超声斑点追踪成像评价法洛四联症患者术后右心室局部及整体功能

Assessment of right ventricular regional and global function in patients with repaired tetralogy of Fallot by ultrasound speckle tracking imaging

目的应用超声斑点追踪成像（STI）技术评价法洛四联症（TOF）患者术后右室局部及整体功能。方法正常对照组35例，无症状TOF术后（术后〉1年）患者36例，获取心尖四腔观，应用STI技术测量并记录右室游离壁及室间隔基底段、中间段、心尖段纵向收缩峰值应变（e）、收缩峰值应变率（SRs）及右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）、舒张晚期峰值应变率（GLSRa），并分析右室收缩指标与术后时间、肺动脉瓣反流程度和QRS间期的关系。结果①TOF患者术后右室游离壁、室间隔部分节段￡、SRs及GLs、GLSRs、GLSRe、GLSRa均低于对照组，差异有统计学意义（P均〈0．05），且跨瓣环补片组GI＆GI，SRs较右室流出道补片组进一步减低。②TOF术后轻、中、重度肺动脉瓣反流组GLs、GLSRs、GI．SRe、GLSRa均低于对照组，但肺动脉瓣不同反流程度组间比较右搴整体功能无差异。③GLSRs与qRS间期及术后时间呈负相关（r1=-0．431，P1=0．009；r2=0．469，P2=0．004），GLS、GLSRs和肺动脉瓣反流程度无关。结论TOF患者术后长期右室局部及整体功能减低，STI可早期发现无症状TOF患者术后右室功能不全。手术方式影响术后长期右室功能，右室形变异常与电去极化异常有关。

Objective To assess right ventricular（RV） regional and global function in patients with repaired tetralogy of Fallot （TOF） by speckle tracking imaging （STI）. Methods 36 asymptomatic patients with repaired T（）I5 whose postoperative period is more than one year and 35 healthy controls were studied. RV longitudinal peak systolic strain （ε）, strain rate （SRs） were measured in RV free wall and interventricular septum（IVS） for basal, mid and apical segments by STI from the apical 4-chamber view, RV global longitudinal peak systolic strain （GLS）, strain rate （GI.SRs）, early diastolic strain rate （GI.SRe） and late diastolic strain rate （GLSRa） were measured from the above view. The correlations between RV systolic functional parameters and the postoperative period, degree of pulmonary regurgitation （PR） and QRS duration were explored. Results （1）Compared with controls, εand SRs of RV free wall and IVS for most segments,GLS, GLSRs, GLSRe, and GLSRa were significantly impaired in patients with repaired TOF （P 〈 0. 05 for all）. Both GLS and GLSRs were lower in postoperative patients with transannular patch than in those with RV out tract patch. （2）In comparison with controls, GLS, GI.SRs, GLSRe and GLSRa were decreased in postoperative patients with mild, mid and severe PR, Whereas, there was no difference in RV global function among the patients with varying degree of PR. （3）GLSRs of RV was correlated inversely with postoperative period and QRS duration（r1 - - 0.431 , P2 = 0. 009 ; r2 = - 0. 469, P2 = 0. 004） , RV GLS and GLSRs had no correlation with PR. Conclusions RV regional and global function in patients with late repaired TOF are decreased, STI can early detect right ventricular dysfunction in asymptomatic patients with repaired TOF. The type of operation impacts on late prognosis, RV abnormal deformations are associated with electrical depolarization abnormalities