应用超声斑点追踪技术评价房间隔缺损封堵前后心脏旋转运动的变化

Evaluation the changes of left ventricular rotation using speckle tracking imaging after transcatheter closure of ASD

目的:探讨房间隔缺损(ASD)患者右室容量负荷增加及右室重构对左室心尖部、基底部的旋转运动的影响,并评价经皮房间隔缺损封堵术对左室旋转运动的急性期影响。方法:应用超声斑点追踪显像技术分别测量25例单纯房间隔缺损的患者术前及封堵术后3天的左室基底部及心尖部短轴6个节段的收缩期的旋转角度峰值及平均峰值,绘出左室基底部及心尖部短轴的平均旋角度—时间曲线;双平面Simpson法测左室射血分数(LVEF)。25例年龄性别匹配的正常人作为对照。结果:与对照组相比,ASD组术前基底部前间隔、侧壁、后壁、下壁、后间隔的顺时针旋转角度峰值减低(P<0.05),前壁的旋转角度峰值也减低,但差异无统计学意义。而术前左室心尖部短轴6个节段的收缩期的旋转角度峰值均较对照组降低,但是差异无统计学意义。而ASD组术后基底部前间隔、侧壁、后壁、下壁、后间隔的顺时针旋转角度峰值较术前升高(P<0.05),前壁的旋转角度峰值也升高,但差异无统计学意义。术后左室心尖部短轴6个节段的收缩期的旋转角度峰值较术前升高,但是差异无统计学意义。与正常对照组而言,ASD患者术后除侧壁仍较低外,其余各节段的旋转角度均接近正常对照组。结论:ASD引起的右室容量负荷增加及右室重构对左室基底部的旋转和左室整体扭转运动有影响,对心尖部的旋转运动的影响不明显。经皮房间隔缺损封堵术可以改善左室基底部的旋转因而也改善了左室整体扭转运动。

Objective：To investigate the left ventricular rotation in patients with atrial septal defect（ASD）after transcatheter closure of ASD.Methods：Using speckle tracking imaging（STI）,the rotation of 6 segments of basal and apical short-axises were measured repeatedly in 25 patients with ASD before and after closure.25 healthy subjects were included as controls.The global rotation of the 6 segments in basal and apical short-axises versus time profile were drawn,and the peak rotation of basal and apical short-axises were calculated.LV ejection fraction（EF）was measured by biplane Simpson method.Results：Compared with healthy subjects,the peak rotation of antsept wall,laterior wall,posterior wall,inferior wall and postsept wall in basal of ASD group were lower（P 〈 0.05）.There was no significant difference between two groups on the peak rotation.LV rotation of apical short-axise increased after close,but was still lower than that of control group（P 〉 0.05）.Conclusion：Transcatheter closure of ASD could increase rotation of basal short-axises,and also improve LV twist.