Pietrzak Radosław, Werner Bożena
Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw Zwirki i Wigury, Warsaw, Poland.
PLoS One. 2017 Jan 3;12(1):e0169178. doi: 10.1371/journal.pone.0169178. eCollection 2017.
The aim of the study was to determine whether segmental interactions, as expressed by postsystolic shortening (PSS), affects RV mechanics and are connected with impaired systolic and diastolic function in rTOF children.
55 rTOF adolescent (study group), and 34 healthy volunteers (control group) were examined using classical Doppler flow (Doppler), Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE). PSS was found to occur when time to peak (TTP) was longer than pulmonary valve closure time (PVCT). TTP and strain were derived from RV lateral segments-basal (BL), medial (ML) and apical (AL) in STE. PVCT was measured from the beginning of QRS complex in the ECG to the termination of Doppler flow at the pulmonary valve. TDI was obtained at the lateral tricuspid annulus site and the systolic (S'), early (E') and late diastolic (A') peak velocities were measured along with isovolumic contraction (IVCT), and relaxation (IVRT) time. PW was used to measure early tricuspid inflow velocity (E) for calculating the E/E' ratio. The TDI data in patients with PSS presence (TTP>PVCT) and those in whom it did not occur (TTP≤PVCT) were compared.
PSS in BL, ML and AL were observed respectively in: 27(51,9%), 9 (18%), and 8 (16,7%) patients. Mean values of TTP in BL, ML, and AL were respectively: 420.6±55.5ms, 389.8±50.0ms and 366.7±59.0ms. PVCT mean value was 396.6±33.5ms. In the study group, the mean E' in TTP>PVCT was significantly lower (4.8±1.8 cm/s) compared to mean E' in TTP≤PVCT (8.4±2.6 cm/s), p<0.01. The average E/E' was significantly higher in TTP>PCVT than in TTP≤PVCT, respectively 21.6±7.3 vs 12.2±5.1, p<0.05. IVRT was significantly prolonged in TTP>PVCT compared to IVRT in TTP≤PVCT, respectively 95.9±38.7 vs 77.0±35.1, p<0.05. Furthermore, in TTP>PVCT, significantly higher strain in BL (-28.8±8.7%) was observed when compared to that parameter in TTP≤PVCT (-35.3±13.1%), p <0.05.
Tissue Doppler Echocardiography and Speckle Tracking Echocardiography are useful techniques for detecting regional systolic and diastolic dysfunction in children after Tetralogy of Fallot surgical repair. Postsystolic shortening in the basal lateral segment is commonly seen in children after the Tetralogy of Fallot surgical repair, and is associated with altered right ventricular systolic and diastolic function.
本研究的目的是确定收缩后缩短（PSS）所表现出的节段间相互作用是否会影响右心室力学，并与法洛四联症（rTOF）患儿的收缩和舒张功能受损相关。
使用经典多普勒血流（Doppler）、组织多普勒成像（TDI）和斑点追踪超声心动图（STE）对55名rTOF青少年（研究组）和34名健康志愿者（对照组）进行检查。当达到峰值时间（TTP）长于肺动脉瓣关闭时间（PVCT）时，发现存在PSS。TTP和应变值来自STE中右心室外侧节段——基底段（BL）、中间段（ML）和心尖段（AL）。PVCT从心电图中QRS波群开始到肺动脉瓣处多普勒血流终止进行测量。在三尖瓣环外侧部位获取TDI，并测量收缩期（S'）、舒张早期（E'）和舒张晚期（A'）峰值速度以及等容收缩期（IVCT）和舒张期（IVRT）时间。使用脉冲波（PW）测量三尖瓣早期流入速度（E）以计算E/E'比值。比较存在PSS（TTP>PVCT）和未出现PSS（TTP≤PVCT）患者的TDI数据。
在BL、ML和AL中分别观察到PSS的患者有：27例（51.9%）、9例（18%）和8例（16.7%）。BL、ML和AL中的TTP平均值分别为：420.6±55.5毫秒、389.8±50.0毫秒和366.7±59.0毫秒。PVCT平均值为396.6±33.5毫秒。在研究组中，TTP>PVCT时的平均E'（4.8±1.8厘米/秒）显著低于TTP≤PVCT时的平均E'（8.4±2.6厘米/秒），p<0.01。TTP>PCVT时平均E/E'显著高于TTP≤PVCT时，分别为21.6±7.3和12.2±5.1 p<0.05。与TTP≤PVCT时的IVRT相比，TTP>PVCT时IVRT显著延长，分别为95.9±38.7和77.0±35.1，p<0.05。此外，与TTP≤PVCT时该参数（-35.3±13.1%）相比，TTP>PVCT时BL中的应变显著更高（-28.8±8.7%），p<0.05。
组织多普勒超声心动图和斑点追踪超声心动图是检测法洛四联症手术修复后儿童局部收缩和舒张功能障碍的有用技术。法洛四联症手术修复后的儿童中常见基底外侧节段的收缩后缩短，且与右心室收缩和舒张功能改变相关。
