Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Sci Rep. 2017 Apr 28;7(1):1252. doi: 10.1038/s41598-017-01448-2.
Left ventricular (LV) remodeling after tetralogy of Fallot (TOF) repair may influence LV stiffness. We hypothesized that LV stiffness is altered after TOF repair and related to myocardial calibrated integrated backscatter (cIB) and LV diastolic myocardial deformation. Seventy-seven TOF patients and 80 controls were studied. LV stiffness was assessed by diastolic wall strain (DWS) as defined by (LVPW-LVPW)/LVPW, where LVPW is LV posterior wall thickness, and stiffness index as defined by (E/e/LV end-diastolic dimension), where E and e are respectively early diastolic transmitral inflow and mitral annular velocities. Septal and LVPW cIB and LV diastolic strain rates were determined. Patients had significantly lower DWS (p < 0.001), higher stiffness index (p < 0.001), and greater cIB (p < 0.001). LV DWS correlated negatively with LV stiffness index (r = -0.31, p < 0.001), septal cIB (r = -0.21, p = 0.01), E/e ratio (r = -0.30, p < 0.001) and RV end-diastolic area (r = -0.31, p < 0.001), and positively with LV early (r = 0.33, p < 0.001) and late (r = 0.20, p = 0.01) diastolic strain rates and RV fractional area change (FAC) (r = 0.24, p = 0.003). Multivariate analysis revealed E/e (β = -0.26, p = 0.008), RV end-diastolic area (β = -0.20, p = 0.02), and RV FAC (β = 0.18, p = 0.01) as significant correlates of DWS. Left ventricular stiffening occurs after TOF repair and is related to impaired LV diastolic myocardial deformation, myocardial cIB, and RV volume overload.
法洛四联症（TOF）修复后左心室（LV）重构可能会影响 LV 僵硬度。我们假设 TOF 修复后 LV 僵硬度发生改变，并与心肌校准后向散射（cIB）和 LV 舒张心肌变形有关。研究了 77 例 TOF 患者和 80 例对照者。通过舒张壁应变（DWS）评估 LV 僵硬度，定义为（LV 后壁厚度 LVPW-LVPW）/LVPW，其中 LVPW 是 LV 后壁厚度，僵硬度指数定义为（E/e/LV 舒张末期内径），其中 E 和 e 分别为早期舒张二尖瓣前向血流速度和二尖瓣环速度。测量室间隔和 LVPW 的 cIB 和 LV 舒张应变率。患者的 DWS 明显降低（p<0.001），僵硬度指数明显升高（p<0.001），cIB 明显增大（p<0.001）。LV DWS 与 LV 僵硬度指数（r=-0.31，p<0.001）、室间隔 cIB（r=-0.21，p=0.01）、E/e 比值（r=-0.30，p<0.001）和 RV 舒张末期面积（r=-0.31，p<0.001）呈负相关，与 LV 早期（r=0.33，p<0.001）和晚期（r=0.20，p=0.01）舒张应变率和 RV 射血分数（FAC）（r=0.24，p=0.003）呈正相关。多变量分析显示，E/e（β=-0.26，p=0.008）、RV 舒张末期面积（β=-0.20，p=0.02）和 RV FAC（β=0.18，p=0.01）是 DWS 的显著相关因素。TOF 修复后出现 LV 僵硬度增加，与 LV 舒张心肌变形、心肌 cIB 和 RV 容量超负荷受损有关。
