慢性重度主动脉瓣反流患者左室心肌纵向分层应变特点及其与左室构型的相关性分析  

Longitudinal layer-specific strain characteristics of left ventricular myocardium and its correlation with left ventricular configuration in patients with chronic severe aortic valve regurgitation

作　　者：龚敏 吴娟 裴勇凯 王艳丽 曹思奇 吴海波 武俊[1] GONG Min;WU Juan;PEI Yongkai;WANG Yanli;CAO Siqi;WU Haibo;WU Jun(Department of Cardiovascular Ultrasound,the Second Affiliated Hospital of Dalian Medical University,Liaoning 116027,China)

机构地区：[1]大连医科大学附属第二医院心血管超声科,辽宁省大连市116027 [2]大连医科大学附属第二医院心外科,辽宁省大连市116027

出　　处：《临床超声医学杂志》2022年第2期106-111,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用二维斑点追踪超声心动图(2D-STE)评估慢性重度主动脉瓣反流(AR)患者左室心肌纵向分层应变特点,并探讨其与左室构型之间的相关性。方法前瞻性纳入43例慢性重度AR患者(AR组)及20例健康志愿者(对照组),应用常规超声心动图获取两组左室舒张末期内径指数(LVEDDI)、左室收缩末期内径指数(LVESDI)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、后壁厚度(PWT)、室间隔厚度(IVST)、左房前后径(LAD)、左室射血分数(LVEF)、左室质量指数(LVMI)和球形指数(SPI),2D-STE获取左室整体及各节段心内膜下、中层及心外膜下心肌纵向应变(LS_(endo)、LS_(mid)、LS_(epi)),以及整体纵向分层应变跨壁梯度(TG)。比较两组上述各参数差异;分析左室整体纵向分层应变参数与左室构型参数的相关性。结果与对照组比较,AR组LVEDDI、LVESDI、LVEDVI、LVESVI、PWT、IVST、LAD、LVMI和SPI均增大,LVEF降低,差异均有统计学意义(均P<0.001)。AR组整体LS_(endo)、LS_(mid)、LS_(epi)及TG均较对照组明显降低,差异均有统计学意义(均P<0.001)。对照组整体LS_(endo)、LS_(mid)、LS_(epi)呈递减趋势(F=38.967,P<0.001);AR组整体LS_(endo)、LS_(mid)、LS_(epi)比较差异无统计学意义(F=1.422,P=0.246)。对照组LS_(endo)、LS_(mid)及LS_(epi)从基底段至心尖段均呈递增趋势(F=67.502、36.337、44.673,均P<0.001),且组内两两比较差异均有统计学意义(均P<0.05)。AR组从基底段至心尖段LS_(endo)比较差异虽有统计学意义(F=4.730,P=0.011),但基底段与中间段LSendo比较差异无统计学意义,递增趋势消失;仅LS_(mid)和LS_(epi)从基底段至心尖段呈递减趋势(均P<0.001)。左室整体LS_(endo)、LS_(mid)及LS_(epi)分别与LVEDDI、LVESDI、LVEDVI、LVESVI、PWT、IVST、LAD、LVMI和SPI均呈负相关(均P<0.001)。结论 2D-STE能够定量评估慢性重度AR患者左室心肌纵向分层应变,且左室纵向分层应变与其构型相�Objective patients with chronic severe aortic regurgitation(AR)by two-dimensional speckle tracking echocardiography(2 D-STE),and to explore the correlation between the longitudinal layer-specific strain and LV configuration.MethodsForty-three patients with chronic severe AR(AR group)and 20 healthy volunteers(control group)were prospectively selected.The LV end-diastolic diameter index(LVEDDI),LV end-systolic diameter index(LVESDI),LV end-diastolic volume index(LVEDVI),LV endsystolic volume index(LVESVI),posterior wall thickness(PWT),interventricular septum thickness(IVST),left atrial diameter(LAD),LV ejection fraction(LVEF),LV mass index(LVMI)and spherical index(SPI)were measured by conventional echocardiography.The global and segmental longitudinal strain of endocardial(LS_(endo)),mid-myocardial(LS_(mid)),epicardial(LS_(epi)),and global longitudinal layer-specific strain transmural gradient(TG)were acquired by 2 D-STE.The differences of above parameters between the control group and the AR group were compared,and the correlation between global longitudinal layer-specific strain and LV configuration parameters were analyzed.Results LVESDI,LVEDVI,LVESVI,PWT,IVST,LAD,LVMI and SPI were significantly increased in the AR group,while the LVEF was decreased(all P<0.001).The global LSendo,LSmid,LSepiand TG in the AR group were lower than those in the control group(all P<0.001).Global LS_(endo),LS_(mid),LSepishowed a decreasing trend in the control group(F=38.967,P<0.001).There were no significant difference of global LS_(endo),LS_(mid),LS_(epiin) the AR group(F=1.422,P=0.246).In the control group,LS_(endo),LS_(mid),LS_(epi) increased from the base to the apex(F=67.502,36.337,44.673,all P<0.001),and there were significant differences between the pairwise(all P<0.05).In the AR group,although there was significant difference of LSendofrom base to apex(F=4.730,P=0.011),there were no significant difference between base and middle LS_(endo),and the increasing trend disappeared,only LS_(mid)and LS_(epi) showed a decreasing tren

关 键 词：超声心动描记术 斑点追踪 主动脉瓣反流 重度 慢性 心室重构 左 分层应变 

分 类 号：R540.45[医药卫生—心血管疾病] R542.5[医药卫生—内科学]