二维斑点追踪技术评价左室射血分数正常的中重度二尖瓣反流患者术后左心室收缩功能的价值  

Value of two-dimensional speckle tracking technology to the evaluation of left ventricular systolic function in moderate to severe mitral regurgitation patients with normal left ventricular ejection fraction

作　　者：孙微[1] 刘洁[1] 吴玲 程晓磊 SUN Wei;LIU Jie;WU Ling;CHENG Xiao-lei(Department of Ultrasound,the Second Affiliated Hospital of Shenyang Medical College,Shenyang,Liaoning 110002,China;Grade 2018,Clinical School of Shenyang Medical College,Shenyang,Liaoning 110034,China)

机构地区：[1]沈阳医学院附属第二医院超声科,辽宁沈阳110002 [2]沈阳医学院临床医学系,辽宁沈阳110034

出　　处：《中华实用诊断与治疗杂志》2021年第3期301-305,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：辽宁科技厅基金项目(20187078)。

摘　　要：目的应用二维斑点追踪技术测量左室射血分数(left ventricular ejection fraction,LVEF)正常的中重度二尖瓣反流患者左心室心尖段收缩期纵向峰值应变(apical systolic peak longitudinal strain,ALS)、中间段收缩期纵向峰值应变(mid-systole peak longitudinal train,MLS)、基底段收缩期纵向峰值应变(basal peak longitudinal train,BLS)、左心室整体径向应变(global radial systolic strain,GRS)、整体纵向应变(global longitudinal systolic strain,GLS)、整体圆周应变(global circumferential systolic strain,GCS),探讨二维斑点追踪技术测量的心肌应变参数预测LVEF正常的中重度二尖瓣反流患者术后LVEF降低的价值。方法中重度二尖瓣反流患者216例,行二尖瓣成形术或置换术,分别于术前及术后第14天行超声心动图检查,采用Simpson's法测量LVEF、左心室收缩末期内径、左心室舒张末期内径、左心室收缩末期容积、左心室舒张末期容积,采用二维斑点追踪技术测定ALS、MLS、BLS、GRS、GLS、GCS。依据术后LVEF变化情况将216例患者分为LVEF降低(术后LVEF降低≥10%)组91例和LVEF未降低(术后LVEF降低<10%)组125例。同期体检健康者216例为对照组,于体检日行超声心动图检查测量LVEF等指标,并与LVEF降低组、LVEF未降低组进行比较。多因素logistic回归分析LVEF正常的中重度二尖瓣反流患者术后LVEF降低的影响因素;ROC曲线分析术前GLS、BLS预测LVEF正常的中重度二尖瓣反流患者术后LVEF降低的价值。结果LVEF降低组、LVEF未降低组术前左心室收缩末期内径、舒张末期内径、收缩末期容积、舒张末期容积均大于对照组(P<0.05),LVEF降低组与LVEF未降低组比较差异无统计学意义(P>0.05);3组术前LVEF比较差异均无统计学意义(P>0.05)。LVEF降低组、LVEF未降低组术前GLS[(-19.25±1.59)%、(-21.89±2.12)%]、ALS[(-27.72±6.38)%、(-28.12±5.05)%]均低于对照组[(-23.53±0.98)%、(-32.86±5.23)%](P<0.05),LVEF降低�Objective To apply two-dimensional speckle tracking technology to measure the apical systolic peak longitudinal strain(ALS),mid-systolic peak longitudinal train(MLS),basal peak longitudinal train(BLS),left ventricular global radial systolic strain(GRS),global longitudinal systolic strain(GLS)and global circumferential systolic strain(GCS)in moderate to severe mitral regurgitation patients with normal left ventricular ejection fraction(LVEF),and to investigate the value of myocardial strain parameters measured by two-dimensional speckle tracking technology to the prediction of postoperative LVEF reduction in patients with moderate to severe mitral regurgitation.Methods Totally 216patients with moderate to severe mitral regurgitation underwent mitral valve replacement or mitral valvuloplasty,and received echocardiography before and on the 14th day after surgery.Simpson's method was used to measure LVEF,left ventricular end-systolic dimension,left ventricular end-diastolic dimension,left ventricular end-systolic volume,and left ventricular end-diastolic volume,and two-dimensional speckle tracking technology was used to measure ALS,MLS,BLS,GRS,GLS and GCS.Based on postoperative LVEF changes,216patients were divided into 91patients with postoperative LVEF reduction≥10%(LVEF reduction group)and 125patients with postoperative LVEF decrease<10%(no-reduction group).During the same period,216healthy volunteers were as controls(control group),and received echocardiography on the physical examination day to measure LVEF and other indicators.The preoperative LVEF and other indicators were compared among three groups.Multivariate logistic regression analysis was used to analyze the influencing factors of LVEF reduction.ROC was drawn to analyze the values of preoperative GLS and BLS to the prediction of the postoperative LVEF reduction in patients with moderate to severe mitral regurgitation.Results The preoperative left ventricular end-systolic dimension,end-diastolic dimension,end-systolic volume and end-diastolic volume we

关 键 词：二尖瓣反流 二维斑点追踪技术 左室射血分数 二尖瓣置换术 二尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]