微创左心室折叠减容术后左心室血流动力学变化的双模态影像学对比研究

Comparative study of left ventricular hemodynamic changes after Revivent surgery by dual-modality imaging

目的应用心脏磁共振及超声心动图双模态影像学技术评价左室心尖部室壁瘤患者经皮微创左室折叠减容术(Revivent)后左室血流动力学变化.方法选取左室心尖部室壁瘤拟行Revivent术患者22例,在Revivent术前1周、术后1个月及术后1年行经胸二维及三维超声心动图,术前1周与术后1年行心脏磁共振检查,测量左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、左室射血分数(LVEF)、每搏输出量(SV)、每搏输出量指数(SVI)、心排量(CO)及心排血指数(CI)等血流动力学参数,并进行统计学分析.结果心脏磁共振及超声心动图双模态影像学数据表明Revivent术前与术后1个月LVEDV、LVESV、LVEDd、LVEF差异有统计学意义(均P<0.05),术前与术后1年LVESd差异有统计学意义(P<0.01);但SV、SVI、CO、CI在Revivent术前及术后不同时间段相比较,差异均无统计学意义(P>0.05).Bland‐Altman图分析显示数据点均位于95%的一致性界限内且临床可接受,说明超声心动图与心脏磁共振影像学数据具有较好的一致性.结论Revivent术为左室心尖部室壁瘤患者提供了一种有效及可行的治疗方法,超声心动图及心脏磁共振双模态影像学检查是评价该手术疗效的可靠技术方法.

Objective To investigate the hemodynamic changes before and after Revivent surgery in patients with left ventricular apical aneurysm by cardiac magnetic resonance imaging(CMR) and echocardiography. Methods Twenty-two cases with left ventricular apical aneurysm were examined by two-dimensional and three-dimensional transthoracic echocardiography 1 week before operation, 1 month and 12 months after operation, by CMR 1 week before operation and 12 months after operation.Left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVESd), left ventricular ejection fraction (LVEF), stroke volume (SV), stroke output index (SVI), cardiac output (CO) and cardiac output index(CI) were quantitatively measured and statistical analysis were performed. Results There were significant differences between preoperation and 1 month after operation for the measurements of LVEDV, LVESV, LVEDd and LVEF by both CMR and echocardiography (all P<0.05). Compared with preoperation, LVESd decreased significantly 12 months after operation (P<0.01). However, there were no significant differences between preoperation and 1 or 12 months after operation for the measurements of SV, SVI, CO and CI (all P>0.05). The consistency between CMR and echocardiography measurements was good. Conclusions Revivent surgery provides an effective and feasible treatment for patients with left ventricular apical ventricular aneurysm. The dual-modality imaging with CMR and echocardiography are reliable technical means to evaluate the changes of left ventricular heamodynamiscs during the perioperative period of Revivent.