单心动周期实时三维超声评价心脏移植患者右心室形态及功能

目的 探讨心脏移植术后供心的右心形态学及功能学改变.方法 入组健康志愿者60例及心脏移植术患者31例.所有研究对象均行常规超声心动图检查,并应用单心动周期实时三维超声心动图评价右心室形态及收缩功能的相关参数,所有心脏移植患者超声检查3个月内曾行心内膜活检.根据1990年国际心肺移植协会排异反应标准,将病例组分为排异组和非排异组.结果 对照组、非排异组、排异组间右室每搏输出量(RVSV)及右室射血分数(RVEF)测值呈递减趋势,差异有统计学意义[RVSV:对照组、非排异组、排异组分别为(56.18±23.72)ml、(36.08±10.94)ml和(26.22±9.84)ml,P＜0.0001;RVEF:对照组、非排异组、排异组分别为(62.09±7.18)%、(51.04±7.58)%和(35.86±9.86)%,P＜0.00001].剔除排异患者后,短期组、长期组间差异无统计学意义.结论 实时三维超声心动图能够快速评价右室形态及整体收缩功能,其中RVEF最敏感和稳定,对心脏移植患者术后长期监测随访具有良好的临床应用前景.

Assessment of shape and function of right ventricle in heart transplantation patients by single beat real-time three-dimensional echocardiography

Objective To investigate the shape and function of right ventricles in patients received heart transplantation(HT). Methods Sixty healthy volunteers(control group) and 31 HT patients(HT group) were enrolled, and the HT group was further divided into the nonrejected(HTn) group and the rejected(HTp) group based on the endomyocardial biopsy(EMB) results. All the participants received routine echocardiography. Single beat real-time three-dimensional echocardiography (sRT-3DE) was performed in all to evaluate parameters concerning modality and systolic function of participants' right ventricles. Results 1) Right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) were significantly different among the groups[RVSV: control group vs HTn group vs HTp group was (56.18 ± 23.72)ml vs (36.08 ± 10.94)ml vs (26.22 ± 9.84)ml, P ＜0.0001; RVEF:control group vs HTn group vs HTp group was (62.09± 7.18)% vs (51.04 ± 7.58) vs (35.86 ± 9.86)%, P ＜0.00001＝.2＝ When taking the influence of rejection into consideration,RVEF was proved to be a stable and sensitive indicator. Conclusions sRT-3DE can quickly assess shape and systolic function of right ventricle.RVEF was the most stableand sensitive among all the RV-related indicators and is a promising indicator in the clinic follow-up of HT patients.