三维斑点追踪成像评价主动脉瓣置换术后左室扭转运动  

Assessment of left ventricular torsion by three-dimensional speckle tracking imaging after aortic valve replacement

作　　者：糜素霖 周树良[1] MI Sulin;ZHOU Shuliang(Department of Ultrasound,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院超声影像科,武汉市430071

出　　处：《临床超声医学杂志》2020年第7期495-499,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用三维斑点追踪成像(3D-STI)评价慢性重度主动脉瓣反流患者左室扭转运动及主动脉瓣置换术(AVR)前后左室扭转指标的变化,探讨左室扭转和旋转指标与左室构型、左室射血分数(LVEF)的关系,分析AVR对左室扭转功能的影响。方法将76例慢性重度主动脉瓣反流患者分为AR-A组40例(LVEF≥55%)和AR-B组36例(LVEF<55%),另选健康对照组30例;应用3D-STI测量各组左室基底部旋转角度(Basal-Rot)及旋转达峰时间(BasalRot TP)、心尖部旋转角度(Api-Rot)及旋转达峰时间(Api-Rot TP)、整体扭转(Torsion)及扭转达峰时间(Twist TP)。31例行AVR的患者于术后2周复查超声检查,测量上述参数。应用Pearson相关分析法分析左室扭转和旋转指标与左室构型、LVEF的关系。结果①AR-A组Api-Rot和Torsion均较健康对照组减小(均P<0.05),Basal-Rot与健康对照组比较差异无统计学意义;AR-B组Api-Rot、Basal-Rot及Torsion均较健康对照组减小(均P<0.05),Basal-Rot和Torsion均小于AR-A组(均P<0.05),Api-Rot与AR-A组比较差异无统计学意义;②与健康对照组比较,AR-A组Basal-Rot TP和Twist TP均延长(均P<0.05),AR-B组Basal-Rot TP、Api-Rot TP及Twist TP均缩短(均P<0.05);③31例行ARV的患者术后2周Torsion和Api-Rot均较术前增大(均P<0.05),Basal-Rot与术前比较差异无统计学意义;④Pearson相关分析显示Torsion、Api-Rot、Basal-Rot均与LVEF呈正相关(r=0.591、0.327、0.369,均P<0.05);Torsion、Api-Rot均与左室球形化指数呈负相关(r=-0.506、-0.320,均P<0.05)。结论 3D-STI测得的左室扭转和旋转指标均可有效评价慢性重度主动脉反流患者左室整体和局部功能,敏感地反映AVR对左室心肌功能的影响。Objective To assess left ventricular(LV) torsional mechanics in patients with chronic severe aortic regurgitation(AR) by three-dimensional speckls tracking imaging(3D-STI),and to assess the effect of aortic valve replacement(AVR) on LV twist function.Methods A total of 76 patients with chronic severe aortic regurgitation were divided into 40 patients in AR-A group(LVEF≥55%) and 36 patients in AR-B group(LVEF<55%),and 30 healthy controls were selected(healthy control group).LV basal rotation(Basal-Rot),apical rotation(Api-Rot) and time to peak rotation(Basal-Rot TR,ApiRot TP),LV Torsion(Torsion) and time to peak twist(Twist TP) by 3D-STI were analyzed and compared among subgroups.31 patients who underwent AVR were re-examined 2 weeks after operation,and the above parameters were measured.Results①Both Api-Rot and Torsion in AR-A group were reduced compared with those of healthy control group(both P<0.05),there was no statistical difference of Basal-Rot between AR-A group and healthy control group.In AR-B group,Api-Rot,Basal-Rot and Torsion were all lower than those in healthy control group(all P<0.05).Basal-Rot and Torsion were lower than those in AR-A group(both P<0.05),and there was no statistically significant difference of AR between AR-B group and AR-A group.② Compared with healthy control group,Basal-Rot TP and Twist TP were longer in AR-A group(both P<0.05),Twist TP,Api-Rot TP and Basal-Rot TP were shortened in AR-B group(all P<0.05).③2 weeks after AVR,Torsion and Api-Rot in 31 patients were significantly increased(both P<0.05).④ Pearson correlation analysis revealed that Torsion,Api-Rot,Basal-Rot were associated with LVEF(r=0.591,0.327,0.369,all P<0.05).Torsion and Api-Rot were correlated with LV-SpI(r=-0.506,-0.320,both P<0.05).Conclusion 3D-STI could quantitatively assess the LV torsional dynamics in chronic severe AR patients and contribute to a deeper understanding of LV subtle mechanic changes.Parameters of torsional dynamics can sensitively reflect the improvement of LV myocardial function a

关 键 词：斑点追踪成像 三维 主动脉瓣反流 重度 慢性 主动脉瓣置换术 扭转 旋转 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]