Labombarda Fabien, Verdier Laurine, Maragnes Pascale, Milliez Paul, Beygui Farzin
Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France.
Université Caen Normandie, Medical School, UNICAEN, CHU Caen, EA, 4650, Signalisation, électrophysiologie Et Imagerie Des lésions D'ischémie-Reperfusion Myocardique, 14000, Caen, France.
Pediatr Cardiol. 2020 Apr;41(4):827-836. doi: 10.1007/s00246-020-02320-3. Epub 2020 Feb 24.
This study examines the function of the right ventricle (RV) using two-dimensional (2D) strain analysis after aortic coarctation (CoA) repair, as well as relationships between potential RV strain abnormalities and patient characteristics. The study examined 39 patients (61% male, age 32 ± 16 years) with CoA repair (33 post end-to-end anastomosis/sub-clavian flap, 6 post stenting/bypass/Teflon patch) and 42 controls. The structure and function of the left ventricle (LV), left atrium (LA), and RV were assessed using 2D standard echocardiography, tissue Doppler imaging, and 2D strain imaging. The characteristics examined included global RV longitudinal strain (RV-GLS), global LV longitudinal strain (LV-GLS), and LA longitudinal strain (LA strain). RV dysfunction was defined by RV-GLS lower than the mean minus 2 standard deviations (SDs) of the control group value. LV mass and mitral E/E were significantly higher in the CoA group. Septal E, LV-GLS, and LA strain were significantly lower in the CoA group. RV dysfunction (RV-GLS > - 16%) was present in 10 (25.6%) CoA patients. RV-GLS was correlated with lateral E, LV-GLS, and LA strain (r = - 0.35, p = 0.02; r = - 0.54, p < 0.001; and r = - 0.44, p = 0.005, respectively). Patients who had a stenting/bypass/Teflon patch as the first initial repair exhibited significantly lower RV-GLS. RV systolic strain abnormalities may occur in patients late after CoA repair. RV strain was correlated with parameters of LV dysfunction. Further large-scale studies are required to confirm these findings and to determine the mechanisms and prognostic implications of RV strain in such patients.
本研究采用二维（2D）应变分析，探讨主动脉缩窄（CoA）修复术后右心室（RV）的功能，以及潜在的RV应变异常与患者特征之间的关系。该研究纳入了39例接受CoA修复的患者（男性占61%，年龄32±16岁）（33例行端端吻合/锁骨下皮瓣修复，6例行支架置入/旁路移植/Teflon补片修复）和42例对照。使用二维标准超声心动图、组织多普勒成像和二维应变成像评估左心室（LV）、左心房（LA）和RV的结构与功能。所检测的特征包括整体RV纵向应变（RV-GLS）、整体LV纵向应变（LV-GLS）和LA纵向应变（LA应变）。RV功能障碍定义为RV-GLS低于对照组值的均值减2个标准差（SDs）。CoA组的LV质量和二尖瓣E/E显著更高。CoA组的室间隔E、LV-GLS和LA应变显著更低。10例（25.6%）CoA患者存在RV功能障碍（RV-GLS＞-16%）。RV-GLS与侧壁E、LV-GLS和LA应变相关（r分别为-0.35，p = 0.02；r为-0.54，p＜0.001；r为-0.44，p = 0.005）。首次初始修复采用支架置入/旁路移植/Teflon补片的患者表现出显著更低的RV-GLS。CoA修复术后晚期患者可能出现RV收缩期应变异常。RV应变与LV功能障碍参数相关。需要进一步开展大规模研究以证实这些发现，并确定此类患者中RV应变的机制和预后意义。
