斑点追踪成像在肥厚型梗阻性心肌病患者室间隔酒精消融术后随访中的应用价值
发布时间：2019-02-16 01:23
【摘要】：目的探讨斑点追踪成像(speckle tracking imaging,STI)在肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)患者行室间隔酒精消融术(alcohol septal ablation,ASA)术后随访中的应用价值。方法对照组为30例健康志愿者,其中男性16例,女性14例,年龄28~40(34.30±6.10)岁;病例组为2012年4月至2014年7月西南医院心内科住院部HOCM患者19例,其中男性8例,女性11例,年龄32~67(46.53±11.66)岁;对照组和病例组均行超声检查(病例组为ASA术前和术后3 d,1、3、6个月共5次),获得左心室射血分数(left ventricular ejection fraction,LVEF)、左心室流出道压力阶差(left ventricular outflow tract pressure gradient,LVOTG)、室间隔(interventricular septum,IVS)厚度等指标;同时应用STI技术、QLAB软件获得左室各节段纵向、径向、周向收缩期峰值应变及应变率,将左室心肌分为肥厚节段和非肥厚节段,分别比较以上各指标在不同时期的差异。结果HOCM患者术前和术后3 d,1、3、6个月LVOTG较对照组增高(P0.05),术后LVOTG较术前明显下降(P0.05)。术后3 d IVS厚度较术前稍有下降,术后1、3、6个月IVS厚度明显低于术前(P0.05)。术前及术后各随访时间点所测LVEF均无统计学差异(P0.05)。肥厚节段术前、术后各方向收缩期峰值应变(率)均低于对照组(P0.05)。与术前比较,肥厚节段术后3 d各方向应变(率)差异无统计学意义(P0.05);术后1、3、6个月各方向收缩期峰值应变(率)均增高(P0.05)。术前及术后肥厚节段应变(率)均低于非肥厚节段(P0.05)。非肥厚节段、术前纵向应变(率)低于对照组(P0.05),而术后各随访时间点纵向应变(率)高于术前(P0.05),并且与对照组无明显差异(P0.05)。结论应用STI技术评价HOCM患者应变及应变率的变化,反映出HOCM患者行ASA能够提高肥厚心肌节段的局部心功能,并且能帮助非肥厚心肌节段恢复心功能;STI技术能够成为HOCM患者ASA术后长期随访的一种准确、无创、可重复性强的影像学手段。
[Abstract]:Objective to investigate the value of dot-tracing imaging (speckle tracking imaging,STI) in follow-up of patients with hypertrophic obstructive cardiomyopathy (hypertrophic obstructive cardiomyopathy,HOCM) after (alcohol septal ablation,ASA. Methods the control group consisted of 30 healthy volunteers, including 16 males and 14 females, aged 2840 (34.30 卤6.10) years. From April 2012 to July 2014, 19 patients with HOCM in Department of Cardiology, Southwest Hospital, including 8 males and 11 females, aged 326.53 卤11.66 years, were enrolled in the study group. The left ventricular ejection fraction (left ventricular ejection fraction,LVEF) and left ventricular outflow tract pressure step (left ventricular outflow tract pressure gradient,LVOTG) were obtained in the control group and the case group (3 days before and 3 days after ASA, 5 times in 6 months). The thickness of ventricular septum (interventricular septum,IVS); At the same time, the peak strain and strain rate in longitudinal, radial and circumferential systolic period were obtained by STI and QLAB software. The left ventricular myocardium was divided into hypertrophic segment and non-hypertrophic segment. Results the LVOTG of patients with HOCM was significantly higher than that of the control group (P0.05) before and 3 days after operation and 6 months after operation (P0.05), and the LVOTG after operation was significantly lower than that before operation (P0.05). The thickness of IVS was slightly decreased at 3 days after operation, and the thickness of IVS was significantly lower than that before operation at 1 and 6 months postoperatively (P0.05). There was no significant difference in LVEF between preoperative and postoperative follow-up time points (P0.05). Before and after operation, peak systolic strain (rate) of hypertrophic segment was lower than that of control group (P0.05). There was no significant difference in the strain (rate) in all directions at 3 days after operation (P0.05), but the peak strain (rate) in each direction increased at 1 and 6 months after operation (P0.05). The strain rate of hypertrophic segment before and after operation was lower than that of non hypertrophic segment (P0.05). In the non-hypertrophic segment, the preoperative longitudinal strain (rate) was lower than that in the control group (P0.05), but the longitudinal strain (rate) at each follow-up time after operation was higher than that before the operation (P0.05), and there was no significant difference from the control group (P0.05). Conclusion the changes of strain and strain rate in patients with HOCM were evaluated by STI technique, which indicated that ASA in HOCM patients could improve the regional cardiac function of hypertrophic myocardial segment, and could help non-hypertrophic myocardial segment to recover cardiac function. STI technique can be an accurate, non-invasive and reproducible imaging method for long-term follow-up of ASA patients with HOCM.
【作者单位】： 第三军医大学西南医院超声科;第三军医大学西南医院心血管内科 重庆市介入心脏病学研究所;
【基金】：国家国际科技合作专项资助项目(2015DFA30920)~~
【分类号】：R542.2;R540.45
本文编号：2423900
[Abstract]:Objective to investigate the value of dot-tracing imaging (speckle tracking imaging,STI) in follow-up of patients with hypertrophic obstructive cardiomyopathy (hypertrophic obstructive cardiomyopathy,HOCM) after (alcohol septal ablation,ASA. Methods the control group consisted of 30 healthy volunteers, including 16 males and 14 females, aged 2840 (34.30 卤6.10) years. From April 2012 to July 2014, 19 patients with HOCM in Department of Cardiology, Southwest Hospital, including 8 males and 11 females, aged 326.53 卤11.66 years, were enrolled in the study group. The left ventricular ejection fraction (left ventricular ejection fraction,LVEF) and left ventricular outflow tract pressure step (left ventricular outflow tract pressure gradient,LVOTG) were obtained in the control group and the case group (3 days before and 3 days after ASA, 5 times in 6 months). The thickness of ventricular septum (interventricular septum,IVS); At the same time, the peak strain and strain rate in longitudinal, radial and circumferential systolic period were obtained by STI and QLAB software. The left ventricular myocardium was divided into hypertrophic segment and non-hypertrophic segment. Results the LVOTG of patients with HOCM was significantly higher than that of the control group (P0.05) before and 3 days after operation and 6 months after operation (P0.05), and the LVOTG after operation was significantly lower than that before operation (P0.05). The thickness of IVS was slightly decreased at 3 days after operation, and the thickness of IVS was significantly lower than that before operation at 1 and 6 months postoperatively (P0.05). There was no significant difference in LVEF between preoperative and postoperative follow-up time points (P0.05). Before and after operation, peak systolic strain (rate) of hypertrophic segment was lower than that of control group (P0.05). There was no significant difference in the strain (rate) in all directions at 3 days after operation (P0.05), but the peak strain (rate) in each direction increased at 1 and 6 months after operation (P0.05). The strain rate of hypertrophic segment before and after operation was lower than that of non hypertrophic segment (P0.05). In the non-hypertrophic segment, the preoperative longitudinal strain (rate) was lower than that in the control group (P0.05), but the longitudinal strain (rate) at each follow-up time after operation was higher than that before the operation (P0.05), and there was no significant difference from the control group (P0.05). Conclusion the changes of strain and strain rate in patients with HOCM were evaluated by STI technique, which indicated that ASA in HOCM patients could improve the regional cardiac function of hypertrophic myocardial segment, and could help non-hypertrophic myocardial segment to recover cardiac function. STI technique can be an accurate, non-invasive and reproducible imaging method for long-term follow-up of ASA patients with HOCM.
【作者单位】： 第三军医大学西南医院超声科;第三军医大学西南医院心血管内科 重庆市介入心脏病学研究所;
【基金】：国家国际科技合作专项资助项目(2015DFA30920)~~
【分类号】：R542.2;R540.45
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