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Intern J Cardiol:法洛四联症和房间隔缺损患者具有不同适应机制

2012-12-03 Intern J Cardiol Intern J Cardiol

法洛四联症房间隔缺损适应性机制
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        加拿大学者的一项研究表明，在法洛四联症（ToF）和房间隔缺损（ASD）患者中，慢性容量负荷对右室整体和局部心肌变形影响各异，提示这两种疾病具有不同的适应性机制，也表明应变测量受心室体积的影响，在解释应变值时应予以考虑。论文于2012年11月2日在线发表于《国际心脏病学杂志》（Intern J Cardiol）。

        加拿大学者的一项研究表明，在法洛四联症（ToF）和房间隔缺损（ASD）患者中，慢性容量负荷对右室整体和局部心肌变形影响各异，提示这两种疾病具有不同的适应性机制，也表明应变测量受心室体积的影响，在解释应变值时应予以考虑。论文于2012年11月2日在线发表于《国际心脏病学杂志》（Intern J Cardiol）。
 
　　此项研究共纳入85例受试者，ToF修复后患者、ASD未修复患者和年龄匹配对照者分别为50、15和20例。ToF组和对照组患者在磁共振成像（MRI）提示相关征象时接受超声心动图检查。ASD组患者接受包括右室容量估算在内的常规超声心动图检查。利用二维斑点追踪成像分析纵向变形。
 
　　结果显示，ToF组患者的右室游离壁整体和节段纵向变形显著低于ASD和对照组（P<0.001）。在ToF组患者中，心脏基部至心尖的应力值呈进行性降低；ASD组患者则进行性增加。右室大小和右室纵向应力指标呈显著负相关。对右室大小进行校正之后，ASD组患者均具有正常或较高的变形值，ToF组患者则有半数显著降低。



Background
Right ventricular (RV) volume overload results in RV dilatation in patients with atrial septal defect (ASD) and after tetralogy of Fallot (ToF) repair with pulmonary regurgitation.
Aim
Study the differential effects of chronic RV volume loading on regional and global RV deformation in patients with ASD and after TOF repair.
Methods
We studied 85 subjects: 50 patients after ToF repair, 15 patients with unrepaired ASD and 20 age-matched controls. The ToF patients and controls underwent an echocardiography at the time of a clinically indicated MRI. The ASD patients had a routine echocardiogram including RV volume calculations. Longitudinal deformation was analyzed using 2-D speckle tracking echocardiography.
Results
RV free wall global and segmental longitudinal deformation was significantly lower in ToF patients compared with ASD and controls (p<0.001). In ToF patients, there was a progressive decrease in strain values from base to apex (p<0.001), while in the ASD group there was a progressive increase (p=0.04). We found strong negative correlations between RV size and RV longitudinal strain measurements, strongest with RV length (R=0.72). When corrected for RV size, all ASD patients had normal or higher deformation values while half of the TOF patients had significantly lower values.
Conclusion
Global and regional myocardial RV deformation is differently affected by chronic volume loading in ASD versus TOF patients, especially regarding the apical function. This suggests a different adaptation mechanism in both diseases. Our data also suggest that strain measurements are strongly influenced by ventricular size, which should be taken into consideration when interpreting strain values.

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    2016-09-18 知难而进

    谢谢分享！

    0

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    2016-09-18 知难而进

    继续关注！

    0

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    2013-08-26 nian.wang1982

    #适应机制#

    0

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    2013-03-20 仁者大医

    #Cardiol#

    0

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    2012-12-04 tongyongming

    #法洛四联症#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=130152, encodeId=2f49130152e6, content=谢谢分享！, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sun Sep 18 14:41:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=130153, encodeId=467a13015350, content=继续关注！, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sun Sep 18 14:41:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1814236, encodeId=7be0181423668, content=<a href='/topic/show?id=4c7394e11a1' target=_blank style='color:#2F92EE;'>#适应机制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94711, encryptionId=4c7394e11a1, topicName=适应机制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f63175, createdName=nian.wang1982, createdTime=Mon Aug 26 09:00:00 CST 2013, time=2013-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1781607, encodeId=0a111e8160777, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Wed Mar 20 23:00:00 CST 2013, time=2013-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421492, encodeId=06761421492fb, content=<a href='/topic/show?id=068c6486e77' target=_blank style='color:#2F92EE;'>#法洛四联症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64867, encryptionId=068c6486e77, topicName=法洛四联症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f87f3671641, createdName=tongyongming, createdTime=Tue Dec 04 15:00:00 CST 2012, time=2012-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1459417, encodeId=d850145941ea4, content=<a href='/topic/show?id=0820542427d' target=_blank style='color:#2F92EE;'>#房间隔缺损#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54242, encryptionId=0820542427d, topicName=房间隔缺损)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Dec 04 15:00:00 CST 2012, time=2012-12-04, status=1, ipAttribution=)]
    2012-12-04 智智灵药

    #房间隔缺损#

    0