肥厚型心肌病心肌切除术后的局部左心室逆向重构

Regional Left Ventricular Reverse Remodeling After Myectomy in Hypertrophic Cardiomyopathy.

作者信息

Wang Jingjin, Sun Xin, Xiao Minghu, Zhang Minghui, Chen Haibo, Zhu Changsheng, Wang Shuiyun, Wang Hao

机构信息

Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Ann Thorac Surg. 2016 Jul;102(1):124-31. doi: 10.1016/j.athoracsur.2015.12.072. Epub 2016 Mar 26.

DOI:10.1016/j.athoracsur.2015.12.072

PMID:27021034

Abstract

BACKGROUND

Surgical extended septal myectomy is appropriate treatment for obstructive hypertrophic cardiomyopathy (HCM) with refractory symptoms. Using 3-layer speckle tracking imaging, we aimed to evaluate the effects of myectomy on left ventricular (LV) regions and the potential factors associated with LV reverse remodeling.

METHODS

In 71 patients (mean age, 41.0 ± 15.0 years) undergoing septal myectomy, 3-layer speckle tracking was performed before myectomy and latest review. We evaluated the myectomy site (target anteroseptum) and LV free wall longitudinal strain (LS) and circumferential strain (CS) in endocardial, midmyocardial, and epicardial layers. The thickness of each free wall segment was calculated and totaled for the free wall thickness score.

RESULTS

Compared with before myectomy, LS increased; however, CS decreased at the myectomy site after myectomy. For the free wall, LS and CS improved in all 3 layers after the procedure (all p < 0.05). Factors independently associated with latest-review free wall strain were free wall thickness score (LS, β = -0.150; p < 0.001; CS, β = -0.090; p < 0.001), age (LS, β = 0.118; p < 0.001), and ΔLV outflow tract gradient (CS, β = 0.039; p = 0.002). Factors independently associated with myectomy site strain were resected thickness (LS, β = -0.439; p = 0.001; CS, β = -0.736; p = 0.001), and age (LS, β = 0.178; p < 0.001).

CONCLUSIONS

Sufficient relief of obstruction and lower resected thickness in the target anteroseptum lead to more favorable remodeling. Free wall thickness score and age are important factors associated with reverse remodeling.

摘要

背景

外科扩大性室间隔心肌切除术是治疗有难治性症状的梗阻性肥厚型心肌病（HCM）的合适方法。我们旨在使用三层斑点追踪成像技术评估心肌切除术对左心室（LV）各区域的影响以及与左心室逆向重构相关的潜在因素。

方法

对71例行室间隔心肌切除术的患者（平均年龄41.0±15.0岁），在心肌切除术之前及最新复查时进行三层斑点追踪成像。我们评估了心肌切除术部位（目标前间隔）以及心内膜、心肌中层和心外膜层的左心室游离壁纵向应变（LS）和圆周应变（CS）。计算每个游离壁节段的厚度并汇总得出游离壁厚度评分。

结果

与心肌切除术之前相比，纵向应变增加；然而，心肌切除术后心肌切除术部位的圆周应变降低。对于游离壁，术后所有三层的纵向应变和圆周应变均有所改善（所有p<0.05）。与最新复查时游离壁应变独立相关的因素为游离壁厚度评分（纵向应变，β=-0.150；p<0.001；圆周应变，β=-0.090；p<0.001）、年龄（纵向应变，β=0.118；p<0.001）和左心室流出道压差变化（圆周应变，β=0.039；p=0.002）。与心肌切除术部位应变独立相关的因素为切除厚度（纵向应变，β=-0.439；p=0.001；圆周应变，β=-0.736；p=0.001）和年龄（纵向应变，β=0.178；p<0.001）。