三维斑点追踪成像评价子痫前期患者妊娠晚期及产后左心功能变化

Evaluation of left ventricular function in patients with preeclampsia at the third trimester of pregnancy and postpartum by three-dimensional speckle tracking imaging

目的应用三维斑点追踪成像(3D-STE)技术评价子痫前期患者妊娠晚期左心结构及功能,并追踪其产后变化。方法选取在我院生产的妊娠期妇女75例,其中子痫前期组50例,正常妊娠组25例,分别于妊娠晚期及产后12～18周内应用3D-STE采集心尖四腔全容积图像,分析左室舒张末期容积指数(LVEDVI)、左室质量指数(LVMI)、球形指数(SPI)及左室心肌整体纵向应变(GLS)、圆周应变(GCS)、径向应变(GRS)、面积应变(GAS)。结果与正常妊娠组比较,子痫前期组妊娠晚期LVEDVI、LVMI、SPI均增加,左室心肌GLS、GRS、GCS、GAS均下降,差异均有统计学意义(均P<0.05);产后复查,子痫前期组LVMI、LVEDVI及SPI下降,GLS、GRS、GCS、GAS升高,但LVMI较正常妊娠组产后仍高,GLS较正常妊娠组产后仍低,差异均有统计学意义(均P<0.05)。结论子痫前期患者妊娠晚期心脏离心性重构,心肌受损,产后随着血压下降,心脏重构、心功能较产前改善,但心肌损害仍存在;3D-STE有助于临床准确评价子痫前期心功能变化。

Objective To investigate the left ventricular structure and function in patients with preeclampsia at the third trimester of pregnancy by three-dimensional speckle tracking imaging,and to observe its changes in postpartum.Methods Totally 75 women of childbearing age were chosen. The case group included 50 preeclampsia women,the control group included 25 normal pregnant women. The 3 D full volume datasets on the apical four chamber full volume images at the third trimester of pregnancy and 12~18 weeks after delivery were collected,the left ventricular end diastolic volume index(LVEDVI),left ventricular mass index(LVMI),sphericity index(SPI) and the global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS)and global area strain(GAS)were analyzed. Results Compared with the control group, the LVEDVI,LVMI and SPI were increased in case group,GLS,GRS,GCS and GAS decreased at the third trimester of pregnancy(all P<0.05). In postpartum,LVMI,LVEDVI and SPI were decreased in case group,while LVMI was compared with the control group(all P<0.05).Conclusion Patients with preeclampsia exhibited eccentric hypertrophy at the third trimester of pregnancy,and the myocardial strain decreased significantly. With the decrease of blood pressure,cardiac remodeling and cardiac function improved after postpartum,but myocardial damage still existed. 3 D-STE is helpful to accurately evaluate the changes of cardiac function in preeclampsia.