Qin J X, Shiota T, McCarthy P M, Firstenberg M S, Greenberg N L, Tsujino H, Bauer F, Travaglini A, Hoercher K J, Buda T, Smedira N G, Thomas J D
Department of Cardiology, Thoracic and Cardiovascular Surgery and Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Circulation. 2000 Nov 7;102(19 Suppl 3):III101-6. doi: 10.1161/01.cir.102.suppl_3.iii-101.
Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes.
Thirty patients who underwent IE (mean age 61+/-8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42+/-67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99+/-40, 67+/-26, and 71+/-31 mL/m(2), respectively; ESVI 72+/-37, 40+/-21, and 42+/-22 mL/m(2), respectively; P:<0.05). LV ejection fraction increased significantly and remained higher (0.29+/-0.11, 0.43+/-0.13, and 0.42+/-0.09, respectively, P:<0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22+/-12, 53+/-24, and 58+/-21 mL, respectively, P:<0.005). New York Heart Association functional class at an average 285+/-144 days of clinical follow-up significantly improved from 3.0+/-0.8 to 1.8+/-0.8 (P:<0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman's rho=0.58 and 0.60, respectively).
RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.
梗死灶切除术（IE）是一种用于缺血性心肌病患者左心室（LV）运动障碍或运动不能节段的左心室重建技术，由于复杂的几何形状变化，需要准确的容积定量来确定手术效果。
30例行IE手术的患者（平均年龄61±8岁，73%为男性）在IE手术前后接受了心外膜实时三维超声心动图（RT3DE）检查。22例患者在术后42±67天经胸进行RT3DE随访。采用重复测量方差分析比较IE手术前后及随访时的值。IE手术后及随访时，左心室舒张末期（EDVI）和收缩末期（ESVI）容积指数明显下降（EDVI分别为99±40、67±26和71±31 mL/m²；ESVI分别为72±37、40±21和42±22 mL/m²；P<0.05）。左心室射血分数显著增加且维持在较高水平（分别为0.29±0.11、0.43±0.13和0.42±0.09，P<0.05）。16例术前有二尖瓣反流的患者，IE手术后及随访时前向搏出量显著改善（分别为22±12、53±24和58±21 mL，P<0.005）。平均临床随访285±144天时，纽约心脏协会心功能分级从3.0±0.8显著改善至1.8±0.8（P<0.0001）。IE手术后立即用RT3DE测量的较小舒张末期和收缩末期容积与临床随访时纽约心脏协会心功能分级的改善密切相关（Spearman相关系数分别为0.58和0.60）。
RT3DE可用于定量评估复杂左心室重建术后左心室容积和功能的变化。左心室容积减小和射血分数增加意味着IE手术后左心室壁应力降低，并预示着症状改善。
