2D-STI技术在LVEF≥50%高跨瓣压差重度主动脉瓣狭窄患者围术期疗效评估中的应用价值  

Application value of 2D-STI technique in perioperative evaluation of severe aortic stenosis patients with LVEF≥50% high transvalvular pressure difference

作　　者：白金川[1] 娄元仓 焦宝园 陈秋冰 Bai Jinchuan;Lou Yuancang;Jiao Baoyuan;Chen Qiubing(Department of Ultrasound,the Third Affiliated Hospital of Xinxiang Medical College,Xinxiang 453000,China;Department of Equipment,the Third Affiliated Hospital of Xinxiang Medical College,Xinxiang 453000,China;Department of Magnetic Resonance Imaging,the Third Affiliated Hospital of Xinxiang Medical College,Xinxiang 453000,China;School of Medical Engineering,Xinxiang Medical University,Xinxiang 453000,China)

机构地区：[1]新乡医学院第三附属医院超声科,河南新乡453000 [2]新乡医学院第三附属医院设备科,河南新乡453000 [3]新乡医学院第三附属医院核磁共振科,河南新乡453000 [4]新乡医学院医学工程学院,河南新乡453000

出　　处：《临床医学》2022年第12期11-14,共4页Clinical Medicine

基　　金：新乡医学院教育教学改革项目(2021-XYJG-41)

摘　　要：目的探讨二维斑点追踪(2D-STI)技术在左室射血分数(LVEF)≥50%高跨瓣压差重度主动脉瓣狭窄患者围术期疗效评估中的应用价值。方法选取2019年12月至2021年11月新乡医学院第三附属医院收治的LVEF≥50%高跨瓣压差重度主动脉瓣狭窄患者36例为研究组,均行主动脉瓣置换术(AVR),并于手术前后应用2D-STI技术评价患者左心室心肌情况;另选同期健康体检者25例为对照组,应用2D-STI技术评价受试者左心室心肌情况。统计比较左室长轴、短轴应变参数。结果研究组术前收缩期左室心尖长轴水平、两腔心水平、四腔心水平心内膜层心肌纵向峰值应变(LSendo)、心外膜层心肌纵向峰值应变(LSepi)、中层心肌纵向峰值应变(LSmid)绝对值低于对照组(P<0.05)。研究组术后收缩期左室心尖长轴水平、两腔心水平、四腔心水平LSendo、LSepi、LSmid绝对值低于术前(P<0.05)。研究组术前收缩期左室心尖水平心外膜层心肌周向峰值应变(CSepi)、中层心肌周向峰值应变(CSmid)、心内膜层心肌周向峰值应变(CSendo)、乳头肌水平、二尖瓣水平CSepi、CSmid绝对值低于对照组(P<0.05)。研究组术后收缩期左室乳头肌水平、二尖瓣水平CSepi、CSmid、CSendo绝对值低于术前,心尖水平CSepi、CSmid、CSendo绝对值高于术前(P<0.05)。结论2D-STI技术可定量评价LVEF≥50%高跨瓣压差重度主动脉瓣狭窄患者手术前后左心室心肌分层应变及整体情况,可为临床判断预后提供有效指导。Objective To investigate the application value of two-dimensional speckle tracking(2D-STI)technique in perioperative evaluation of severe aortic stenosis patients with left ventricular ejection fraction(LVEF)≥50%and high transvalvular pressure difference.Methods Thirty-six patients with severe aortic stenosis with LVEF≥50%and high transvalvular pressure differential in the Third Affiliated Hospital of Xinxiang Medical College were selected as the study group.All patients underwent aortic valve replacement(AVR),and left ventricular myocardial status was evaluated by 2D-STI technique before and after operation.A total of 25 healthy subjects were selected as control group.The left ventricular myocardium was evaluated by two-dimensional speckle tracking(2D-STI)technique.The strain parameters of long axis and short axis of left ventricle were statistically compared.Results The absolute values of LSendo,LSepi and LSmid in the study group were lower than those in the control group(P<0.05).In the study group,the absolute values of LSendo,LSepi and LSmid at the long axis of left ventricular apex,two-chamber heart and four-chamber heart levels were lower than those before operation(P<0.05).The absolute values of left ventricular apical CSepi,CSmid,CSendo,papillary muscle,mitral valve CSepi and CSmid in the study group were lower than those in the control group(P<0.05).In the study group,the absolute values of CSepi,CSmid and CSendo at the left ventricular papillary muscle level and mitral valve level were lower than those before operation,and the absolute values of CSepi,CSmid and CSendo at the apex level were higher than those before operation(P<0.05).Conclusions 2D-STI technique can quantitatively evaluate the left ventricular myocardial stratified strain and overall situation in patients with severe aortic stenosis with LVEF≥50%and high transvalvular pressure difference before and after operation,which can provide effective guidance for clinical judgment of prognosis.

关 键 词：重度主动脉瓣狭窄 左室射血分数≥50% 二维斑点追踪技术 左心室心肌分层 

分 类 号：R654.2[医药卫生—外科学]