Int J Cardiol 2011 Oct;152 (1): 28-34. [IF:6.802]
Diastolic ventricular interaction in patients after atrial switch for transposition of the
great arteries: a speckle tracking echocardiographic study.
Chow PC , Liang XC , Cheung YF .
Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital 102 Pokfulam Road, Hong Kong, China.
香港玛丽医院小儿心脏科，儿科和青少年医学部
Abstract
We tested the hypothesis that diastolic ventricular interaction occurs after atrial switch operation for transposition of the great arteries (TGA) and that subpulmonary LV diastolic function is influenced by septal geometry. Twenty-nine patients (male 19) after atrial switch operation for TGA aged 20.8 ± 4.1 years and 27 healthy controls were studied. Two-dimensional longitudinal systolic strain, systolic (SRs), early diastolic (SRe), and late diastolic (SRa) strain rates of both ventricles were determined using speckle tracking echocardiography. Early diastolic trans-atrioventricular velocity (E) and myocardial early diastolic myocardial velocity (e) at the ventricular free wall-annular junction were measured. Geometry of the morphologic left ventricle was quantified by the diastolic eccentricity index (EI). In both systemic and subpulmonary ventricles, SRe and SRa were significantly lower and trans-atrioventricular E/e ratios higher in patients than controls (all p<0.001). In patients, RV SRe correlated with left ventricular (LV) SRe (r=0.49, p=0.008), and RV SRa correlated with LV SRa (r=0.46, p=0.01). Significant leftward shifting of the septum in patients was reflected by the greater LV EI (p<0.001). In patients, LV EI correlated with age- and sex-adjusted z score of LV end-diastolic volume. As a group, LV EI correlated negatively with LV SRe (r=-0.62, p<0.001) and LV SRa (r=-0.51, p<0.001), and positively with mitral E/e ratio (r=0.33, p=0.02). Systemic RV diastolic dysfunction occurs after atrial switch operation and correlates with subpulmonary LV diastolic dysfunction. The observed diastolic ventricular interaction may potentially be mediated through alteration of septal geometry.
摘要：
此项研究目的为探明：大动脉转位（TGA）的患者接受心房转位术后舒张期心室的相互作用及肺下左心室功能受室间隔的几何形体学影响。此项研究共纳入29例（男性19例）大动脉转位（TGA）并接受心房转位术的患者，年龄为20.8 ± 4.1岁，对照组收集27例，均为健康人。用斑点追踪超声心动行二维超声确定心室收缩强度及收缩期、舒张早期、舒张晚期左右心室的应变率。在心室游离壁环形口处测量舒张早期跨房室处的心肌运动速度及舒张早期心肌运动速度。用心室舒张时的偏心指数衡量左室形态。实验组的患者无论是整个心室还是肺下心室，舒张早期和舒张晚期的变应率均明显低于对照组的健康人，且跨房室E/e值高于对照组健康人(两者均为p<0.001)。实验组中，患者的右室舒张早期变应率与左室早期变应率密切相关(r=0.49, p=0.008)，且右室舒张晚期与左室舒张晚期的变应率(r=0.46, p=0.01)密切相关。患者的室间隔受大左室EI的影响明显左移(p<0.001)。实验组患者左室的EI值与用年龄、性别校正后的左室舒张末期容量的z值相关。左室EI与左室收缩早期和收缩晚期无明显相关性，分别为r=-0.62, p<0.001，r=-0.51, p<0.001，而确实与二尖瓣的E/e比相关（r=0.33, p=0.02）。心房转位术后可发生整个右室的舒张功能不全，并与肺下左室舒张功能不全密切相关。所观察到的舒张期心室间的相互作用可能同室间隔形态的改变有关。
