实时三平面应变成像评价主动脉瓣返流患者瓣膜置换术后左心室收缩功能  

Evaluation of Left Ventricular Systolic Function in Patients with Aortic Regurgitation after Aortic Valve Replacement Using Real-time Triplane Strain Imaging

作　　者：王斌[1] 陈海燕[2] 舒先红[2] 康瑜[2] 洪涛[1] 王春生[1] 程蕾蕾[2] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032 [2]复旦大学附属中山医院心脏超声诊断室,上海200032

出　　处：《中国临床医学》2013年第5期632-635,共4页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金项目(编号:81201095);上海市卫生局卫生科技项目(编号:20114192)

摘　　要：目的:应用实时三平面应变成像技术评价主动脉瓣返流(aortic regurgitation,AR)患者行主动脉瓣置换(aortic valve replacement,AVR)术后左心室收缩功能。方法:选择未合并持续性房颤、重度主动脉瓣狭窄及既往无胸部手术史的中重度AR患者13例作为AVR组,术前3 d内及术后1周行常规超声心动图、实时三平面应变成像检查及N-末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)检测,分析各指标的变化情况。选择17例健康志愿者作为对照组。结果:AVR组患者术前心尖左心室长轴观应变平均峰值(GLPS-LAX)、心尖四腔观长轴应变平均峰值(GLPS-A4C)、心尖二腔观长轴应变平均峰值(GLPS-A2C)和左心室长轴应变平均峰值(GLPS)分别为(-12.84±10.65)%、(-16.15±7.78)%、(-15.61±8.41)%及(-12.46±5.52)%,术后1周分别为(-9.92±8.64)%、(-8.35±9.46)%、(-10.92±8.66)%及(-8.43±10.81)%,均显著低于对照组[(-20.61±4.40)%、(-21.31±4.15)%、(-21.45±4.58)%及(-21.12±3.75)%],P<0.01。AVR组患者术后左心室各壁纵向应变峰值均显著下降,以前壁和前间隔最为明显,基底段前间隔从(-13.69±6.10)%降至(-6.35±9.45)%,前壁从(-8.77±9.13)%降至(-6.22±10.14)%;中间段前间隔从(-16.76±9.70)%降至(-11.54±8.27)%,前壁从(-15.31±9.10)%降至(-10.85±11.34)%;P均<0.01。术后1周NT-proBNP较术前显著升高[(1306.66±1116.80)ng/L比(392.51±717.31)ng/L],P<0.01;术后1周左心室射血分数(1eft ventricular ejectionfraction,LVEF)降低不显著,P=0.08。结论:实时三平面应变成像可敏感地检测到左心室收缩功能的改变;行AVR的患者术后1周虽然LVEF无明显改变,但左心室纵向应变显著降低。Objective：To evaluate the changes of left ventricular systolic function after aortic valve replacement（AVR） in patients with aortic regurgitation （AR） using real-time triplane strain imaging.Methods：A total of 13 patients with moderate or severe AR without coronary artery disease,severe aortic stenosis and atrial fibrillation were included as AVR group.At 3 days before AVR and 1 week after AVR,all patients underwent conventional echocardiography and real-time triplane strain imaging,and N-terminal pro-brain natriuretic peptide（NT-proBNP） was also detected.Seventeen healthy volunteers were enrolled as control group.Results：The peak values of longitudinal strain including GLPS-LAX,GLPS-A4C,GLPS-A2C and GLPS in AVR group were （-12.84 ± 10.65） ％,（-16.15 ± 7.78） ％,（-15.61 ± 8.41） ％ and （-12.46 ± 5.52） ％ before the operation,and they were （-9.92 ± 8.64） ％,（-8.35 ± 9.46） ％,（-10.92 ± 8.66） ％ and（-8.43 ± 10.81） ％ at 1 week after operation.They were significantly lower than the control group[（-20.61 ± 4.40） ％,（-21.31 ± 4.15） ％,（-21.45 ± 4.58） ％ and （-21.12 ± 3.75） ％,respectively],P＜0.01.After operation,the peak values of left ventricular longitudinal strain decreased significantly,especially in anterior walls and anterior septal walls.The peak values of anterior septal wall and anterior wall of basal segment decreased from （-13.69 ± 6.10） ％ and （-8.77 ± 9.13） ％ to （-6.35 ± 9.45） ％ and （-6.22 ± 10.14） ％,respectively,P＜0.01 ; the peak values of anterior septal wall and anterior wall of middle segment decreased from （-16.76 ± 9.70） ％ and （-15.31 ± 9.10） ％ to （-11.54 ± 8.27）％ and （-10.85 ± 11.34）％,P＜0.01）.The content of NT-proBNP increased from （392.51 ± 717.31）ng/L before operation to （1306.66 ± 1116.80） ng/L at 1 week after successful AVR （P＜ 0.01） ; left ventricular ejection fraction （LVEF） manifested no significant reduction in AVR group（

关 键 词：主动脉瓣返流 实时三平面应变成像 纵向应变 N-末端脑钠肽前体 

分 类 号：R445.1[医药卫生—影像医学与核医学]