健康新生儿心脏纵向和径向心肌变形指标的顺序变化。

Sequential changes of longitudinal and radial myocardial deformation indices in the healthy neonate heart.

机构信息

Heart Institute (InCor) USP, São Paulo, Brazil.

出版信息

J Am Soc Echocardiogr. 2010 Mar;23(3):294-300. doi: 10.1016/j.echo.2009.12.026.

DOI:10.1016/j.echo.2009.12.026

PMID:20138471

Abstract

BACKGROUND

Significant hemodynamic changes, including preload and afterload modifications, occur during the transition from the fetal to the neonatal environment. The ductus arteriosus closes, pulmonary vascular resistance decreases, and pulmonary blood flow increases. Strain rate (SR) and strain (epsilon) have been proposed as ultrasound indices for quantifying regional wall deformation. This study was designed to determine if these indices can detect variations in regional deformation between early and late neonatal periods.

METHODS

Data were obtained from 30 healthy neonates (15 male). The initial study was performed at a mean age of 20.1+/-14 hours (exam 1) and the second at 31.9+/-2.9 days (exam 2). Apical and parasternal views were used to quantify regional left ventricular (LV) and right ventricular (RV) longitudinal and radial SR and epsilon, and systolic, early, and late diastolic values were calculated from these curves. A paired-samples t test was performed comparing the two groups.

RESULTS

Compared with exam 1, LV radial deformation showed significant reductions in peak systolic epsilon in the basal and mid segments (51+/-15% vs 46+/-9%, P<.01). LV longitudinal deformation behaved similarly, showing significant peak systolic epsilon reductions in all measured segments. Systolic SR showed reductions only in the basal and apical segments of the lateral wall and in the mid portion of the inferior wall (-1.9+/-0.5 vs -1.7+/-0.3 s(-1) and -1.9+/-0.4 vs -1.7+/-0.2 s(-1), respectively, P=.03). RV longitudinal free and inferior wall systolic SR and epsilon values were significantly higher in exam 2.

CONCLUSIONS

LV peak systolic epsilon decreases in exam 2 were possibly due to afterload increase and preload decrease. The lower RV initial deformation indices could be attributed to increased afterload caused by physiologic pulmonary hypertension or immature RV contractile properties. SR seemed to be a more robust index than epsilon and less influenced by preload and afterload hemodynamic alteration.

摘要

背景

从胎儿环境过渡到新生儿环境时，会发生显著的血流动力学变化，包括前负荷和后负荷的改变。动脉导管关闭，肺血管阻力降低，肺血流量增加。应变率（SR）和应变成（epsilon）已被提议作为量化局部壁变形的超声指数。本研究旨在确定这些指数是否可以检测早期和晚期新生儿期之间局部变形的变化。

方法

从 30 名健康新生儿（15 名男性）中获得数据。初始研究在平均年龄为 20.1+/-14 小时（检查 1）时进行，第二次在 31.9+/-2.9 天时（检查 2）进行。使用心尖和胸骨旁视图来量化左心室（LV）和右心室（RV）的局部纵向和径向 SR 和 epsilon，并从这些曲线上计算收缩期、早期和晚期舒张期的值。使用配对样本 t 检验比较两组。

结果

与检查 1 相比，LV 径向变形在基底和中段的收缩期峰值 epsilon 显著降低（51+/-15%对 46+/-9%，P<.01）。LV 纵向变形表现相似，所有测量节段的收缩期峰值 epsilon 均显著降低。收缩期 SR 仅在外侧壁基底和心尖段以及下壁中部段显示降低（-1.9+/-0.5 对-1.7+/-0.3 s(-1)和-1.9+/-0.4 对-1.7+/-0.2 s(-1)，P=.03）。检查 2 中 RV 纵向游离壁和下壁收缩期 SR 和 epsilon 值明显升高。