超声心动图观察围生期心肌病患者转归的研究

Utility of echocardiography in evaluating the outcome of peripartum cardiomyopathy patients

目的探寻影响围生期心肌病患者临床转归的超声因素。方法观察21例围生期心肌病患者首次检查、随访第2个月和随访1年时超声心动图表现,根据随访1年时左心室射血分数(LVEF)是否>35%及临床表现归入病情改善及病情持续组,超声心动图测量左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、LVEF,评价左心室舒张功能并观察各瓣膜关闭不全。利用单因素分析探索与围生期心肌病患者临床转归相关的超声因素。结果 21例围生期心肌病患者随访1年时15例病情改善,6例病情持续,无患者死亡。病情改善组首次检查、随访第2个月及随访1年时LVEDd及LVESd较病情持续组小(P<0.05),两组之间首次检查LVEF差异无统计学意义(P>0.05),随访第2个月及随访1年时病情改善组LVEF明显提高(P<0.01)。随访第2个月、随访1年时病情持续组二尖瓣、三尖瓣、主动脉瓣关闭不全及随访1年时左心室舒张功能障碍检出率较病情改善组增高(P<0.05)。单因素分析发现首次检查LVEDd≥60mm和随访第2个月LVEF<30%患者随访1年时病情持续率较高。结论超声心动图能够观察围生期心肌病患者临床转归,首次检查LVEDd≥60mm和随访第2个月LVEF<30%患者病情常持续,需引起特别关注。

Objective To study the related factors of peripartum cardiomyopathy （PPCM）patients outcomes for echocardiography characteristics. Methods A prospective study over a 1-year period with 21 consecutive women presenting with PPCM were enrolled on first diagnosis, echocardiography assessments were performed at two month and one year after diagnosed. Patients were categorized at one year after diagnosis of their ejection fraction （EF） into persistent left ventricular dysfunction group （EF ≤35% ） and non-persistent left ventricular dysfunction group （ EF 〉 35% ）. The diastolic diameters of left ventricular （ LVEDd）, the systolic diameters of left ventricular （ LVESd）, the left ventricular ejection fraction（ LVEF）, the rate of left ventricular diastolic dysfunction, mitral insufficiency （ MI ） , tricuspid insufficiency （ TI ）, aortic insufficiency（AI） and pulmonary insufficiency（PI） were estimated by echocardiography. Univariate regression were analyzed to study the related factors for PPCM patients＇ outcomes. Results Fifteen patients EF 〉 35% at one year follow-up, and six patients EF ≤35%, nobody died in this period. Patients in persistent left ventricular dysfunction group showed a larger LVEDd and LVESd than non-persistent left ventricular dysfunction group in first diagnosis, two month and one year after diagnosis （ P 〈 0. 05 ） , and there is no significantly difference between two groups in first diagnosis with LVEF （P 〉 0. 05 ）. Nonpersistent left ventficular dysfunction group patients＇ LVEF improved at two month and one year after diagnosis than persistent left ventricular dysfunction group （P 〈 0. 01 ）. Patients in persistent left ventricular dysfunction group showed a higher rate of MI, TI, PI at two month and one year after diagnosis, and a higher rate of left ventricular diastolic dysfunction at one year after diagnosis than non-persistent left ventricular dysfunction group （ P 〈 0. 05 ）. LVEDd i〉 60 mm at first diagnosis and EF 〈 30% at two month after diagnosis were correlated with persistent left ventricular dysfunction by univatriat analysis. Conclusions Echocardiography can estimate the outcome of peripartum cardiomyopathy. Patients with LVEDd ≥60mm at first diagnosis and EF 〈 30% at two month after diagnosis were correlated with poor outcome.