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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

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Keywords: 超声心动描记术,二维应变,肥厚型梗阻性心肌病,室间隔酒精消融术

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Abstract:

目的探讨斑点追踪成像(speckletrackingimaging,STI)在肥厚型梗阻性心肌病(hypertrophicobstructivecardiomyopathy,HOCM)患者行室间隔酒精消融术(alcoholseptalablation,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3d,1、3、6个月共5次),获得左心室射血分数(leftventricularejectionfraction,LVEF)、左心室流出道压力阶差(leftventricularoutflowtractpressuregradient,LVOTG)、室间隔(interventricularseptum,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3d,1、3、6个月LVOTG较对照组增高(P<0.05),术后LVOTG较术前明显下降(P<0.05)。术后3dIVS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(P<0.05)。术前及术后各随访时间点所测LVEF均无统计学差异(P>0.05)。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(P<0.05)。与术前比较,肥厚节段术后3d各方向应变(率)差异无统计学意义(P>0.05);术后1、3、6个月各方向收缩期峰值应变(率)均增高(P<0.05)。术前及术后肥厚节段应变(率)均低于非肥厚节段(P<0.05)。非肥厚节段、术前纵向应变(率)低于对照组(P<0.05),而术后各随访时间点纵向应变(率)高于术前(P<0.05),并且与对照组无明显差异(P>0.05)。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。

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