左室纵向应变及应变达峰时间离散度评价人工心脏瓣膜置换术后患者左室收缩功能及同步性  

The value of left ventricular longitudinal strain and strain peak time dispersion in the assessment of left ventricular longitudinal strain and left ventricular motion synchronization after artificial heart valve replacement

作　　者：刘丽萍 郑哲岚[2] Liu Liping

机构地区：[1]杭州市中医院,310000 [2]浙江大学医学院附属第一医院,310000

出　　处：《浙江临床医学》2022年第1期32-34,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨左室纵向应变及应变达峰时间离散度评价人工心脏瓣膜置换术后患者左室收缩功能及同步性的应用价值.方法选取人工心脏瓣膜(PHV)置换术后患者70例为瓣膜置换术后组,并分为主动脉瓣置换(AVR,25例)、二尖瓣置换(MVR,24例)和主动脉瓣、二尖瓣双瓣置换(DVR,21例)三个亚组,同时选取健康体检者25例作为对照组.行常规超声心动图检查,用二维斑点追踪技术获得所有患者左室17节段收缩期纵向应变峰值(LPS)、整体纵向应变峰值(GLPS)、17节段纵向应变达峰时间(TTPLS)及纵向应变达峰时间离散度(PSD).结果瓣膜置换术后组在LAD、LVMI、LVDd等方面均高于对照组(P<0.05),FS、LVEF与对照组比较相对降低(P<0.05);瓣膜置换术后各组各切面各节段GLPS绝对值明显低于对照组,PSD明显高于对照组(P<0.05);瓣膜置换术后组PSD与LVDd、LVMI呈正相关(r=0.4543,r=0.36217,P<0.05);与FS、EF、GLPS绝对值呈负相关(r=-0.3662,r=-0.4085,r=-0.4985,P<0.05).结论左室纵向应变及应变达峰时间能直接准确反映人工心脏瓣膜置换术后左室收缩功能和收缩同步性,能早于传统超声心动图发现左室心肌收缩功能的亚临床表现.Objective To evaluate the application of left ventricular longitudinal strain and strain peak time dispersion to evaluate the left ventncular longitudinal strain and left ventricular motion synchronization after artificial heart valve replacement.Methods Seventy patients with prosthetic heart valve(PHV)replacement were divided into aortic valve replacement group(AVR,25 cases),mitral valve replacement group(MVR,24 cases)and double valve replacement group(DVR,21 cases),and 25 healthy subjects were selected as control group.Routine transthoracic echocardiography was performed to obtain the left ventricular 17-segment systolic longitudinal strain peak(LPS),overall longitudinal strain peak(GLPS),and 17-segment longitudinal strain peak time(TTPLS)and longitudinal strain peak time dispersion(PSD)using two-dimensional speckle tracking technique.Results In the total valve replacement group,LAD,LVMI and LVDd were higher than those in the control group.FS and LVEF were relatively lower in the control group(P<0.05).But the absolute value of GLPS in each segment of each group was significantly lower in the total valve replacement group than that in the control group.PSD was significantly higher in the total valve replacement group than that in the control group(P<0.05).PSD was positively correlated with LVDd and LVMI after valve replac ement(r=0.4543,r=0.36217,P<0.05),and negatively correlated with FS,EF and GLPS(r=-0.3662,r=-0.4085,r=-0.4985,P<0.05).Conclusion Left ventricular longitudinal strain and strain peak time dispersion can directly and accurately reflect left ventricular contractility and contraction synchrony after prosthetic heart valve replacement and evaluate the local or global systolic function of the left ventricle quantitatively,and can be used to detect subclinical manifestations of left ventricular myocardial systolic fiinction earlier than conventional echocardiography.

关 键 词：超声心动图 人工心脏瓣膜 心室功能 应变 达峰时间离散度 

分 类 号：R54[医药卫生—心血管疾病]