超声三维斑点追踪技术评价左室射血分数正常的TAVI术患者左室整体收缩功能  

Assessment on left ventricular global systolic function of patients with normal left ventricular ejection fraction after transcatheter aortic valve implantation by three dimensional speckle tracking imaging

作　　者：张敏[1] 金修才[1] 徐芬[1] 熊文峰[1] 赵宝珍[1] 

机构地区：[1]第二军医大学附属长海医院超声科,上海200433

出　　处：《中国医学装备》2016年第3期73-77,共5页China Medical Equipment

摘　　要：目的:探讨三维斑点追踪显像(3D-STI)技术对左室射血分数(LV-EF)正常的重度主动脉瓣狭窄(AS)患者行经导管主动脉瓣腔内植入术(TAVI)后左室早期整体收缩功能变化的应用价值。方法:选取行TAVI术的LVEF正常的16例重度AS患者纳入TAVI组,选取年龄、性别匹配的健康志愿者20名纳入对照组。采集16例AS患者术前、术后3 d、术后1个月、术后3个月、术后6个月及健康对照组标准心尖四腔观左室实时三维动态图像,应用3D-STI技术测量并比较各组左室整体纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)及径向应变(GRS)。结果:TAVI组术后各时间点主动脉瓣前向血流最大流速(AV),最大跨瓣压差(Max PAG)均较术前明显下降;术前TAVI组LVEF均>50%,术后各时间点LVEF变化不明显;3D-STI分析TAVI组术后各组左室纵向应变、圆周应变、面积)应变及径向应变较术前均有明显改善,并呈上升趋势,术后3个月左室舒张末重量指数(LVEDMI)出现明显改善,但仍低于健康对照组。结论:3D-STI技术分析左室整体应变可在LVEF变化不明显的情况下早期有效地评价TAVI患者左室收缩功能的变化。Objective： To evaluate left ventricular（LV） global systolic function in patients with normal left ventricular ejection fraction（LVEF） underwent transfemoral balloon dilated aortic valve implantation operation（TBDAVI） by three-dimensional speckle tracking imaging（3D-STI） technology. Methods： Sixteen patiens with severe aortic stenosis were enrolled in this study, all of them with normal left ventricular ejection fraction（LVEF） underwent successful TAVI operation. 20 normal subjects matched with age and sex were selected as control groups. The real-time 3D full–volume images of left ventricular on apical four-chamber view were acquired and analyzed by 3D-STI online software on before, 3days, 1 month, 3 months, 6 months after TAVI. Left ventricular global longitudinal strain（GLS）, global circumferential strain（GCS）, global area strain（GAS）, global radial strain（GRS） were calculated and compared. Results： Compared with the pre-operation, aortic valve blood flow velocity（AVmax）, max aortic valve pressure gradient（max PG） of 3 days after operation decreased significantly; LV-EF had no significant differences before and after operation; LV 3D-GLS, GCS, GAS, GRS were higher than pre-operation and each group afteroperation was on the the rise, but it was still lower than the normal control group. Left ventricular mass index at the end of diastole period decreased significantly 3 months after TAVI. Conclusion： LV 3D-strain calculation by 3D-STI could evaluate the early change of heart systolic function of TAVI patients whose LVEF had no significant differences before and after operation.

关 键 词：三维斑点追踪技术 应变 主动脉瓣狭窄 主动脉瓣植入术 左室功能 

分 类 号：R654.2[医药卫生—外科学]