二维斑点追踪技术评价中重度二尖瓣反流隐匿性左心室收缩功能异常  

Evaluation of early left ventricular systolic dysfunction in patients with moderate to severe mitral regurgitation using two-dimensional speckle tracking echocardiography

作　　者：张静 陈昕[2] ZHANG Jing;CHEN Xin(Department of Ultrasound,The Second Affiliated Hospital of Shandong University,Jinan Shandong 250033,China;Department of Cardiovascular Ultrasound,The FirstAffiliated Hospital of China Medical University,Shenyang Liaoning 110001,China)

机构地区：[1]山东大学第二医院特检科,山东济南250033 [2]中国医科大学附属第一医院心血管超声科,辽宁沈阳110001

出　　处：《转化医学杂志》2020年第1期29-33,共5页Translational Medicine Journal

摘　　要：目的应用二维斑点追踪技术评价左室射血分数(left ventricular ejection fraction,LVEF)正常的中重度二尖瓣反流患者行二尖瓣成形术前及术后早期左心室收缩功能的改变,探讨可以早期提示左心室功能异常的相关指标。方法选择拟行二尖瓣成形术的中重度二尖瓣反流患者30例,根据术后2周较术前的LVEF减低是否大于10%,分为2组:A组(LVEF减低<10%)15例,B组(LVEF减低≥10%)15例,并选取年龄匹配的健康体检者20例,作为对照组。A、B 2组分别于术前3 d及术后2周测量左心室整体纵向应变(global longitudinal systolic strain,GLS)及整体纵向应变率(global longitudinal systolic strain rate,GLSr),整体径向应变(global radial systolic strain,GRS)及整体径向应变率(global radial systolic strain rate,GRSr),整体圆周应变(global circumferential systolic strain,GCS)及整体圆周应变率(global circumferential systolic strain rate,GCSr),并将其结果进行对比分析。将术前2组的各应变指标与LVEF的改变之间进行相关性分析。将术后LVEF减低≥10%定义为因变量1,术后LVEF减低<10%定义为因变量0,应用Logistic回归找到预测术后LVEF减低≥10%最强的因素,并绘制受试者工作曲线(receiver operating characteristic curves,ROC)。结果A组术前GLS和GLSr较对照组升高(P<0.05);B组术前GLS和GLSr较对照组减低(P<0.05)。术后2周A、B组的GLS、GLSr,GRS、GRSr,GCS、GCSr均较对照组减低(P<0.05)。且术前GLS、GLSr与术后早期LVEF改变之间存在中等程度负相关关系(r=-0.74,r=-0.57,P<0.01)。将可能影响术后早期LVEF减低≥10%的相关超声参数进行Logistic逐步向前回归分析发现术前GLS、GLSr是预测术后早期LVEF减低≥10%的预测因素。对比GLS、GLSr的ROC曲线下面积,发现GLS参数曲线下面积最大,截断点为-19.69,特异度和敏感度分别为87%和87%。结论B组患者的术前GLS及GLSr较正常人减低,尽管术前LVEF正常,但已存在隐匿性的左室收缩功Objective This study was to evaluate left ventricular early systolic function in patients with moderate to severe mitral regurgitation and left ventricular ejection fraction(LVEF)>60%before and after mitral valvuloplasty(MVP)by using two-dimensional speckle tracking echocardiography and try to find early predicative indicators of post-operative left ventricular dysfunction.Methods Thirty patients who underwent MVP for moderate to severe mitral regurgitation caused by MVP were selected.According to 2 weeks post-operative LVEF decrease>10%,these patients were divided into two groups:group A(LVEF decreased<10%),and group B(LVEF decreased reduced≥10%).Twenty normal patients were matched.Two-dimensional speckle tracking echocardiography were performed in the control,group A and group B before and after the operation.Global longitudinal systolic strain(GLS)and global longitudinal systolic systolic strain rate(GLSr),global radial systolic strain(GRS)and global radial systolic strain rate(GRSr),global circumferential systolic strain(GCS)and global circumferential systolic strain rate(GCSr)were measured.These parameters were compared among group A,group B and the control group before and after the operation.The correlations between preoperative left ventricular strain and post-operative changes of LVEF were analyzed.Logistic regression was used to find the strongest predictors and drawing the receiver operating characteristic curve(ROC)to find the optimal cut-off diagnosis.Results Preoperative GLS and GLSr in group A were significantly higher than those in the control group(P<0.05).Preoperative GLS and GLSr in group B were significantly lower than those in the control group(P<0.05).There was medium negative correlation between preoperative GLS and early postoperative LVEF change(r=-0.74,P<0.01).There was medium negative correlation between preoperative GLSr and early postoperative LVEF change(r=-0.57,P<0.01).The possible ultrasonic parameters of early detection of postoperative LVEF reduction≥10%were included into ste

关 键 词：二维斑点追踪技术 应变 二尖瓣反流 二尖瓣成形术 

分 类 号：R542.5[医药卫生—心血管疾病] R445.1[医药卫生—内科学]