二维斑点追踪超声心动图观察脓毒性休克患者左心室心肌功能的变化
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摘要
目的通过分层二维斑点追踪显像技术评价脓毒性休克患者长期预后心肌分层应变的变化趋势。方法选择2016年1月至2017年2月苏北人民医院重症监护室38例脓毒性休克存活患者(作为脓毒性休克组)进行长期随访跟踪,并选取35例正常对照者作为健康对照组,应用GE vividE9和Echopac工作站的分层斑点追踪技术,比较其左心室总体及左室心肌内膜、中层、外膜的心肌纵向、环向应变结果。结果 (1)与健康对照组比较,脓毒性休克组心率无明显变化,差异无统计学意义(F=1.668,P=0.177);脓毒性休克组治疗后1个月左心室射血分数(LVEF)无明显变化,差异无统计学意义(P> 0.05),治疗后3、6个月明显降低,差异具有统计学意义(均P <0.05);治疗后6个月左心室舒张末期容积(LVEDV)明显升高,差异具有统计学意义(P <0.05);治疗后1、3、6个月舒张早期二尖瓣血流峰值速度/舒张早期二尖瓣环峰值速度(E/Em)明显升高,差异具有统计学意义(均P <0.05)。(2)脓毒性休克组各时间节点组内比较,心率、E/Em无明显变化,差异无统计学意义(P> 0.05);治疗后6个月LVEF、GLS绝对值、GRS绝对值、GCS绝对值明显降低,LVEDV明显升高,差异具有统计学意义(均P <0.05)。(3)脓毒性休克组心内膜下、中层、心外膜下心肌的纵向应变及环向应变均低于健康对照组,差异具有统计学意义(均P <0.05)。结论脓毒性休克患者左室心肌内膜、中层、外膜三层心肌收缩功能均减弱,分层斑点追踪技术可以发现其心肌收缩功能的改变。且为脓毒性休克患者评估心功能不全提供了无创参数体系,从而指导临床诊疗,改善脓毒性休克患者的预后。
Objective To evaluate long-term prognosis among septic shock patients by stratified two-dimensional speckle tracking imaging. Methods 38 septic shock survivors were followed up for 6 months and 35 matched healthy people as control. The assessment of longitudinal and circumferential strains of the endocardium, myocardium, epicardium, and global myocardium was performed with the stratified speckle tracking imaging technique(GE vivid E9 and Echopac). Results(1)There was no significant difference in heart rate between septic shock group and control group(F=1.668, P=0.177). In septic shock group, LVEF did not change in the first follow-up month(P > 0.05), but decreased significantly both in the third and in the sixth follow-up month(all P < 0.05). There was a significant difference in LVEF of the sixth follow-up month and E/Em of the first, third, sixth follow-up month between groups(all P < 0.05).(2)There was no significant change in heart rate or E/Em among different follow-up time points in septic shock group(P > 0.05). LVEF and the absolute value of GLS, GRS, GCS were significantly reduced in 6 months′follow up; LVEDV significantly increased in 6 months′ follow up(all P < 0.05).(3)The longitudinal and circumferential strains of the endocardium, myocardium, and epicardium in septic shock group were significantly lower than those in healthy control group(all P < 0.05). Conclusion The longitudinal and circumferential strains of the endocardium, myocardium, epicardium and global myocardium in septic shock patients are all decreased afterwards. The stratified speckle tracking imaging technique can be used to evaluate changes in myocardial systolic function. Moreover, this noninvasive assessment can provide predictive values for prognosis of cardiac function in septic shock patients and therefore guide clinical treatment.
Objective To evaluate long-term prognosis among septic shock patients by stratified two-dimensional speckle tracking imaging. Methods 38 septic shock survivors were followed up for 6 months and 35 matched healthy people as control. The assessment of longitudinal and circumferential strains of the endocardium, myocardium, epicardium, and global myocardium was performed with the stratified speckle tracking imaging technique(GE vivid E9 and Echopac). Results(1)There was no significant difference in heart rate between septic shock group and control group(F=1.668, P=0.177). In septic shock group, LVEF did not change in the first follow-up month(P > 0.05), but decreased significantly both in the third and in the sixth follow-up month(all P < 0.05). There was a significant difference in LVEF of the sixth follow-up month and E/Em of the first, third, sixth follow-up month between groups(all P < 0.05).(2)There was no significant change in heart rate or E/Em among different follow-up time points in septic shock group(P > 0.05). LVEF and the absolute value of GLS, GRS, GCS were significantly reduced in 6 months′follow up; LVEDV significantly increased in 6 months′ follow up(all P < 0.05).(3)The longitudinal and circumferential strains of the endocardium, myocardium, and epicardium in septic shock group were significantly lower than those in healthy control group(all P < 0.05). Conclusion The longitudinal and circumferential strains of the endocardium, myocardium, epicardium and global myocardium in septic shock patients are all decreased afterwards. The stratified speckle tracking imaging technique can be used to evaluate changes in myocardial systolic function. Moreover, this noninvasive assessment can provide predictive values for prognosis of cardiac function in septic shock patients and therefore guide clinical treatment.
引文
1Cimolai MC, Alvarez S, Bode C, et al. Mitochondrial mechanisms in septic cardiomyopathy[J]. Int J Mol Sci, 2015, 16(8):17763-17778.
2 Whalley GA, Wasywich CA, Walsh H, et al. Role of echocardiography in the contemporary management of chronic heart failure[J]. Expert Rev Cardiovasc Ther, 2005, 3(1):51-70.
3 Tee M, Noble JA, Bluemke DA. Imaging techniques for cardiac strain and deformation:comparison of echocardiography[J]. Expert Rev Cardiovasc Ther, 2013, 11(2):221-231.
4 Huang SJ, Orde S. From speckle tracking echocardiography to torsion:research tool today, clinical practice tomorrow[J]. Curr Opin Crit Care, 2013, 19(3):250-257.
5 Bloechlinger S, Berger D, Bryner J, et al. Left ventricular torsion abnormalities in septic shock and corrective effect of volume loading:a pilot study[J]. Can J Cardiol, 2013, 29(12):1665-1671.
6 Court O, Kumar A, Parrillo JE, et al. Clinical review:myocardial depression in sepsis and septic shock[J]. Crit Care, 2002, 6(6):500-508.
7 Pulido JN, Afessa B, Masaki M, et al. Clinical spectru, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock[J]. Mayo Clin Proc, 2012, 87(7):620-628.
8 Chu M, Gao Y, Zhou B, et al. Circumferential strain can be used to detect lipopolysaccharide-induced myocardial dysfunction and predict the mortality of severe sepsis in mice[J]. PLoS One, 2016, 11(5):e0155346.
9 Leitman M, Lysiansky M, Lysyansky P, et al. Circumferential and longitudinal strain in 3 myocardial layers in normal subjects and in patients with regional left ventricular dysfunction[J]. J Am Soc Echocardiogr, 2010, 23(1):64-70.
10 史静,潘翠珍,舒先红,等.二维斑点追踪显像技术定量评价正常成年人左心室心肌分层应变[J].中华超声影像学杂志, 2015, 24(5):378-381.
11 崔洪岩,黄冬梅,夏稻子,等.超声二维应变评价无左心室重构高血压患者心肌分层应变[J].中国超声医学杂志, 2015, 31(8):716-718.
12 孙琳,何怡华,赵映,等.斑点追踪技术研究扩张型心肌病左室重构、应变和收缩功能的相关性[J].中国超声医学杂志, 2016, 32(3):208-210.
2 Whalley GA, Wasywich CA, Walsh H, et al. Role of echocardiography in the contemporary management of chronic heart failure[J]. Expert Rev Cardiovasc Ther, 2005, 3(1):51-70.
3 Tee M, Noble JA, Bluemke DA. Imaging techniques for cardiac strain and deformation:comparison of echocardiography[J]. Expert Rev Cardiovasc Ther, 2013, 11(2):221-231.
4 Huang SJ, Orde S. From speckle tracking echocardiography to torsion:research tool today, clinical practice tomorrow[J]. Curr Opin Crit Care, 2013, 19(3):250-257.
5 Bloechlinger S, Berger D, Bryner J, et al. Left ventricular torsion abnormalities in septic shock and corrective effect of volume loading:a pilot study[J]. Can J Cardiol, 2013, 29(12):1665-1671.
6 Court O, Kumar A, Parrillo JE, et al. Clinical review:myocardial depression in sepsis and septic shock[J]. Crit Care, 2002, 6(6):500-508.
7 Pulido JN, Afessa B, Masaki M, et al. Clinical spectru, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock[J]. Mayo Clin Proc, 2012, 87(7):620-628.
8 Chu M, Gao Y, Zhou B, et al. Circumferential strain can be used to detect lipopolysaccharide-induced myocardial dysfunction and predict the mortality of severe sepsis in mice[J]. PLoS One, 2016, 11(5):e0155346.
9 Leitman M, Lysiansky M, Lysyansky P, et al. Circumferential and longitudinal strain in 3 myocardial layers in normal subjects and in patients with regional left ventricular dysfunction[J]. J Am Soc Echocardiogr, 2010, 23(1):64-70.
10 史静,潘翠珍,舒先红,等.二维斑点追踪显像技术定量评价正常成年人左心室心肌分层应变[J].中华超声影像学杂志, 2015, 24(5):378-381.
11 崔洪岩,黄冬梅,夏稻子,等.超声二维应变评价无左心室重构高血压患者心肌分层应变[J].中国超声医学杂志, 2015, 31(8):716-718.
12 孙琳,何怡华,赵映,等.斑点追踪技术研究扩张型心肌病左室重构、应变和收缩功能的相关性[J].中国超声医学杂志, 2016, 32(3):208-210.