Solarz David E, Witt Sandra A, Glascock Betty J, Jones Frederick D, Khoury Philip R, Kimball Thomas R
Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA.
J Am Soc Echocardiogr. 2004 Apr;17(4):338-44. doi: 10.1016/j.echo.2004.01.012.
Indices such as strain rate (SR) and strain (epsilon) are free of geometric assumptions and, thus, may provide new insights into right ventricular (RV) function and compensatory mechanisms in repaired tetralogy of Fallot (TOF).
All those with postoperative (>1 year) TOF had echocardiography evaluation of SR and epsilon indices along the RV lateral free wall (RVFW) and the interventricular septum (IVS) in the apical 4-chamber view. Pulmonary regurgitation, pulmonary stenosis, QRS duration, RV ejection fraction, and RV dimension were also measured and compared with control subjects.
There were 15 patients with TOF (7 +/- 4 years old) 6 +/- 3 years remote from surgical repair and 25 control subjects (10 +/- 5 years old). In the patients with TOF, systolic and diastolic SR and epsilon in the RVFW were significantly reduced but were normal in the IVS. In the RVFW, reduced systolic SR and epsilon correlated with reduced RV ejection fraction (r = -0.7 [P <.01] and -0.6 [P <.03], respectively), and poorer early diastolic SR correlated with poorer RV ejection fraction (r = 0.7, P <.01).
In patients with postoperative TOF, systolic and diastolic RV SR and epsilon were impaired in the RVFW but preserved in the IVS. We speculate that IVS myocardial function is preserved as a compensatory mechanism for impaired RVFW function.
诸如应变率（SR）和应变（ε）等指标不受几何假设的限制，因此，可能为法洛四联症（TOF）修复术后右心室（RV）功能及代偿机制提供新的见解。
所有法洛四联症术后（>1年）患者均在经胸超声心动图检查中于心尖四腔心切面评估右心室游离壁（RVFW）和室间隔（IVS）的SR和ε指标。同时测量肺反流、肺动脉狭窄、QRS时限、右心室射血分数和右心室大小，并与对照组进行比较。
有15例法洛四联症患者（年龄7±4岁），手术修复后6±3年，以及25名对照者（年龄10±5岁）。法洛四联症患者中，右心室游离壁的收缩期和舒张期SR及ε显著降低，但室间隔正常。在右心室游离壁，收缩期SR和ε降低与右心室射血分数降低相关（分别为r = -0.7 [P <.01]和-0.6 [P <.03]），舒张早期SR较差与右心室射血分数较差相关（r = 0.7，P <.01）。
法洛四联症术后患者中，右心室游离壁的收缩期和舒张期右心室SR及ε受损，但室间隔保留。我们推测室间隔心肌功能得以保留是作为右心室游离壁功能受损的一种代偿机制。
