分层应变技术评估主动脉瓣狭窄患者左室心肌收缩功能的价值  

Evaluation of left ventricular myocardial systolic function in patients with aortic stenosis by layer-specific strain

作　　者：卓宇 龙湘党[1] 敖琨[1] 谢娟娟[1] 钟刚 文琼莉 Zhuo Yu;Long Xiangdang;Ao Kun;Xie Juanjuan;Zhong Gang;Wen Qiongli(Department of Ultrasound,Hunan Provincial People′s Hospital(The First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)超声医学科,长沙410005

出　　处：《中国医师杂志》2022年第11期1665-1669,共5页Journal of Chinese Physician

基　　金：湖南省自然科学基金(2020JJ8013)。

摘　　要：目的探讨应用分层应变技术评估主动脉瓣狭窄(AS)患者左室心肌收缩功能的价值。方法选取2019年1月至2022年3月湖南省人民医院收治的90例左室射血分数(LVEF)≥50%的AS患者, 包括轻度AS组30例、中度AS组30例、重度AS组30例, 并选取同期健康体检者30例为对照组, 比较对照组和不同程度AS组受试者的常规超声心动图参数, 应用分层应变技术测量各受试者左室三层心肌收缩期峰值纵向应变(GLS)和周向应变(GCS), 并分析应变参数与主动脉瓣收缩期峰值流速(Vmax)的相关性。结果轻、中、重度AS组舒张末期室间隔厚度(IVSD)、舒张末期左室后壁厚度(LVPWD)、主动脉瓣平均跨瓣压差(MPG)、Vmax均高于对照组(均P<0.05);轻、中、重度AS组左室各层GLS均低于对照组(均P<0.05);中、重度AS组左室各层GCS均低于对照组(均P<0.05)。中度AS组左室心内膜层GLS低于轻度AS组(P<0.05);重度AS组左室各层GLS及GCS低于轻、中度AS组(均P<0.05)。AS组左室心内膜层、中层、心外膜层GLS、GCS与Vmax呈负相关(r=-0.716, -0.660, -0.669, P<0.001;r=-0.669, -0.686, -0.598, P<0.001)。结论分层应变技术能反映AS患者左室心肌功能变化, 具有一定应用价值。Objective To explore the value of layer-specific strain technique in evaluating the changes of left ventricular myocardial systolic function in patients with aortic stenosis(AS).Methods From January 2019 to March 2022,90 AS patients with left ventricular ejection fraction(LVEF)≥50%in Hunan Provincial People's Hospital were selected,including 30 mild AS patients,30 moderate AS patients,and 30 severe AS patients.In addition,30 health examinees in the same period were selected as the control group.The normal echocardiographic parameters of the control group and the AS groups with different degrees were compared.The global systolic peak longitudinal strain(GLS)and global circumferential strain(GCS)of the left ventricular three-layer myocardium were measured by the layer-specific strain technique,and the correlation between the strain parameters and the peak systolic velocity(Vmax)of the aortic valve was analyzed.Results The levels of interventricular septal depth(IVSD),left ventricular posterior wall depth(LVPWD),mean pressure gradient(MPG),and Vmax in mild,moderate and severe AS group were higher than those in the control group(all P<0.05);the GLS of each layer of left ventricle in mild,moderate and severe AS group was lower than those in control group(all P<0.05);the GCS of each layer of left ventricle in moderate and severe AS group was lower than those in control group(all P<0.05).The GLS of left ventricular endocardium in moderate AS group was lower than those in mild AS group(all P<0.05);the GLS and GCS of left ventricular layers in severe AS group were lower than those in mild and moderate AS group(all P<0.05).In AS group,GLS and GCS in endocardium,middle layer and epicardium were negatively correlated with Vmax(r=-0.716,-0.660,-0.669,P<0.001;r=-0.669,-0.686,-0.598,P<0.001).Conclusions The layer-specific strain can reflect the changes of left ventricular myocardial function in patients with AS,and has certain application value.

关 键 词：主动脉瓣狭窄 心室功能 左 超声心动描记术 分层应变 

分 类 号：R542.52[医药卫生—心血管疾病]