斑點(diǎn)追蹤成像在肥厚型梗阻性心肌病患者室間隔酒精消融術(shù)后隨訪中的應(yīng)用價(jià)值
發(fā)布時(shí)間：2019-02-16 01:23
【摘要】：目的探討斑點(diǎn)追蹤成像(speckle tracking imaging,STI)在肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)患者行室間隔酒精消融術(shù)(alcohol septal ablation,ASA)術(shù)后隨訪中的應(yīng)用價(jià)值。方法對(duì)照組為30例健康志愿者,其中男性16例,女性14例,年齡28~40(34.30±6.10)歲;病例組為2012年4月至2014年7月西南醫(yī)院心內(nèi)科住院部HOCM患者19例,其中男性8例,女性11例,年齡32~67(46.53±11.66)歲;對(duì)照組和病例組均行超聲檢查(病例組為ASA術(shù)前和術(shù)后3 d,1、3、6個(gè)月共5次),獲得左心室射血分?jǐn)?shù)(left ventricular ejection fraction,LVEF)、左心室流出道壓力階差(left ventricular outflow tract pressure gradient,LVOTG)、室間隔(interventricular septum,IVS)厚度等指標(biāo);同時(shí)應(yīng)用STI技術(shù)、QLAB軟件獲得左室各節(jié)段縱向、徑向、周向收縮期峰值應(yīng)變及應(yīng)變率,將左室心肌分為肥厚節(jié)段和非肥厚節(jié)段,分別比較以上各指標(biāo)在不同時(shí)期的差異。結(jié)果HOCM患者術(shù)前和術(shù)后3 d,1、3、6個(gè)月LVOTG較對(duì)照組增高(P0.05),術(shù)后LVOTG較術(shù)前明顯下降(P0.05)。術(shù)后3 d IVS厚度較術(shù)前稍有下降,術(shù)后1、3、6個(gè)月IVS厚度明顯低于術(shù)前(P0.05)。術(shù)前及術(shù)后各隨訪時(shí)間點(diǎn)所測(cè)LVEF均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。肥厚節(jié)段術(shù)前、術(shù)后各方向收縮期峰值應(yīng)變(率)均低于對(duì)照組(P0.05)。與術(shù)前比較,肥厚節(jié)段術(shù)后3 d各方向應(yīng)變(率)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后1、3、6個(gè)月各方向收縮期峰值應(yīng)變(率)均增高(P0.05)。術(shù)前及術(shù)后肥厚節(jié)段應(yīng)變(率)均低于非肥厚節(jié)段(P0.05)。非肥厚節(jié)段、術(shù)前縱向應(yīng)變(率)低于對(duì)照組(P0.05),而術(shù)后各隨訪時(shí)間點(diǎn)縱向應(yīng)變(率)高于術(shù)前(P0.05),并且與對(duì)照組無(wú)明顯差異(P0.05)。結(jié)論應(yīng)用STI技術(shù)評(píng)價(jià)HOCM患者應(yīng)變及應(yīng)變率的變化,反映出HOCM患者行ASA能夠提高肥厚心肌節(jié)段的局部心功能,并且能幫助非肥厚心肌節(jié)段恢復(fù)心功能;STI技術(shù)能夠成為HOCM患者ASA術(shù)后長(zhǎng)期隨訪的一種準(zhǔn)確、無(wú)創(chuàng)、可重復(fù)性強(qiáng)的影像學(xué)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 鹵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 鹵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.
【作者單位】： 第三軍醫(yī)大學(xué)西南醫(yī)院超聲科;第三軍醫(yī)大學(xué)西南醫(yī)院心血管內(nèi)科 重慶市介入心臟病學(xué)研究所;
【基金】：國(guó)家國(guó)際科技合作專項(xiàng)資助項(xiàng)目(2015DFA30920)~~
【分類號(hào)】：R542.2;R540.45
本文編號(hào)：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 鹵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 鹵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.
【作者單位】： 第三軍醫(yī)大學(xué)西南醫(yī)院超聲科;第三軍醫(yī)大學(xué)西南醫(yī)院心血管內(nèi)科 重慶市介入心臟病學(xué)研究所;
【基金】：國(guó)家國(guó)際科技合作專項(xiàng)資助項(xiàng)目(2015DFA30920)~~
【分類號(hào)】：R542.2;R540.45
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