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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (03) : 185 -190. doi: 10.3877/cma.j.issn.1672-6448.2016.03.005

所属专题： 文献；

心血管超声影像学

肥厚型梗阻性心肌病室间隔心肌消融术的疗效及术后左心房容积的变化特点
高一鸣1, 王剑鹏1, 赵星1, 李慧1, 段福建1,†(), 乔树宾2, 王浩1   
  1. 1. 100037　北京，北京协和医学院　中国医学科学院　国家心血管病中心　阜外医院超声影像中心
    2. 100037　北京，北京协和医学院　中国医学科学院　国家心血管病中心　阜外医院心内科
  • 收稿日期:2015-10-14 出版日期:2016-03-01
  • 通信作者: 段福建

Effect of septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy and the change of left atrial function after procedure

Yiming Gao1, Jianpeng Wang1, Xing Zhao1, Hui Li1, Fujian Duan1,†(), Shubin Qiao2, Hao Wang1   

  1. 1. Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
    2. Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
  • Received:2015-10-14 Published:2016-03-01
  • Corresponding author: Fujian Duan
  • About author:
    Corresponding author: Duan Fujian, Email:
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引用本文：

高一鸣, 王剑鹏, 赵星, 李慧, 段福建, 乔树宾, 王浩. 肥厚型梗阻性心肌病室间隔心肌消融术的疗效及术后左心房容积的变化特点[J]. 中华医学超声杂志（电子版）, 2016, 13(03): 185-190.

Yiming Gao, Jianpeng Wang, Xing Zhao, Hui Li, Fujian Duan, Shubin Qiao, Hao Wang. Effect of septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy and the change of left atrial function after procedure[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(03): 185-190.

目的

评价肥厚型梗阻性心肌病（HOCM）患者经皮室间隔心肌消融术（PTSMA）的疗效，并应用三维超声心动图（3DE）探讨术后左心房容积的变化特点。

方法

34例HOCM患者入选此研究。于术前1周、术后1周及术后1年行超声心动图检查。经常规超声获取左心室舒张末期前后径（LVd）、左心房最大前后径（LAd）、左心室射血分数（LVEF）、室间隔基底段舒张末期最大厚度（IVSd）、左心室后壁舒张末期厚度（LVPWd）、左心室流出道压差（LVOT-PG）等，经3DE获取左心房时间-容积曲线，测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）及左心房收缩前容积（LAVp），计算左心房排空分数（LAEF）、左心房被动排空分数（LAPEF）及左心房主动排空分数（LAAEF）及左心房扩张指数（LAEI），比较术前、术后各参数的变化特点。

结果

与术前相比，术后1周LVOT-PG（54.5±34.5）mmHg（1 mmHg=0.133 kPa）、LVEF（71.4±5.7）%、LAVmax（90.2±36.5）ml、LAVp（73.0±34.0）ml及LAVmin（53.2±28.8）ml均明显减低，差异具有统计学意义（t=4.002、3.234、3.502、3.611、2.253，P值均<0.05）；术后1年LVOT-PG（38.3±31.7）mmHg、IVSd（16.7±8.3）mm、LVPWd（11.0±1.9）mm、平均E/e′ 12.0±4.6、LAVmax（80.9±24.8）ml、LAVp（61.3±23.1）ml、LAVmin（42.6±19.5）ml、MI 1.46±1.06均明显减低，差异具有统计学意义（t=5.371、4.165、3.473、3.940、3.655、4.046、4.046、Z=-2.873，P值均<0.01），而LAPEF（25.1±5.1）%升高，差异具有统计学意义（t=-3.270，P<0.01）。与术后1周比较，术后1年LVOT-PG、IVSd、LVPWd、LAVmax、LAVp、LAVmin、MI均明显减低，差异值有统计学意义（t=2.256、5.067、3.137、2.200、2.740、2.016、Z=-2.003，P值均<0.05），而LVd（41.6±4.0）mm、LAEF（48.3±7.9）%及LAPEF升高，差异有统计学意义（t=-2.288、-2.725、-2.907，P值均<0.05）。

结论

HOCM患者PTSMA术后左心室流出道梗阻减轻，左心室充盈压降低，二尖瓣反流改善。3DE用于评估左心房大小较二维超声准确而敏感，HOCM患者PTSMA术后各时相LAV逐渐缩小。

关键词: 超声心动描记术, 心肌病，肥厚性, 心室功能，左, 经皮穿刺腔内室间隔心肌消融
Objective

To evaluate the effect of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and the change of left atrial volume after PTSMA by three-dimensional echocardiography (3DE).

Methods

Thirty-four patients with HOCM were enrolled in this study. Echocardiography was done at 1 week before PTSMA, 1 week and 1 year after PTSMA. Left ventricular end-diastolic diameter (LVd), 1eft atrial diameter (LAd), interventricular septal thickness (IVSd), 1eft ventricular posterior wall thickness (LVPWd), 1eft ventricular ejection fraction (LVEF) and left ventricular out?ow tract peak gradient (LVOT-PG) etc. were acquired by conventional echocardiography. Time-volume curve of left atrium was acquired by 3DE. Left atrial maximal volume (LAVmax), 1eft atrial minimal volume (LAVmin) and 1eft atrial pre-systolic volume (LAVp) were acquaired. Left atrium emptying fraction (LAEF), left atrium passive emptying fraction (LAPEF), left atrium active emptying fraction (LAAEF) and left atrial expansion index (LAEI) were calculated. Comparative analysis was done between before and after PTSMA.

Results

Compared with pre-procedure, LVOT-PG (54.5±34.5) mmHg (1 mmHg=0.133 kPa), LVEF (71.4±5.7)%, LAVmax (90.2±36.5) ml, LAVp (73.0±34.0) ml and LAVmin (53.2±28.8) ml decreased significantly (t=4.002, 3.234, 3.502, 3.611, 2.253, P<0.05) at 1 week after PTSMA; LVOT-PG (38.3±31.7) mmHg, IVSd (16.7±8.3) mm, LVPWd (11.0±1.9) mm, E/e′ 12.0±4.6, LAVmax (80.9±24.8)ml, LAVp (61.3±23.1) ml, LAVmin (42.6±19.5)ml, MI (1.46±1.06) decreased signi?cantly (t=5.371, 4.165, 3.473, 3.940, 3.655, 4.046, 4.046, z=-2.873, P<0.01), but LAPEF (25.1±5.1)% increased signi?cantly (t=-3.270, P<0.01) at 1 year after PTSMA. Compared with 1 week follow-up, LVOT-PG, IVSd, LVPWd, LAVmax, LAVp, LAVmin, MI decreased significantly (t=2.256, 5.067, 3.137, 2.200, 2.740, 2.016, Z=-2.003, P<0.05), but LVd (41.6±4.0) mm, LAEF (48.3±7.9)% and LAPEF increased signi?cantly (t=-2.288, -2.725, -2.907, P<0.05) at 1 year follow-up.

Conclusions

For the patients with HOCM after PTSMA, left ventricular outflow tract obstruction relieved, left ventricular filling pressure decreased, and mitral regurgitation improved. 3DE is more accurate and sensitive than two-dimensional echocardiography to evaluate left atrial size. For the patients with HOCM after PTSMA, left atrial volume decreased progressively.

Key words: Echocardiography, Cardiomyopathy, hypertrophic, Ventricular function, left, Percutaneous transluminal septal myocardial ablation
表1 肥厚型梗阻性心肌病患者经皮穿刺腔内室间隔心肌消融术前、术后左心房（室）常规参数的比较（±s）
组别 例数 IVSd（mm） LVPWd（mm） Lad（mm） LVd（mm） LVEF（%） LVOT-PG 平均E/e′ MI
术前 34 22.8±5.2 12.4±2.4 40.8±5.1 40.1±4.7 76.7±6.2 84.3±26.7 16.7±4.9 2.17±0.48
术后1周 34 23.2±6.2 12.1±2.3 39.8±5.9 39.2±4.6 71.4±5.7a 54.5±34.5a 14.0±6.2 1.88±0.68
术后1年 34 16.7±8.3b，c 11.0±1.9b，c 39.2±6.4 41.6±4.0c 73.5±6.2 38.3±31.7b，c 12.0±4.6b 1.46±1.06b，c
图2 肥厚型梗阻性心肌病患者经皮穿刺腔内室间隔心肌消融术后1年左心房时间-容积曲线，各时相LAV较术前减低
表2 肥厚型梗阻性心肌病患者经皮穿刺腔内室间隔心肌消融术前、术后1周左心房3DE参数的比较（±s）
组别 例数 LAVmax（ml） LAVp（ml） LAVmin（ml） LAEF（%） LAPEF（%） LAAEF（%） LAEI（%）
术前 30 98.6±36.1 79.8±32.7 57.5±27.5 42.5±11.1 19.7±5.4 28.8±10.3 0.8±0.4
术后1周 30 90.2±36.5 73.0±34.0 53.2±28.8 43.0±8.2 20.3±6.1 28.8±5.6 0.8±0.2
t值 ? 3.502 3.611 2.253 -0.245 -0.535 -0.011 0.235
P值 ? 0.002 0.002 0.036 0.809 0.599 0.992 0.817
表3 肥厚型梗阻性心肌病患者经皮穿刺腔内室间隔心肌消融术前、术后1年左心房3DE参数的比较（±s）
组别 例数 LAVmax（ml） LAVp（ml） LAVmin（ml） LAEF（%） LAPEF（%） LAAEF（%） LAEI（%）
术前 25 103.1±38.7 83.6±35.7 60.6±29.6 41.9±11.7 19.9±5.8 27.9±10.8 0.8±0.4
术后1年 25 80.9±24.8 61.3±23.1 42.6±19.5 48.7±8.1 25.1±5.1 31.6±8.5 1.0±0.3
t值 ? 3.655 4.046 4.046 -2.140 -3.270 -1.034 -1.740
P值 ? 0.003 0.001 0.001 0.050 0.006 0.319 0.104
表4 肥厚型梗阻性心肌病患者经皮穿刺腔内室间隔心肌消融术后1周、术后1年左心房3DE参数的比较（±s）
组别 例数 LAVmax（ml） LAVp（ml） LAVmin（ml） LAEF（%） LAPEF（%） LAAEF（%） LAEI（%）
术后1周 25 93.9±40.0 77.0±37.7 57.5±31.7 41.0±9.0 19.7±6.4 26.8±6.4 0.8±0.3
术后1年 25 80.5±24.9 60.8±23.2 42.7±19.4 48.3±7.9 25.3±5.1 30.9±7.8 1.0±0.3
t值 ? 2.200 2.740 2.016 -2.725 -2.907 -1.646 -1.745
P值 ? 0.045 0.016 0.011 0.016 0.011 0.122 0.116
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