现心肌间质及心内膜均出现纤维组织增生。结论:心腔压力测量和病理结果证实了本实验建立的右心室后负荷增加动物模型是成功的。应力及应变都无法真实代表心肌的内在特性。延长的心肌应变达峰时间在右心室后负荷增加、心肌损伤的过程中,能够较为持久地间接反映心肌受损的进展。Objectives:To explore the dynamic changes of right ventricular global longitudinal strain(RVGLS)on echocardiography during the process of right ventricular fibrosis with right ventricular pressure overload.Methods:Animal models with RV pressure overload(n=5)were established by main pulmonary artery(PA)banding in piglets.The ratio of RV pressure to left ventricular(LV)pressure was greater than 60%as assessed by the pressure measuring needle during the operation.Pre-and post-operative echocardiography were performed.Histopathological examination of RV tissues was performed at the end of the experiment.Results:During the establishment of the animal models,2 piglets died due to hemorrhagic shock,while 3 piglets survived and were included in the analysis.Systolic RV pressure,systolic PA pressure and mean PA pressure(measured at the proximal end of the constriction)were significantly increased immediately after PA banding,mean RV pressure and mean PA pressure were significantly inreased at 14 weeks postopseratively(all P<0.05).Tricuspid annulus plane systolic excursion and peak early diastolic velocity of tricuspid annulus(TV e’)decreased immediately after operation(all P<0.05).They returned to the pre-operative level in the following three weeks.The absolute values of RVGLS were reduced after PA banding(all P>0.05).The RVGLS of the inner membrane layer began to recover after 3 weeks,and the RVGLS of the middle and outer membrane layers began to recover after 7 weeks.However,the time to peak RVGLS was significantly prolonged and could not be restored even untill the end of the experiment(14 weeks after surgery)(all P<0.05).At the end of the experiment,pathological examination revealed fibrous tissue hyperplasia in both the myocardial interstitium and endocardium.Conclusions:The measurement of intracardiac pressure and pathological results confirmed the success of the establishment of the animal model of increased right ventricular afterload.Both stress and strain cannot truly represent the intrinsic characteristics o

关 键 词：长轴应变 应变达峰时间 压力负荷 右心室纤维化 

分 类 号：R54[医药卫生—心血管疾病]