斑点追踪超声心动图评价移植心脏左心室旋转及扭转

Evaluation of left ventricular rotation and twist by speckle tracking echocardiography in heart transplant recipients

目的 应用斑点追踪超声心动图测量移植心脏左室壁峰值旋转及扭转角度,并观察其随移植术后时间的变化趋势,建立移植心脏左室旋转及扭转在无并发症的稳定的临床状态时的“正常”值.方法 26例心脏移植患者于移植术后1个月、术后3个月、术后6个月、术后12个月进行超声心动图检查,26例正常人作为对照.采集左室短轴基底水平及心尖水平的高帧频动态二维图像,导入EchoPAC工作站进行分析,获取基底部和心尖部旋转角度以及左室壁扭转角度随心动周期的变化曲线,记录左室基底部和心尖部峰值旋转角度、左室壁峰值扭转角度,并进行统计学分析.结果 心脏移植患者与正常对照者左室射血分数及左室短轴缩短率的差异无统计学意义,心脏移植患者左室心尖部峰值旋转角度[术后1个月（7.56±4.55）°,术后3个月（9.14±4.42）°,术后6个月（7.84±3.65）°,术后12个月（8.03±4.96）°;正常组（13.66±5.57）°]、左室壁峰值扭转角度[术后1个月（12.88±4.45）°,术后3个月（14.07±5.69）°,术后6个月（12.14±3.96）°,术后12个月（11.89±4.68）°;正常组（17.03±5.38）°]均较正常对照组显著减低（P＜0.05）,差异具有统计学意义;左室基底部峰值旋转角度与正常组的差异无统计学意义[术后1个月（-5.58±2.70）°,术后3个月（-4.94±3.58）°,术后6个月（-5.02±2.62）°,术后12个月（-4.34±2.99）°;正常组（-4.14±1.87）°,P＞0.05].心脏移植术后各组间比较,左室心尖部峰值旋转角度、左室基底部峰值旋转角度、左室壁峰值扭转角度的差异均无统计学意义（P＞0.05）.结论 移植心脏虽然左室整体功能正常,但心尖部旋转及左室扭转仍较正常人减低.斑点追踪超声心动图为准确评价移植心脏左室旋转及扭转提供了简便快捷的方法.

Objective To evaluate the left ventricular rotation and twist in the cardiac allograft by speckle tracking echocardiography.Methods Twenty-six heart transplant recipients underwent echocardiographic studies at 1st,3rd,6th and 12th month after heart transplantation.Twenty-six healthy subjects served as controls.Parasternal basal and apical short-axis images of left ventricle were recorded and then were analyzed using EchoPAC software.The curves of basal and apical rotation and left ventricular twist were obtained,Peak values of basal and apical rotation and left ventricular twist were measured and then statistically analyzed.Results There were no significant differences in left ventricular ejection fraction （LVEF） and fractional shortening （LVFS） between heart transplant recipients and controls （P 〉0.05）.The left ventricular twist,apical rotation were significantly lower in heart transplant recipients at 1 st,3rd,6th and 12th month after surgery than those in controls （P 〈0.05） ;while basal rotation in heart transplant recipients had no significant difference when compared with controls （P 〉0.05）.The left ventricular twist,apical and basal rotation in heart transplant recipients among 1 st,3rd,6th and 12th month after surgery had no significant difference （P 〉 0.05）.Conclusions Although the LVEF and LVFS of cardiac allograft seemed “normal”,the left ventricular twist,apical rotation were still significantly lower in heart transplant recipients than those in controls.Speckle tracking echocardiography can be used for accurate assessment of left ventricular twist in heart transplant recipients.