Three-dimensional speckle tracking imaging for quantitative evaluation of left ventricular global strain in renal transplant recipients
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摘要:
目的 探讨采用三维斑点追踪成像（3D-STI）技术定量评价肾移植受者术后3个月内左心室整体应变的应用价值。 方法 选取34例肾移植受者，分别于术前、术后7 d、术后1个月、术后3个月收集受者的血压、血清肌酐和他克莫司血药浓度等资料，同时对受者行常规超声心动图和3D-STI检查，收集受者超声心动图检查参数[左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）]和3D-STI检查参数[左心室整体纵向峰值应变（GPLS）、整体圆周峰值应变（GPCS）、整体径向峰值应变（GPRS）及整体面积峰值应变（GPAS）]。比较受者术前、术后7 d、术后1个月、术后3个月上述指标的变化，分析应用3D-STI技术定量评价肾移植受者术后3个月内左心室整体应变的变化特点及其应用价值。 结果 肾移植受者术前至术后3个月内各时间点间LVEF和GPCS比较，差异均无统计学意义（均为P > 0.05）。术前至术后3个月内各时间点间LVEDV、LVESV、GPLS、GPAS和GPRS比较，差异均有统计学意义（均为P < 0.001）。GPLS、GPAS、GPRS在术后1个月内呈连续下降趋势，术后3个月有所上升但仍低于术前水平。 结论 应用3D-STI技术能够敏感地发现肾移植受者术后LVEF未见明显改变时左心室整体应变的改变，与常规超声心动图比较，3D-STI可以更准确地评价肾移植受者术后左心室整体应变的变化特点。 -
关键词:
- 三维斑点追踪成像（3D-STI） /
- 肾移植 /
- 左心室射血分数（LVEF） /
- 超声心动图 /
- 左心室整体应变 /
- 左心室舒张末期容积（LVEDV） /
- 左心室收缩末期容积（LVESV） /
- 他克莫司 /
- 整体纵向峰值应变（GPLS） /
- 整体径向峰值应变（GPRS） /
- 整体面积峰值应变（GPAS）
Abstract:Objective To evaluate the application value of three-dimensional speckle tracking imaging (3D-STI) in quantitatively evaluating the left ventricular global strain in recipients within 3 months after renal transplantation. Methods Clinical data including blood pressure, serum creatinine and tacrolimus blood concentration of 34 renal transplant recipients were collected before operation, 7 d, 1 month and 3 months after operation, respectively. Meanwhile, conventional echocardiography and 3D-STI examination were performed. Echocardiographic parameters [left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF)] and 3D-STI parameters [left ventricular global peak longitudinal strain (GPLS), global peak circumferential strain (GPCS), global peak radial strain (GPRS) and global peak area strain (GPAS)] of recipients were collected. The changes of these parameters before operation, 7 d, 1 month and 3 months after operation were statistically compared. The changing characteristic and application value of 3D-STI in quantitatively evaluating the left ventricular global strain in recipients within 3 months after renal transplantation were evaluated. Results LVEF and GPCS did not significantly differ at different time points (all P > 0.05), whereas LVEDV, LVESV, GPLS, GPAS and GPRS significantly differed at different time points from preoperative to within postoperative 3 months (all P < 0.001). GPLS, GPAS and GPRS trended to decline within postoperative 1 month, and slightly increased at 3 months after operation, which was still lower than the preoperative levels. Conclusions Application of 3D-STI may sensitively detect the changes of left ventricular global strain in recipients after renal transplantation when no significant variations are observed in postoperative LVEF. Compared with conventional echocardiography, 3D-STI may more accurately evaluate the changes of left ventricular global strain in recipients after renal transplantation. -
Key words:
- Three-dimensional speckle tracking imaging (3D-STI) /
- Renal transplantation /
- Left ventricular ejection fraction (LVEF) /
- Echocardiography /
- Left ventricular global strain /
- Left ventricular end-diastolic volume (LVEDV) /
- Left ventricular end-systolic volume (LVESV) /
- Tacrolimus /
- Global peak longitudinal strain (GPLS) /
- Global peak radial strain (GPRS) /
- Global peak area strain (GPAS)
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图 1 1例受者肾移植术前、术后左心室GPLS曲线
注：A、B、C、D图分别为肾移植受者术前、术后7 d、术后1个月、术后3个月的左心室GPLS曲线。
Figure 1. The GPLS curves of a recipient before and after renal transplantation
表 1 肾移植术前、术后受者一般情况比较
Table 1. Comparison of general conditions of recipients before and after renal transplantation(x±s)
检查时间 n 收缩压（mmHg①） 舒张压（mmHg） 血清肌酐（μmol/L） 他克莫司血药浓度（ng/mL） 术前 34 143±14 91±9 1 008±389 -② 术后7 d 34 136±13 87±10 189±75a 13.6±3.4 术后1个月 34 130±8a, b 83±8a 147±42a, b 14.8±3.0 术后3个月 34 128±6a, b 80±6a, b 137±20a, b 9.8±1.6b, c P值 < 0.001 < 0.001 < 0.001 < 0.001 注：与术前比较，aP < 0.05/6;与术后7 d比较，bP < 0.05/6;与术后1个月比较，cP < 0.05/6。
①1 mmHg=0.133 kPa。
②-为无数据。
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表 2 肾移植术前、术后受者常规超声心动图检查结果比较
Table 2. Comparison of conventional echocardiography results in recipients before and after renal transplantation(x±s)
检查时间 n LVEDV（mL） LVESV（mL） LVEF（%） 术前 34 101±23 46±12 55±5 术后7 d 34 96±24 a 42±11 a 55±4 术后1个月 34 88±18 a, b 38±9 a, b 56±5 术后3个月 34 83±14 a, b 36±9 a, b 57±6 P值 < 0.001 < 0.001 0.199 注：与术前比较，aP < 0.05/6;与术后7 d比较，bP < 0.05/6。
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表 3 肾移植术前、术后受者3D-STI检查结果比较
Table 3. Comparison of 3D-STI examination results in recipients before and after renal transplantation(x±s, %)
检查时间 n GPLS GPCS GPAS GPRS 术前 34 10.3±2.2 12.5±3.2 21±5 29±8 术后7 d 34 8.8±2.1a 12.9±2.8 20±4 a 27±7a 术后1个月 34 7.9±2.1a, b 11.5±3.2 18±4a, b 24±7a, b 术后3个月 34 9.6±2.2a, b, c 12.6±2.7 20±4c 28±6c P值 < 0.001 0.121 < 0.001 < 0.001 注：与术前比较，aP < 0.05/6;与术后7 d比较，bP < 0.05/6;与术后1个月比较，cP < 0.05/6。
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表 4 3D-STI检查的可重复性检测
Table 4. Repeatability test of 3D-STI examination(x±s, %)
测量顺序 n GPLS GPCS GPAS GPRS 第1次 10 10.5±1.4 12.2±2.1 20.1±2.5 28±5 第2次 10 10.6±1.4 12.1±3.2 20.5±3.2 28±6 P值 0.90 0.85 0.45 0.74
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