实时三维超声心动图及组织多普勒评价心脏移植术后右心室功能的变化

Right ventricular function evaluated by real-time three-dimensional echocardiography and tissue Doppler imaging in heart transplant patients

目的探讨超声心动图参数在诊断心脏移植术后排斥反应中的价值。方法2000年8月至2008年12月在复旦大学附属中山医院行心脏移植后随访的患者30例,根据心内膜活检(EMB)和临床诊断分为排斥组(A组)和非排斥组(B组)。选取健康体检成年人30例作为正常对照(C组)。所有研究对象行常规超声心动图检查;脉冲多普勒记录三尖瓣、肺动脉瓣血流图;组织多普勒记录三尖瓣环右室侧壁频谱;实时三维超声心动图(RT3DE)采集右室全容积图像储存光盘并进行脱机分析。结果(1)A、B组左房内径均大于C组(P均<0.05)。A组右室射血分数明显低于B组(P<0.01),B组右室射血分数略低于C组(P<0.05)。(2)A、B组右室每搏输出量小于C组(P均<0.05),A组右室体部和流出道部局部射血分数均小于B组和C组(P均<0.05),B组右室流出道部射血分数小于C组。(3)A组三尖瓣环右室侧壁的收缩速度较B组降低(P<0.05),B组右室侧壁的收缩速度和A峰峰值速度低于C组(P<0.05)。(4)RT3DE测得的右室射血分数与右室Tei指数及三尖瓣环右室侧壁的收缩速度有较好相关性(r分别为0.592和0.543,P<0.01)。结论心脏移植术后排斥患者右室收缩功能较正常人明显下降,非排斥患者右室收缩功能较正常人略有下降,实时三维右室射血分数和组织多普勒参数有助于心脏移植术后排斥反应的诊断。

Objective This study was aimed to evaluate the potential role of right ventricular echocardiography in detecting allograft rejection in heart transplant patients. Methods The heart transplant recipients were divided into rejection group （group A） and non-rejection group （group B ）, based on endomyocardial biopsy and clinical diagnosis. Two-dimensional echocardiography and Real-time Three-dimensional echocardiography （RT3DE）, pulse wave Doppler and tissue Doppler （TDI） were performed in heart transplant patients （ group A and B） and normal controls （ group C）. Results Left atrial diameter in group A and B was enlarger than that of group C（P 〈0. 05）. RVEF with RT3DE in group A was lower than those of group B and C （ P 〈 0.01 ）, RVSV in group A and B was lower than in group C （ P 〈 0. 05 ）, EF of RV body and outflow tract were decreased significantly in group A （ P 〈 0. 05 ）. systolic velocity in tricuspid annulus and right ventrieular wall, velocity of peak A in group A were reduced significantly compared with those of group B and C （P 〈 0. 05 ）. There were correlations between RVEF with RT3DE and both right ventricular Tei index （r = 0. 592 ,P 〈 0. 01 ） and TD-derived systolic velocity in tricuspid annulus and right ventrieular wall （ r = 0. 543, P 〈 0. 01 ）. Conclusions Right ventricular systolic function deteriorated significantly in allograft rejection heart transplants compared with healthy subjects, and right ventricular systolic function decreased slightly in non-rejection recipients. Right ventricular EF with RT3DE and systolic velocity and velocity of peak A could be useful in detecting allograft rejection.