二维应变超声心动图评价移植心脏左心室收缩功能

Left ventricular systolic function evaluated by two-dimensional strain echocardiography in heart transplant recipients

目的应用二维应变超声心动图检测移植心脏左室壁峰值收缩应变,探讨二维应变超声心动图评价移植心脏左室收缩功能的价值。方法9例心脏移植受者共进行41次超声检查;23例正常人作为对照。记录心尖长轴观、心尖两腔观及心尖四腔观的高帧频二维图像,应用二维应变分析软件测量左室壁各节段的峰值收缩应变及心尖各切面观心肌总的峰值收缩应变、左室整体平均峰值收缩应变。结果无排异反应的心脏移植受者与正常人相比,除了4个心尖节段（后壁心尖段、前间隔心尖段、侧壁心尖段、前壁心尖段）外,左室壁各节段峰值收缩应变均显著降低（P〈0.05）;心尖各切面观心肌总的峰值收缩应变及左室整体平均峰值收缩应变均较正常显著降低（P〈0.05）。急性排异反应与无排异反应的心脏移植受者后室间隔及侧壁各节段相比,峰值收缩应变均有下降趋势,但仅后室间隔心尖段峰值收缩应变降低具有统计学意义（P〈0.05）。急性排异反应的心脏移植受者心尖四腔观心肌总的峰值收缩应变较无排异反应的心脏移植受者则显著降低（P〈0.05）。结论二维应变超声心动图可用于快速准确评价移植心脏左室收缩功能,在排异反应诊断方面具有潜在价值。

Objective To evaluate the value of two-dimensional strain echocardiography for assessing left ventricular systolic function in heart transplant recipients. Methods Nine heart transplant recipients underwent 41 echocardiographic studies after heart transplantation. High frame rate two-dimensional images were recorded from apical long-axis view, four-chamber view, two-chamber view of left ventricle. Peak systolic strain of left ventricular segments,global peak systolic strain of apical long-axis view, four-chamber view, two-chamber view and average global peak systolic strain of whole left ventricle were measured using two-dimensional strain software. Twenty-three healthy individuals were measured as controls. Results The peak systolic strain of all left ventricular segments except apical segments in anteroseptal, anterior, posterior and lateral walls reduced significantly in transplant recipients with no rejection when compared with the controls（ P〈0.05）. The global peak systolic strain of apical long-axis view, four-chamber view, two-chamber view and average global peak systolic strain of whole left ventricle in transplant recipients with no rejection were significantly lower than those of the controls （ P 〈0. 05）. Although the peak systolic strain of segments in septum and lateral wall in transplant recipients with rejection had the tendency to decrease when compared with transplant recipients with no rejection,only the peak systolic strain of apical septum significantly decreased（ P〈0.05）. However, the global peak systolic strain of apical four-chamber view in transplant recipients with rejection reduced significantly when compared with transplant recipients with no rejection （ P〈0.05）. Conclusions Two-dimensional strain echocardiography can precisely quantify left ventricular systolic function noninvasively in heart transplant recipients and has the potential value to diagnose rejection.