| Objective:To analysis of preoperative transthoracic echocardiography and dynamic electrocardiogram related data of patients with severe main thoracic scoliosis,and provide reference for the evaluation of the preoperative heart and the management of perioperative period in patients with severe main thoracic scoliosis.Methods:This study retrospectively analyzed 38 cases of patients with severe main thoracic scoliosis in the second affiliated hospital of kunming medical university from October 2015 to October 2019.Inclusion criteria:(1)The main curve is the thoracic curve;(2)The main thoracic curve on the coronal plane is greater than 90 degrees;(3)The parietal vertebra is located in the T5-T10 region.Lenken type 1 adolescent idiopathic scoliosis with a main thoracic curve Cobb<90° were selected as a control study.Exclusion criteria for the two groups:(1)Spinal deformities caused by tuberculosis.fractures.and so on;(2)Incomplete auxiliary examination data;(3)Spinal deformities caused by skeletal dysplasia,Ma Fan,neurofibromatosis,syndrome type and so on.Collect the patient’s general information and cardiac related examination data through the hospital patient data database.The parameters measured by echocardiography included the followings:Left ventricular diastolic diameter(LVDd),right atrial diameter(RAD),left atrial diameter(LAD),aortic diameter(AO),ascending aorta(AAO),main pulmonary artery diameter(MPAD),right ventricular diastolic diameter(RVDd),right ventricular outflow tract(ROVT),inter ventricular septum thickness(IVST).left ventricular posterior wall thickness(LVPWT),ejection fraction(EF),fractional shortening(FS),stroke volume(SV),cardiac output(CO),cardiac index(CI),pulmonary artery systolic pressure and other parameters.The parameters measured by dynamic electrocardiogram included the followings:the average heart rate,abnormal heart rhythms.heart rate variability(HRV).The dynamic electrocardiogram records the average heart rate of the subject’s heart,the type and number of abnormal heart rhythms,and heart rate variability(HRV)parameters that reflect subtle changes in heart rate.Through the statistical analysis of the above parameters,explore the changes of cardiac structure and function and its influencing factors in patients with severe main thoracic scoliosis.SPSS22.0 statistical analysis software was used for statistical processing and analysis.The measurement data was expressed as mean±standard deviation.For two independent samples of the same comparison index between the two groups,independent sample T-test was used to verify the hypothesis.For measurement data,Chi-square test was used to define P<0.05 as considered statistically significant.Pearson correlation analysis was used to study the correlation between Cobb angle and cardiac ultrasound parameters.Results:1.Comparison between groups:38 cases of severe spine deformity group were included in the study,including 17 males and 21 females,aged 12-18 years,average age(14.89±2.14)years,coronal Cobb angle(115.34.97±21.19°).The total of 38 patients in the control group were included in the study,including 16 males and 22 females,aged 12-18 years,average age(14.31±1.89)years,coronal Cobb angle(48.76±11.11°).There was no statistical significance difference between the two grouos in sex and age(P>0.05).Height:The severe spinal deformity group(143.27±12.73cm)was lower than the control group(159.9±7.52cm),and the difference was statistically significant(P=0.000).Weight:The severe spinal deformity group(37.01±9.29kg)was lower than the control group(45.83±6.89kg),and the difference was statistically significant(P=0.000).BMI:The severe spinal deformity group(17.84±3.20kg/m2)was lower than the control group(17.85±1.80kg/m2),and the difference was not statistically significant(P=0.886).n the control group,5 cases of valve abnormalities(5/38,13.16%)were detected by echocardiography,and no other abnormalities such as pericardial effusion were found.In the severe spinal deformity group,16 cases of valve abnormalities(16/38,42.11%)were detected by cardiac ultrasound.There were 2 cases of effusion(2/38,5.21%),and the difference in the incidence of abnormal heart valves between the two groups was statistically significant(P=000).Left ventricular end-diastolic diameter(LVDd):the severe spinal deformity group(36.34±6.70mm)was lower than the control group(39.06 ±4.07mm),and the difference was statistically significant(P=0.036).Left atrium inner diameter(LAD):the severe spinal deformity group(22.84± 3.18mm)was lower than the control group(23.26±3.75mm),and the difference was not statistically significant(P=0.602).Aortic inner diameter(AO):the severe spinal deformity group(21.36±3.59mm)was lower than the control group(22.18±2.77mm),and the difference was not statistically significant(P=0.270).Ascending aorta(AAO):The severe spinal deformity group(22.55±3.02mm)was higher than the control group(22.15±3.05mm),and the difference was not statistically significant(P=0.562).Right ventricular end-diastolic diameter(RVDd):the severe spinal deformity group(19.36±2.46mm)was higher than the control group(17.79 ±2.53mm),and the difference was statistically significant(P=0.008).Right atrium inner diameter(RAD):the severe spinal deformity group(26.86 ±3.39mm)was higher than the control group(26.1 8 ±3.18mm),and the difference was not statistically significant(P=0.374).Pulmonary artery inner diameter(MPAD):The severe spinal deformity group(17.07 ±2.81mm)was lower than the control group(17.73±2.33mm),and the difference was not statistically significant(P=0.271).Right ventricular outflow tract(ROVT):the severe spinal deformity group(19.33 ±2.87mm)was lower than the control group(19.58 ±2.88mm),and the difference was not statistically significant(P=0.700).End-diastolic septal thickness(IVST):the severe spinal deformity group(6.92±1.43mm)was lower than the control group(7.43±1.61mm),and the difference was not statistically significant(P=0.150).Left ventricular posterior wall thickness(LVPWT):the severe spinal deformity group(6.97±1.15mm)was lower than the control group(7.17 ±0.93mm),and the difference was not statistically significant(P=0.389).Mitral valve E/A peak ratio:the severe spine deformity group(1.68±0.37mm)was higher than the control group(1.57±0.44mm).and the difference was not statistically significant(P=0.243).Left ventricular ejection fraction(EF):the severe spinal deformity group(66.02±4.76%)was lower than the control group(68.89±3.77%),and the difference was statistically significant(P=0.005).Left ventricular shortening score(FS):the severe spinal deformity group(37.66±7.06%)was lower than the control group(38.13±3.12%),and the difference was not statistically significant(P=0.708).Stroke output(SV):the severe spinal deformity group(50.84±13.22ml)was lower than the control group(58.25±13.05ml).and the difference was statistically significant(P=0.016).Cardiac output(CO):the severe spinal deformity group(4.21±0.63L/min)was higher than the control group(4.18±0.56L/min),and the difference was not statistically significant(P=0.805).Cardiac index(CI):The severe spinal deformity group(2.79±0.46L/min.m2)was lower than the control group(3.03 ±0.40L/min.m2),and the difference was not statistically significant(P=0.018).Pulmonary artery systolic pressure:the severe spinal deformity group(30.71±3.24mmHg)was higher than the control group(26.39±4.42mmHg).and the difference was statistically significant(P=0.000).Aortic valve blood flow velocity(AV):the severe-.spinal deformity group(1.03 ± 0.19m/s)was lower than the control group(1.17±0.21m/s),and the difference was statistically significant(P=0.005).Related parameters of dynamic electrocardiogram:Severe group:6 cases of supraventricular premature beats,1 case of supraventricular tachycardia,1 case of premature ventricular beats,1 case of ST segment changes,6 cases of T wave changes:control group:7 cases of supraventricular premature beats.supraventricular There were 1 case of tachycardia,8 cases of ventricular premature beats,2 cases of ST segment changes,and 9 cases of T wave changes.There was no significant difference in the incidence of arrhythmia between the two groups(P>0.05).The average heart rate of severe group(87.87 ± 3.48 beats/min)is greater than that of control group(78.28±8.17 beats/min),and the difference is statistically significant(P=0.009);SDNN:severe spinal deformity group(147.43± 69.95)was lower than the control group(156.72±41.59),and the difference was not statistically significant(P=0.596):RMSSD:severe spinal deformity group(73.31 ±72.62)was higher than the control group(62.28 ±23.53),and the difference was not statistically significant(P=0.483):PNN50:the severe spinal deformity group(20.25±12.31)was lower than the control group(27.68 ±13.72),and the difference was not statistically significant(P=0.075);SDANN:the severe spinal deformity group(136.50±51.26)was lower In the control group(141.40±41.98),and the difference was not statistically significant(P=0.740)2.Correlation analysis within the group:In the severe group,the Cobb angle of the main thoracic curve showed a moderate positive correlation with the right ventricular end-diastolic diameter(RVDd)(r=0.623,p=0.000).The Cobb angle of the main thoracic curve was moderate positive correlation with the pulmonary artery pressure(r=0.688,p=0.000).Cobb angle of main chest curve is slightly negatively correlated with peak ratio of mitral annulus E/A(r=-0.418,p=0.009).The Cobb angle of the main thoracic curve was slightly negatively correlated with the left ventricular posterior wall thickness(LVPWT)(r=-0.410,p=0.010).The Cobb angle of the main thoracic curve was slightly negatively correlated with cardiac output(CO)(r=-0.364,p=0.025);the right ventricular end-diastolic diameter(RVDd)was slightly positively correlated with pulmonary systolic pressure(r=0.365,p=0.024).The Cobb angle of the main thoracic curve in the control group had no significant correlation with the relevant parameters of echocardiography and dynamic electrocardiogram.Conclusion(s):1.Severe main thoracic scoliosis have a more obvious effect on heart structure.2.Severe main thoracic scoliosis affects left ventricular contraction and diastolic function.The diastolic function is slightly negatively correlated with the severity of spinal deformity.3.Severe main thoracic scoliosis increases pulmonary arterial pressure,reduces the function of the right ventricle,which is moderately related to the severity of the deformity.4.Severe main thoracic scoliosis increases the patient’s average heart rate,but the effect on the cardiac autonomic nerve is not obvious. |
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