组织多普勒联合左心房容积指数评价食管癌患者放疗后早期心脏损伤
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摘要
目的探讨左心房容积指数(LAVI)联合组织多普勒评价食管癌患者放疗后左心功能早期损伤的价值。方法对40例首次接受胸部放疗的食管癌患者,于放疗前、放疗后进行超声心动图检查,记录常规超声参数、组织多普勒参数及LAVI,并进行统计学分析,分析LAVI与舒张早期二尖瓣血流速度(E)/二尖瓣环舒张早期峰值速度(Em)的相关性。结果与放疗前相比,常规超声指标放疗前后无明显变化(P均>0.05);放疗后二尖瓣环舒张期峰值速度(Sm)、Em、Em/二尖瓣环舒张晚期峰值速度(Am)降低,Am和E/Em升高,LAVI放疗后亦升高,且LAVI与E/Em呈正相关(r=0.87,P<0.001)。结论食管癌患者接受放疗后,早期放射性心脏损伤主要表现为心脏舒张功能减退,组织多普勒、E/Em、LAVI可作为早期左心功能损伤的较好指标。
Objective To analyze the value of tissue Doppler imaging and left atrial volume index(LAVI)in evaluating radiation induced left heart injury in patients with esophageal carcinoma.Methods Echocardiography examination were performed in 40 patients with esophageal carcinoma before and after radiation.Conventional parameters,tissue Doppler imaging parameters and LAVI were recorded and compared.The correlation of LAVI and early diastolic mitral flow velocity(E)/early diastolic mitral annular peak velocity(Em)was analyzed.Results Compared with data before radiation,conventional parameters had no significant changes after radiation(all P>0.05),diastolic peak mitral annular velocity(Sm),Em and Em/late diastolic mitral annular peak velocity(Am)deceased while Am and E/Em increased after radiation(all P<0.05)difference,LAVI also increased(P<0.05),which markedly correlated with E/Em(r=0.87,P<0.001).Conclusion After radiation in patients with esophageal carcinoma,acute radiation heart injury mainly diaplayed in left ventricular diastolic dysfunction;tissue Doppler imaging parameters,E/Em,LAVI suggests to be good index to assess acute left ventricular dysfunction.
Objective To analyze the value of tissue Doppler imaging and left atrial volume index(LAVI)in evaluating radiation induced left heart injury in patients with esophageal carcinoma.Methods Echocardiography examination were performed in 40 patients with esophageal carcinoma before and after radiation.Conventional parameters,tissue Doppler imaging parameters and LAVI were recorded and compared.The correlation of LAVI and early diastolic mitral flow velocity(E)/early diastolic mitral annular peak velocity(Em)was analyzed.Results Compared with data before radiation,conventional parameters had no significant changes after radiation(all P>0.05),diastolic peak mitral annular velocity(Sm),Em and Em/late diastolic mitral annular peak velocity(Am)deceased while Am and E/Em increased after radiation(all P<0.05)difference,LAVI also increased(P<0.05),which markedly correlated with E/Em(r=0.87,P<0.001).Conclusion After radiation in patients with esophageal carcinoma,acute radiation heart injury mainly diaplayed in left ventricular diastolic dysfunction;tissue Doppler imaging parameters,E/Em,LAVI suggests to be good index to assess acute left ventricular dysfunction.
引文
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[13]Dokainish H,Nguyen JS,Sengupta R,et al.Do additional echocardiographic variables increase the accuracy of E/e'for predicting left ventricular filling pressure in normal ejection fraction?An echocardiographic and invasive hemodynamic study.J Am Soc Echocardiogr,2010,23(2):156-161.
[14]Tsang TS,Barnes ME,Gersh BJ,et al.Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden.Am J Cardiol,2002,90(12):1284-1289.
[2]Heidenreich PA,Hancock SL,Vagelos RH,et al.Diastolic dysfunction after mediastinal irradiation.Am Heart J,2005,150(5):977-982.
[3]Acarturk E,Koc M,Bozkurt A,et al.Left atrial size may predict exercise capacity and cardiovascular events in patients with heart failure.Tex Heart Inst J,2008,35(2):136-143.
[4]阮琴韵,廖书生,鄢磊.左心房大小与左心室舒张功能相关性的实验研究.中华高血压杂志,2009,17(1):24-27.
[5]Lang RM,Bierig M,Devereux RB,et al.Recommendations for chamber quantification:A report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group,developed in conjunction with the european association of echocardiography,abranch of the European society of cardiology.J Am Soc Echocardiogr,2005,18(12):1440-1463.
[6]Boerma M,Hauer Jensen M.Preclinical research into basic mechanisms of radiation induced heart disease.Cardiol Res Pract,2010,36(7):11-16.
[7]Filopei J,Frishman W.Radiation-induced heart disease.Cardiol Rev,2012,20(4):184-188.
[8]Kasner M,Westermann D,Steendijk P,et al.Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction:A comparative Doppler—conductance catheterization study.Circulation,2007,116(6):637-647.
[9]Teo SG,Yang H,Chai P,et al.Impact of left ventricular diastolic dysfunction on left atrial volume and function:A volumetric analysis.Eur J Echocardioger,2010,11(1):38-43.
[10]Borlaug BA,Paulus WJ.Heart failure with preserved ejection fraction:Pathophysiology,diagnosis,and treatment.EurHeart J,2011,32(6):670-679.
[11]侯苏芸,崔可飞,许进,等.左心房容积追踪技术及实时三维超声评价肥厚型心肌病患者左心房功能.中国医学影像技术,2013,29(2):221-224.
[12]张荔,吕清,谢明星,等.实时三维超声心动图评价左心室构型正常的原发性高血压患者左心房功能.中国医学影像技术,2011,27(1):78-82.
[13]Dokainish H,Nguyen JS,Sengupta R,et al.Do additional echocardiographic variables increase the accuracy of E/e'for predicting left ventricular filling pressure in normal ejection fraction?An echocardiographic and invasive hemodynamic study.J Am Soc Echocardiogr,2010,23(2):156-161.
[14]Tsang TS,Barnes ME,Gersh BJ,et al.Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden.Am J Cardiol,2002,90(12):1284-1289.