二维斑点追踪显像技术评价成人房间隔缺损右心室功能的初步研究

目的本研究通过二维斑点追踪显像技术(2D-STI)对房间隔缺损未行矫正术的成人患者右心室游离壁各节段进行测量,获得应变和应变率等相关数据,分析右心室的局部功能。方法选择35例继发孔型房间隔缺损的成人患者入房间隔缺损组,以20名超声心动图检查显示心脏无结构性和功能性改变、窦性心律、未服用任何药物的成人作为对照组。分别在心尖四腔切面取得连续5个心动周期的动态图像,存盘后用脱机软件QLab中的TMQA功能测得右心室游离壁各节段的纵向应变和应变率数据(结合心电图,以及计算得到最大应变和应变率、平均收缩期应变和应变率、平均舒张期应变和应变率)。结果房间隔缺损组右心室游离壁中间段、心尖段的最大应变和平均收缩期应变均显著高于对照组相同节段(P值均<0.05);右心室游离壁基底段的平均舒张期应变显著低于对照组相同节段(P<0.05),中间段、心尖段的舒张期应变均显著高于对照组相同节段(P值均<0.05)。组右心室游离壁基底段、中间段、心尖段的最大应变率和平均收缩期应变率均显著高于对照组相同节段(P值均<0.05),右心室游离壁中间段、心尖段的平均舒张期应变率均显著高于对照组相同节段(P值均<0.05)。房间隔缺损组室间隔心尖段的平均舒张期应变显著高于对照组相同节段(P<0.05)。结论未行矫正术的房间隔缺损成人患者右心室游离壁应变、应变率与正常成人有显著差异,提示右心系统容量负荷增加对右心局部功能产生显著影响。2D-STI是一种无创评价右心室局部功能的有效手段。

经食管实时三维超声心动图诊断主瓣机械瓣瓣周漏的应用价值

目的研究经食管实时三维超声心动图(RT-3D-TEE)在诊断人工主动脉瓣瓣周漏患者的应用价值。方法方便选取2015年3月—2018年3月期间因人工主动脉瓣瓣周漏在该院接受瓣周漏修补手术或再次换瓣术的患者共15例,所有患者均在术前接受二维经胸超声心动图(2D-TTE)和RT-3D-TEE检查,结合手术结果,对比两种检查方法诊断人工主动脉瓣瓣周漏的准确度。结果 RT-3D-TEE诊断明确的所有13例瓣周漏,3例位于右冠瓣区,2例位于左冠瓣区,4例位于无冠瓣区,4例有多个破口或破口范围较大超过单个瓣叶所在区域。所有患者经手术证实,主瓣人工瓣瓣周漏破口位置与范围与RT-3D-TEE诊断基本一致,RT-3D-TEE可对各个区域瓣周漏破口位置及范围判断均较准确;所有患者中瓣周漏合并瓣周脓肿2例,合并瓣环部分脱位3例,合并二尖瓣机械瓣卡瓣1例,RT-3D-TEE对合并有瓣周脓肿或瓣环部分脱位的诊断准确度高于2D-TTE。结论对比2D-TTE,RT-3D-TEE对人工主动脉瓣瓣周漏的诊断有更高的准确度和精确度,且有多方位观察和整体观图像显示的优势,因此,对2D-TTE发现轻度以上人工主动脉瓣区的可疑返流的患者,应该建议进行RT-3D-TEE检查。

超声动态评价强化治疗对2型糖尿病患者亚临床动脉粥样硬化的价值

目的超声动态评价强化治疗对初诊2型糖尿病(T2DM)患者亚临床动脉粥样硬化(AS)的价值。方法随访135例T2DM患者3年,根据入组时间分为强化治疗组(75例)和常规治疗组(60例)。观察干预3年后两组患者的代谢控制情况及颈总动脉(CCA)、髂总动脉(CIA)、股总动脉(CFA)内膜-中层厚度(IMT)和AS斑块的变化情况。结果强化治疗组的各动脉内膜-中层增厚率均低于常规治疗组,均有统计学差异(均P<0.05)。比较两组患者斑块分布情况,干预1年后和2年后强化治疗组股动脉斑块好转率高于常规治疗组(x～2=5.49、8.39,均P<005),其余指标好转率均无统计学差异(均P>0.05)。结论强化治疗后T2DM患者CCA、CIA及CFA内膜-中层增厚明显减少,但对血管内已形成的AS斑块改善不明显。高频超声可作为首选观察随访手段。

The effect of spironolactone on the levels of GATA4 protein and hypoxia inducible factor-1α in patients receiving coronary stent implantation

In the present study,we aimed to explore the protective effect of spironolactone on cardiac function in patients undergoing coronary stent implantation by determining the serum levels of GATA4 and hypoxia-inducible factor-1α(HIF-1α)proteins before and after the coronary stent implantation.A total of 134 patients undergoing coronary stent implantation in our hospital from March 2019 to March 2020 were retrospectively selected using the propensity score matching(PSM)method.Of the 134 patients,67 patients taking spironolactone were used as a test group,and the other 67 patients without taking spironolactone were used as a control group.In all patients,the levels of serum GATA4,HIF-1α,and troponin I proteins were determined before as well as 24 h and 6 months after the coronary stent implantation.Left ventricular ejection fraction(LVEF)and left ventricular systolic global longitudinal strain(GLS)were determined before and 6 months after the coronary stent implantation.There were no significant differences in the HIF-1αlevel between the two groups before and 6 months after the operation,while the HIF-1αlevel was significantly lower in the test group compared with the control group at 24 h after the operation(P<0.01).There were no significant differences in the GATA4 protein level between the two groups before and 24 h after the operation,while the GATA4 protein level was significantly lower in the test group compared with the control group at 6 months after the operation(P<0.01).There was no significant difference in LVEF between the two groups before and 6 months after the operation.GLS was significantly improved at 6 months after the operation compared with that before the operation in both groups,while GLS was significantly better in the test group compared with the control group at 6 months after the operation(P<0.01).Collectively,spironolactone could protect cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.