斑点追踪技术评价主动脉瓣狭窄行TAVR术后左心心肌功能改变  

Evaluating left ventricular myocardial function after TAVR surgery due to aortic stenosis by using speckle tracking technique

作　　者：梅陈 胡国兵 江峰 丁杰 Mei Chen;Hu Guobing;Jiang Feng;Ding Jie(Yijishan hospital,the first affiliated hospital of Wannan Medical College,Wuhu,Anhui,241000,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院超声科,安徽芜湖241000

出　　处：《齐齐哈尔医学院学报》2023年第1期50-54,共5页Journal of Qiqihar Medical University

摘　　要：目的 探讨斑点追踪技术评价主动脉瓣狭窄行经皮主动脉瓣置换术后左心心肌功能改变。方法 选择2021年1月—2022年4月在本院因主动脉瓣重度狭窄行TAVR手术的30例患者作为研究对象,分别于术前、术后1周及术后3个月采集二维超声心动图图像,记录左房内径(LAD)、左室舒张期内径(LVEDD)、左室收缩期内径(LVESD)、室间隔(IVSD)及左室后壁厚度(LVPWD)、左心室射血分数(LVEF)、主动脉瓣口前向峰值流速(AVmax)、主动脉瓣最大跨瓣压差(AVPGmax)、主动脉瓣口面积(ASA)、舒张早期二尖瓣环侧壁峰值速度(e’)、舒张早期二尖瓣口峰值流速与二尖瓣瓣环侧壁峰值速度比值(E/e’)。采用斑点追踪技术测得左房及左室应变,包括左心房存储应变(LASr)、左心房管道应变(LAScd)、左心房收缩应变(LASct)、心内膜层纵向收缩期峰值应变(LS-endo)、中层心肌纵向收缩期峰值应变(LS-mid)、心外膜层心肌纵向收缩期峰值应变(LS-epi)以及心内膜层环向收缩期峰值应变(CS-endo)、中层心肌环向收缩期峰值应变(CS-mid)、心外膜层心肌环向收缩期峰值应变(CS-epi)。结果 TAVR术后,AVmax、AVPGmax、AVPGmean及ASA较术前明显改善。TAVR术后3月左室收缩功能提升,室间隔及左室后壁厚度变薄,LVEDD、LVESD、e’、E/e’改善不明显。与术前对比,术后1周LS-endo、LASr、LAScd明显改善(P<0.05),与术前对比,术后3月LS-endo、LS-mid、LS-epi、CS-endo、CS-mid、CS-epi及LASr、LAScd、LASct均明显改善(P<0.05),与术后1周对比,术后3月LS-endo、LS-mid、LS-epi及LASr、LAScd、LASct绝对值均增加(P<0.05)。结论 TAVR术后左室射血分数提高,而斑点追踪技术能较早准确的描述TAVR术后左心心肌功能的变化。Objective To explore the evaluation of left ventricular myocardial function variation by using speckle tracking technique after transcatheter aortic valve replacement due to aortic valve stenosis.Methods 30 patients suffered from severe aortic stenosis,those who underwent TAVR in our hospital from January 2021 to April 2022,were selected as the study subjects.Two dimensional echocardiography images were collected at the time before the operation,one week and three months after the operation.Left atrial diameter(LAD),left ventricular end-dimension dystolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),inter ventricular septum(IVSd),left ventricular postal wall(LVPWd),left ventricular ejection fraction(LVEF),aortic valve orifice forward peak velocity(AVmax),aortic valve maximum pressure gradient(AVPGmax),aortic valve orifice area(ASA),peak velocity of the lateral wall of mitral annulus in early diastolic period(e’),and the ratios of peak mitral orifice velocity in early diastolic period to e’(E/e’).The strain of left atrium and left ventricle were measured by speckle tracking technique,including left atrial storage strain(LASr),left atrial pipeline strain(LAScd),left atrial systolic strain(LASct),longitudinal systolic peak strain of endocardium(LS-endo),longitudinal systolic peak strain of middle myocardium(LS-mid),longitudinal systolic peak strain of epicardial myocardium(LS-epi)and circumferential systolic peak strain of endocardium(CS-endo),the circumferential systolic peak strain of middle myocardium(CS-mid)and the circumferential systolic peak strain of epicardial myocardium(CS-epi).Results AVmax,AVPGmax,AVPGmean and ASA were significantly improved after TAVR surgery.Three months after TAVR,left ventricular systolic function was improved,IVSd and LVPWd getting thinner.However,the improvement of LVEDd,LVESD,e ’ and E/e’ were not significant.Compared with those before operation,LS-endo,LASr and LAScd were significantly improved at 1 week after operation(P<0.05).Compared with those befor

关 键 词：经皮主动脉瓣置换术 超声心动图 斑点追踪技术 应变 

分 类 号：R540.45[医药卫生—心血管疾病]