二维超声斑点追踪显像技术评价法洛四联症患者左室整体纵向功能的临床研究

Clinical study of left ventricular global longitudinal function in patients with tetralogy of fallot by two-dimensional ultrasound speckle tracking imaging

目的探讨超声斑点追踪显像技术在评价法洛四联症(TOF)患者左室整体纵向功能中的作用。方法正常对照组38例;TOF患者38例,并按照年龄将其分为儿童组和成人组。应用二维超声斑点追踪显像技术测量左室整体纵向收缩峰值应变(GLS)、收缩峰值应变率(GLSRs)、舒张早期峰值应变率(GLSRe)及舒张晚期峰值应变率(GLSRa)。用双平面Simpson法测量左室射血分数(LVEF),并分析上述指标与心功能的关系。结果①与对照组比较,TOF患者左室GLS、GLSRs和GLSRe显著减低,GLSRa增高,差异有统计学意义(均P<0.05);②与儿童组TOF患者比较,成人组TOF患者左室GLSRs、GLSRe和GLSRa减低,差异有统计学意义(均P<0.05),成人与儿童TOF患者之间左室GLS差异无统计学意义(P>0.05);③LVEF与左室GLS、GLSRs和GLSRe相关,r值分别为0.751、0.714和0.468。三尖瓣环收缩期最大位移和收缩期峰值速度均与左室GLS弱相关,r值分别为-0.321和-0.317。结论法洛四联症患者的左室整体纵向功能减低,且以成人TOF患者减低更加显著。二维超声斑点追踪显像技术可准确、客观地评价左室整体纵向功能。

Objective To assess left ventricular（LV） global longitudinal function in patients with tetralogy of Fallot （TOF） by two-dimensional ultrasound speckle tracking imaging （STI）. Methods According to age, patients with TOF were divided into children group（25 cases） and adult group（ 13 cases）, and 38 normal subjects were as conrol group. LV global longitudinal peak systolic strain （ GLS）, strain rate（ GLSRs ）, early diastolic strain rate （ GLSRe ） and late diastolic strain rate （GLSRa）were measured by STI. Left ventricular ejection fraction （LVEF） was calculated based on biplane Simpson. The correlations between myocardial function and the above parameters were analyzed. Results Compared with control group, left ventricular GLS, GLSRs, GLSRo were significantly decreased, whereas GLSRa was increased in patients with TOF （ all P 〈0. 05 ）. Left ventricular GLSRs ,GLSRe, GLSRa were most altered in adult group compared with children group（ all P 〈0. 05 ）. There was no significant deference in left ventricular GLS between two groups （P〉0. 05）. Left ventricular GLS, GLSRa and GLSRe had correlations with LVEF （ rI = 0. 751, Pt = 0. 000 ; r2 = 0. 714, P2 = 0. 000 ; r3 = 0. 468, P3 = 0. 000 ）. Tricuspid annular plane systolic excursion and peak systolic velocity had weak correlations with left ventricular GLS （ r1 = - 0. 321, P1 = 0. 001 ; r2 = -0. 317 ,P2 =0. 001 ）. Conclusion Left ventricular global longitudinal function decreases in patients with TOF, especially in adult patients. Left ventricular global longitudinal function can be accurately and objectively studied by STI.