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超声心动图评价房间隔缺损合并肺动脉高压患者接受介入封堵术前后左心室纵向收缩功能 |
左武旭1,2,3, 吴元丰1,2,3, 李权1,2,3, 陈丹丹3,4, 董丽莉1,2,3, 孔德红1,2,3, 潘翠珍1,2,3, 舒先红1,2,3,4
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1.复旦大学附属中山医院心脏超声诊断科, 上海 200032;2.上海市影像医学研究所, 上海 200032;3.上海市心血管病研究所, 上海 200032;4.复旦大学附属中山医院心内科, 上海 200032
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摘要: |
目的 应用超声心动图评价房间隔缺损(atrial septal defect,ASD)合并肺动脉高压(pulmonary hypertension,PH)患者在介入封堵术前后左心室纵向收缩功能改变。方法 选择2015年9月至2016年1月在复旦大学附属中山医院进行介入封堵术的ASD患者57例,分为PH组和non-PH组。于术前1 d、术后1 d和术后1~6个月对患者进行超声心动图检查。另选择20例健康人作为对照。应用TomTec软件分析三维左心室整体及16节段纵向应变(longitudinal strain,LS)。结果 PH组共27例,non-PH组共30例。基线状态下,两ASD组患者右心室的收缩功能,包括三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)和三尖瓣环组织多普勒运动速度(S’)较对照组增加(P<0.05)。ASD患者术后1 d右心室纵向收缩功能降低(P<0.05),术后1~6个月小幅上升,但未恢复至术前水平。non-PH组患者术后1 d及1~ 6个月左心室部分节段LS减小(P<0.05); PH组术后1 d左心室整体纵向应变(global longitudinal strain,GLS)减小(P< 0.05),主要为基底部和心室中段LS减小,心尖部LS无明显变化,术后1~6个月左心室GLS有增加趋势。结论 无论合并PH与否,ASD患者封堵术前均出现右心室纵向过度运动,封堵术后逐渐改善;合并PH的ASD患者封堵术后1 d,左心室GLS减小,具有节段性差异。 |
关键词: 超声心动图 心室功能 三维纵向应变 房间隔缺损 肺动脉高压 |
DOI:10.12025/j.issn.1008-6358.2023.20221557 |
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基金项目:国家自然科学基金(81771837),上海市卫生健康委员会青年基金项目(20204Y0345),上海申康临床研究青年项目(SHDC2020CR4071). |
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Echocardiographic evaluation of left ventricular longitudinal systolic function in patients with atrial septal defect and pulmonary hypertension before and after interventional occlusion |
ZUO Wu-xu1,2,3, WU Yuan-feng1,2,3, LI Quan1,2,3, CHEN Dan-dan3,4, DONG Li-li1,2,3, KONG De-hong1,2,3, PAN Cui-zhen1,2,3, SHU Xian-hong1,2,3,4
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1.Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2.Shanghai Institute of Medical Imaging, Shanghai 200032, China;3.Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China;4.Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract: |
Objective To investigate the dynamic changes of left ventricular longitudinal systolic function in patients with atrial septal defect (ASD) and pulmonary hypertension (PH) before and after interventional occlusion using echocardiography. Methods A total of 57 patients undergoing interventional occlusion in Zhongshan Hospital, Fudan University from September 2015 to January 2016 were enrolled.Patients were divided into PH group and non-PH group. Echocardiographic examinations were performed for all subjects one day before, one day after and 1-6 months after the interventional occlusion. Twenty healthy individuals were included as a control group. Global and regional longitudinal strain (LS) of the left ventricle were analyzed using TomTec software. Results There were 27 patients in the PH group and 30 patients in the non-PH group. At baseline, tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler velocity of tricuspid annulus S' in both the PH and non-PH groups were higher than those in the control group (P<0.05). Longitudinal systolic function of the right ventricle decreased significantly on the first day after occlusion (P<0.05), and slightly increased 1-6 months after occlusion. Patients in the non-PH group showed a decreased LS in a small portion of the left ventricular segments 1 d and 1-6 months after occlusion (P<0.05); patients in the PH group showed a decreased left ventricular global longitudinal strain (GLS) on the first day after occlusion (P<0.05), primarily was in the basal and middle parts of the ventricle (P<0.05), without significant change in the apical part, and the LS of the left ventricle tended to increase 1-6 months after occlusion. Conclusions With or without PH, longitudinal movement of the right ventricle in ASD patient is excessive before occlusion, and gradually improves after occlusion. Left ventricular GLS decreases in ASD patients with PH, with segmental differences 1 day after occlusion. |
Key words: echocardiography left ventricular function three-dimensional longitudinal strain atrial septal defect pulmonary hypertension |
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