Mese Timur, Guven Baris, Yilmazer Murat Muhtar, Demirol Mustafa, Çoban Şenay, Karadeniz Cem
Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, 1374 Street Alsancak, 35320, Izmir, Turkey.
Department of Pediatric Cardiology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey.
Pediatr Cardiol. 2017 Feb;38(2):362-367. doi: 10.1007/s00246-016-1522-4. Epub 2016 Nov 23.
Exercise stress echocardiography is rarely used in the follow-up of children with congenital heart disease following surgical repair. There are no data on global longitudinal strain (GLS) and global circumferential strain (GCS) during exercise in adolescents with repaired tetralogy of Fallot (TOF). The purpose of this prospective study was to investigate GLS and GCS using speckle tracking two-dimensional echocardiography (2D-STE) at rest and during exercise in adolescents with repaired TOF. Twenty patients with repaired TOF and 20 controls were included. The subjects exercised on a semi-supine cycle ergometer using a two-staged 3-min step protocol of 20-40 W at 60-75 rpm. Exercise images with 2D-STE measurements were available for all 40 subjects. In the study group, the GLS values changed significantly between the baseline and third and sixth minute of exercise (-18.10 ± 2.20, -16.23 ± 4.47, -14.22 ± 2.63, respectively, p < 001). GCS did not vary significantly from baseline to end of the exercise testing (-17.49 ± 5.14, -17.15 ± 9.20, -15.66 ± 3.59, respectively, p > 0.05). There was a statistically significant difference between the Stage I longitudinal strain values of the study and control groups (-14.26 ± 9.13 and -20.22 ± 2.88, respectively, p = 0.02) but no significant difference between the Stage II values of these groups (-14.22 ± 2.63 and -15.11 ± 2.45, respectively, p > 0.05). The results revealed significant changes in GLS during exercise in patients with repaired TOF. Data gathered from deformation analysis of 2D-STE during exercise testing can enhance the ability to detect subtle ventricular dysfunction in the follow-up of children with repaired TOF.
运动负荷超声心动图很少用于先天性心脏病手术修复后儿童的随访。目前尚无关于法洛四联症（TOF）修复术后青少年运动期间整体纵向应变（GLS）和整体圆周应变（GCS）的数据。这项前瞻性研究的目的是使用斑点追踪二维超声心动图（2D-STE）研究TOF修复术后青少年静息和运动期间的GLS和GCS。纳入了20例TOF修复术后患者和20例对照。受试者在半卧位蹬车测力计上进行运动，采用两阶段3分钟的阶梯方案，功率为20-40瓦，转速为60-75转/分钟。所有40名受试者均获得了带有2D-STE测量值的运动图像。在研究组中，运动基线与第三分钟和第六分钟之间的GLS值有显著变化（分别为-18.10±2.20、-16.23±4.47、-14.22±2.63，p<0.01）。从运动测试基线到结束，GCS无显著变化（分别为-17.49±5.14、-17.15±9.20、-15.66±3.59，p>0.05）。研究组和对照组第一阶段纵向应变值之间存在统计学显著差异（分别为-14.26±9.13和-20.22±2.88，p=0.02），但两组第二阶段值之间无显著差异（分别为-14.22±2.63和-15.11±2.45，p>0.05）。结果显示TOF修复术后患者运动期间GLS有显著变化。运动测试期间从2D-STE变形分析收集的数据可以提高在TOF修复术后儿童随访中检测细微心室功能障碍的能力。
