经导管主动脉瓣置换术对重度主动脉瓣狭窄患者心肌做功的影响  

Impact of transcatheter aortic valve replacement on myocardial work in patients with severe aortic stenosis

作　　者：郑韶欣[1] 高静伟[1] 林永青[1] 张海峰[1] 王飞[1] 苏子焯[1] 舒晓蓉 李嘉杰[1] 屈曾 刘品明[1] 聂如琼[1] 王景峰[1] Zheng Shaoxin;Gao Jingwei;Lin Yongqing;Zhang Haifeng;Wang Fei;Su Zizhuo;Shu Xiaorong;Li Jiajie;Qu Zeng;Liu Pinming;Nie Ruqiong;Wang Jingfeng(Department of Cardiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院心内科,广州510120

出　　处：《中华生物医学工程杂志》2022年第3期317-322,共6页Chinese Journal of Biomedical Engineering

摘　　要：目的探讨经导管主动脉瓣置换术(TAVR)对重度主动脉瓣狭窄(AS)患者心肌做功的影响。方法单中心连续入选2018年3月至2021年8月在中山大学孙逸仙纪念医院行TAVR治疗的重度AS患者。通过超声心动图检查, 应用左心室压力-应变环评估左心室整体心肌做功, 采用配对t检验比较重度AS患者TAVR术前、术后的整体纵向应变(GLS)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)的变化。结果共纳入26例因重度AS行TAVR治疗的患者(男性17例, 女性9例), 年龄(69.1±7.3)岁, 胸外科医师学会(STS)评分为[4.2 (1.1, 9.2)]%。以主动脉瓣平均跨瓣压差加外周收缩压估测的与心导管测得的左心室收缩期内压高度相关(r=0.918)。TAVR术后组舒张压、左心房容积指数、左心室收缩末期容积、主动脉瓣峰值流速及平均跨瓣压差均低于TAVR术前组, 而左心室射血分数高于TAVR术前组(均P<0.05)。心肌做功指标, 校正后TAVR术后组GWW低于TAVR术前组, 而GLS、GWE高于TAVR术前组(均P<0.05)。结论通过主动脉瓣平均跨瓣压差加外周收缩压这一无创方法能可靠地评估重度AS心肌做功。TAVR治疗后GWE显著提高, 其中以GWW减少为主。Objective To investigate the impact of transcatheter aortic valve replacement(TAVR)on myocardial work in patients with severe aortic stenosis(AS).Methods This was a single-center study enrolling consecutive patients with severe AS undergoing TAVR at Sun Yat-sen Memorial Hospital of Sun Yat-sen University between March 2018 and August 2021.The patients were evaluated for the global myocardial work of the left ventricle based on left ventricular pressure-strain loops by echocardiography.Paired t-test was used to compare the global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE)before and after TAVR in these patients with severe AS.Results A total of 26 patients(17 males and 9 females)who underwent TAVR for severe AS were included,with a mean age of(69.1±7.3)years and a Society of Thoracic Surgeons(STS)score of[4.2(1.1,9.2)]%.There was a close correlation between the value of left ventricular systolic pressure as estimated by mean aortic transvalvular pressure gradient plus cuff systolic blood pressure and that as measured by cardiac catheterization(r=0.918).Post-TAVR,the patients had lower diastolic blood pressure,left atrial volume index,left ventricular end-systolic volume,aortic valve peak flow velocity and mean aortic transvalvular pressure gradient,but higher left ventricular ejection fraction,compared with pre-TAVR values(all P<0.05).With regards to the myocardial work,after adjusted for pressure,the GWW was lowered,while the GLS and GWE were higher,in post-TAVR patients compared with the pre-TAVR values(all P<0.05).Conclusion The mean aortic transvalvular pressure gradient plus cuff systolic blood pressure can be used as a reliable,noninvasive approach to assess the myocardial work in patients with severe AS.TAVR leads to significantly improved GWE,predominantly owing to a reduction in GWW.

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 心肌做功 

分 类 号：R654.2[医药卫生—外科学]