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目的:采用超声心动图分层应变技术,评价肥厚型梗阻性心肌病(HOCM)改良扩大Morrow术后左心室游离壁逆重构及其预测影响因素。方法:本研究入选我院2014-06到2014-12期间成功接受改良扩大Morrow术式的HOCM患者60例(HOCM组),男性41例(68.3%),平均年龄(39.1±15.2)岁,采集术前和术后6~24个月临床和超声心动图资料;同期选取健康人40例作为正常对照组。用超声分层应变技术分析术前和术后左心室游离壁三层心肌的(心内膜下、中层和心外膜下心肌)纵向应变和环形应变的变化,用线性回归法识别左心室游离壁逆重构的影响因素。左心室游离壁厚度≥15 mm的节段定义为增厚左心室游离壁节段。结果 :HOCM组患者术后左心室游离壁的前壁、侧壁、后壁和下壁厚度与术前比较均变薄;术后游离壁纵向应变[(-13.8±4.8)%vs(-17.0±5.2)%]和环形应变[(-23.7±3.8)%vs(-25.4±3.7)%]均增厚;差异有统计学意义(P<0.05)。△(术前值-术后值)超声左心室质量指数大于外科切除质量指数[(13.5±30.9)g/m2 vs(3.4±2.0)g/m2,P<0.05]。线性回归分析显示,影响术后左心室游离壁纵向应变的独立因素是术前增厚左心室游离壁节段数(r=-0.680,P<0.001)和年龄(r=0.638,P<0.001),影响术后左心室游离壁环形应变的因素是△左心室流出道(LVOT)压差(r=0.386,P=0.005)。结论 :对于HOCM患者,(1)改良扩大Morrow术后,LVOT梗阻解除引起左心室游离壁的逆重构(室壁厚度变薄,质量减低,功能改善);(2)左心室游离壁的三层心肌均发生逆重构;(3)LVOT压差缓解越好、增厚左心室游离壁节段数越小、年龄较大的患者术后逆重构较好。
OBJECTIVE: To evaluate the effect of hypertrophic obstructive cardiomyopathy (HOCM) on the inverse remodeling of left ventricular free wall after Morrow operation and its influencing factors by using echocardiographic stratified strain technique. Methods: Sixty HOCM patients (HOCM group) were enrolled in this study. Among them, 41 (68.3%) were male patients (mean age, 39.1 ± 15.2 years) who were admitted to our hospital from 2014-06 to 2014-12. Preoperative and postoperative 6 to 24 months clinical and echocardiographic data; the same period selected 40 healthy individuals as a normal control group. The changes of longitudinal strain and ring strain in (subendocardial, middle and epicardial) myocardium of left ventricular free wall in preoperative and postoperative patients were analyzed by ultrasonic stratified strain technique. Linear regression was used to identify the left ventricular free Influencing factors of wall inverse reconstruction. Segments of left ventricular free wall thickness ≥15 mm were defined as thickened left ventricular free wall segments. Results: The thickness of anterior wall, lateral wall, posterior wall and inferior wall of left ventricular free wall in patients with HOCM were both thinner than those before surgery. The longitudinal strain of free wall in the HOCM group [(-13.8 ± 4.8)% vs (-17.0 ± 5.2%] and annular strain [(-23.7 ± 3.8)% vs (-25.4 ± 3.7)%], respectively. All the differences were statistically significant (P <0.05). △ (preoperative value - postoperative value) ultrasonic left ventricular mass index was greater than the surgical resection mass index [(13.5 ± 30.9) g / m2 vs (3.4 ± 2.0) g / m2, P <0.05]. Linear regression analysis showed that the independent factors affecting left ventricular free wall longitudinal strain were preoperative thickening of left ventricular free wall segments (r = -0.680, P <0.001) and age (r = 0.638, P <0.001) The factor that affected the annular strain of left ventricular free wall was △ LVOT pressure difference (r = 0.386, P = 0.005). CONCLUSIONS: (1) In the patients with HOCM, (1) LVOT obstruction relieves the inverse remodeling of the left ventricular free wall (the thickness of the ventricular wall is thinner, the quality is reduced, the function is improved) after Morrow expansion and expansion; (2) (3) LVOT pressure relief better, thickening of the left ventricular free wall segments smaller, older patients with reverse remodeling better.