实时三维超声心动图评价心肌致密化不全患儿左心室收缩功能

Evaluation of left ventricular systolic function in children with left ventricular noncompaction using real-time three-dimensional echocardiography

目的探讨实时三维超声心动图(RT-3DE)评价心肌致密化不全患儿左心室整体及局部收缩功能的价值。方法依据常规超声左心室射血分数(LVEF)将34例LVNC患儿分为LVEF正常组(A组,LVEF≥50%,25例)及LVEF减低组(B组,LVEF<50%,9例),选取同期20名健康儿童作为正常对照组(C组),行RT-3DE检查,测量左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)及LVEF,计算收缩末期左心室最厚处非致密心肌/致密心肌比值(NC/C)并观察左心室17节段心肌受累情况,通过左心室容积-时间曲线分析获得节段舒张末期容积(rEDV)、节段收缩末期容积(rESV)及节段射血分数(rEF),并进行统计分析。结果与C组比较,A组LVEDV(t=-0.17,P=0.87)、LVESV(t=0.79,P=0.44)及LVEF(t=-1.72,P=0.10)差异均无统计学意义;B组LVEDV(t=1.62,P=0.15)差异亦无统计学意义,但LVESV明显增大(t=2.85,P=0.03),且LVEF明显减低(t=-6.15,P<0.01)。A组NC/C与B组间差异无统计学意义(t=-1.15,P=0.27),但左心室心肌受累节段数更少(t=-4.59,P=0.03)。A组与C组间左心室17节段rEDV及rESV差异均无统计学意义(P均>0.05),左心室中部后间隔、后壁及后侧壁、心尖部间隔、下壁及侧壁rEF差异均有统计学意义(P均<0.05)。B组均与C组间左心室17节段rEDV差异无统计学意义(P均>0.05),基底部后侧壁及前侧壁、中部前壁、前间隔、后壁、后侧壁及前侧壁、心尖部前壁、间隔及侧壁rESV、左心室17节段rEF差异均有统计学意义(P均<0.05)。结论应用RT-3DE技术评估LVNC患儿整体和局部收缩功能有利于早期诊断、治疗和改善预后。

Objective To observe the value of real-time three-dimensional echocardiography(RT-3 DE)for evaluating left ventricular global and regional systolic function in children with left ventricular noncompaction(LVNC).Methods According to left ventricular ejection fraction(LVEF)detected with conventional echocardiography,34 children with LVNC were divided into LVEF normal group(group A,LVEF≥50%,n=25)and LVEF reduced group(group B,LVEF<50%,n=9),while 20 healthy children were selected as normal control group(group C)at the same period.RT-3 DE examinations were performed,left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV)and LVEF were measured.The ratio of noncompaction myocardium to compaction myocardium(NC/C)at the thickest area on end-systolic count were calculated.The involvements of left ventricular 17-segment myocardium were observed.Regional end-diastolic volume(rEDV),regional end-systolic volume(rESV)and regional ejection fraction(rEF)were obtained with left ventricular volume-time curve analysis.The data were statistically analyzed.Results There was no statistical difference of LVEDV(t=-0.17,P=0.87),LVESV(t=0.79,P=0.44)and LVEF(t=-1.72,P=0.10)between group A and C,nor of LVEDV(t=1.62,P=0.15)between group B and C.In group B,LVESV significantly increased(t=2.85,P=0.03),while LVEF significantly decreased compared with that in group C(t=-6.15,P<0.01).No statistical difference of NC/C was found between group A and B(t=-1.15,P=0.27),but the number of affected segments in group A was significantly fewer than that in group B(t=-4.59,P=0.03).There was no statistical difference of rEDV and rESV in all of 17 segments of myocardium in left ventricular between group A and C(all P>0.05),while rEF of apical septal,inferior and lateral segments,as well as med inferoseptal,inferior and inferolateral segments were significantly different between group A and C(all P<0.05).There was no significant difference of rEDV in all 17 segments of myocardium in left ventricular between group B and C(all P>0.05),while rESV of basal inferolateral and anterolateral segments,med anterior,anteroseptal,inferior,inferolateral and anterolateral segments,apical anterior,septal and lateral segments,as well as rEF in all 17 segments of myocardium in left ventricular were significantly different between group B and C(all P<0.05).Conclusion RT-3 DE can be used to evaluate the regional and global systolic function,which is helpful to early diagnosis,treatment and prognosis of LVNC children.