分层应变技术评价主动脉瓣狭窄患者左心室心肌功能改变  

Evaluation of left ventricular myocardial function in patients with aortic stenosis by layer-specific strain

作　　者：刘园园 崔存英 李亚南 王莹 胡彦斌 张娟 黄丹青 李广辉 李昭 刘琳 Liu Yuanyuan;Cui Cunying;Li Yanan;Wang Ying;Hu Yanbin;Zhang Juan;Huang Danqing;Li Guanghui;Li Zhao;Liu Lin(Department of Ultrasound,Henan Provincial People′s Hospital,Fuwai Central China Cardiovascular Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Cardiac Surgery,Henan Provincial People′s Hospital,Fuwai Central China Cardiovascular Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院郑州大学人民医院超声科,郑州450003 [2]河南省人民医院阜外华中心血管病医院郑州大学人民医院心外科,郑州450003

出　　处：《中华超声影像学杂志》2019年第11期921-926,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81401419);河南省科技攻关项目(17210231003);河南省医学科技攻关计划项目(201602173,2018020452)。

摘　　要：目的探讨分层应变技术评价不同程度主动脉瓣狭窄(aortic stenosis,AS)患者左室三层心肌及各节段心肌功能改变的应用价值。方法选取2017年12月至2019年6月在河南省人民医院就诊的AS患者98例,其中轻度AS组30例,中度AS组33例,重度AS组35例,选取同期健康体检者30例作为对照组,应用分层应变技术测量各组左心室内层、中层、外层、全层心肌及各节段心肌纵向应变(LS)、圆周应变(CS),并进行比较。结果与对照组比较,不同程度AS组Vmax、PPG、IVSD、LVPWD、LVMI、E/e增加(均P<0.05)。不同程度AS组全层心肌LS、CS随着AS程度的加重而逐渐减低(P<0.05),不同程度AS组基底段、中间段内层、中层、外层及全层心肌LS均较对照组减低(P<0.05);重度AS组心尖段各层心肌LS较对照组减低(P<0.05);与轻度AS组比较,中度AS组内层心肌LS减低,差异有统计学意义(P<0.05),中层、外层心肌LS、CS减低,但差异无统计学意义(P>0.05)。轻度AS组基底段、中间段、心尖段三层及全层心肌CS与对照组比较差异无统计学意义(P>0.05);中度、重度AS组内层、中层、外层及全层心肌CS较对照组减低(均P<0.05)。中度AS组基底段、中间段心内膜层、心肌中层CS较对照组减低(均P<0.05);重度AS组基底段、中间段、心尖段三层心肌CS均较对照组减低(P<0.05)。结论分层应变技术能够定量评价主动脉瓣狭窄患者左心室各层心肌、各节段心肌功能,具有一定的临床价值。Objective To investigate the value of layer-specific strain in evaluating the changes of left ventricular three layers and segmental myocardial function in patients with different degree of aortic stenosis(AS).Methods Ninety-eight AS patients were selected as AS group from December 2017 to June 2019 in Henan Provincial People′s Hospital,they were divided into mild AS group(30 cases),moderate AS group(33 cases),severe AS group(35 cases);30 healthy subjects were enrolled as control group.Longitudinal strain(LS),circumferential strain(CS)of endocardium,mid-myocardium,epicardium,global full thickness and each segment of left ventricular myocardium were measured by layer-specific strain and then compared.Results Compared with the control group,Vmax,PPG,interventricular septal thickness in diastole(IVSD),left ventricular posterior wall thickness in diastole(LVPWD),left ventricular mass index(LVMI),and E/e increased in all three AS groups(all P<0.05).There were stepwise decreases of global full-thickness LS,CS with the increases of AS degree(all P<0.05).LS of endocardial,mid-myocardial,epicardial and global full-thickness myocardium layers in basal and middle left ventricular(LV)segments of different AS groups were decreased compared with the control group(all P<0.05).LS of three myocardium layers in apical LV segment were decreased in severe AS group compared with control group(all P<0.05).Compared with the mild AS group,the endocardial myocardium LS in moderate AS group decreased,and the difference was statistically significant(P<0.05),and LS and CS of mid-myocardial,epicardial myocardium decreased,but the difference was statistically insignificant(all P>0.05).There were no significant difference in CS of endocardial,mid-myocardial,epicardial and global full-thickness myocardium layers in basal,middle and apical LV segments between mild AS group and control group(all P>0.05).CS of endocardial,mid-myocardial,epicardial and global full-thickness myocardium layers were decreased in moderate AS and severe AS groups comp

关 键 词：超声心动描记术 分层应变 主动脉瓣狭窄 心室功能 左 

分 类 号：R54[医药卫生—心血管疾病]