实时三维超声心动图在主动脉瓣中-重度狭窄患者TAVR术后的应用价值  

The application value of real-time three-dimensional echocardiography after TAVR surgery for patients with moderate to severe aortic stenosis

作　　者：颜艳[1] 左明良 罗贤 YAN Yan;ZUO Mingliang;LUO Xian(Department of Ultrasound Medicine,the Fourth People′s Hospital of Zigong City,Zigong,Sichuan 643000,China;Department of Cardiovascular Ultrasound and Cardiac Function,School of Medicine,University of Electronic Science and Technology of China·Sichuan Provincial People′s Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]四川省自贡市第四人民医院超声医学科,四川自贡643000 [2]电子科技大学医学院·四川省人民医院心血管超声及心功能科,四川成都610000

出　　处：《检验医学与临床》2024年第24期3702-3707,3713,共7页Laboratory Medicine and Clinic

基　　金：2019年自贡市卫生健康科研课题(19yb026)。

摘　　要：目的研究实时三维超声心动图对主动脉瓣中-重度狭窄患者经导管主动脉瓣置换(TAVR)术后短期左心室功能状态的评估价值。方法选取2021年8月至2022年8月于四川省自贡市第四人民医院就诊且使用TAVR术治疗的110例主动脉瓣中-重度狭窄患者作为研究组,并以同期在该院进行体检的110例体检健康者作为健康组,于健康组体检时,研究组TAVR术前、术后1周、术后1个月进行实时三维超声心动图检查,获得左心室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室质量指数(LVMI)、左心室重构指数(LVRI)及左心室6、12、16个节段达到收缩末期最小容积的时间最大差值(Tmsv-Dif)、时间标准差(Tmsv-SD)等参数,以评估左心室功能状态。比较主动脉瓣中-重度狭窄患者TAVR术前、术后左心室功能变化及TAVR术后左心室功能状态对术后心血管结局的影响。结果研究组术后1个月、术后1周LVEDVI、LVESVI、LVMI、LVRI、Tmsv-6SD/心率(R-R)(Tmsv-6SD%)、Tmsv-12Dif/R-R(Tmsv-12Dif%)、Tmsv-12SD/R-R(Tmsv-12SD%)、Tmsv-16Dif/R-R(Tmsv-16Dif%)、Tmsv-16SD/R-R(Tmsv-16SD%)均低于术前,LVEF高于术前,差异均有统计学意义(P<0.05)。术后110例主动脉瓣中-重度狭窄患者均获得完整随访,35例术后发生心血管事件患者纳入术后结局不良组,75例未发生心血管事件患者纳入术后结局优良组,术后结局不良组TAVR术后1周及1个月LVEDVI、LVESVI、LVMI、LVRI、Tmsv-6Dif/R-R(Tmsv-6Dif%)、Tmsv-6SD%、Tmsv-12Dif%、Tmsv-12SD%、Tmsv-16Dif%、Tmsv-16SD%均高于术后结局优良组,LVEF低于术后结局优良组,差异均有统计学意义(P<0.05)。结论实时三维超声心动图可准确评价主动脉瓣中-重度狭窄患者TAVR术后短期左心室功能状态,且TAVR术后短期左心室功能恢复状况可影响术后心血管结局,实时三维超声心动图有助于早期了解患者TAVR术后短期左心室功能状态,�Objective To investigate the value of real-time three-dimensional echocardiography in evaluating short-term left ventricular function after transcatheter aortic valve replacement(TAVR)in patients with moderate to severe aortic stenosis.Methods A total of 110 patients with moderate to severe aortic stenosis treated with TAVR surgery at the Fourth People′s Hospital of Zigong City from August 2021 to August 2022 were selected as the study group,a total of 110 healthy people who underwent physical examination in the same hospital during the same period were selected as the healthy group.Real-time three-dimensional echocardiography was performed before TAVR surgery,after surgery one week and after surgery one month,in physical examiner during the physical examination to obtain left ventricular ejection fraction(LVEF),left ventricular end diastolic volume index(LVEDVI),left ventricular end systolic volume index(LVESVI),left ventricular mass index(LVMI),left ventricular remodeling index(LVRI),and maximum difference in time to reach the minimum volume at the end of systole(Tmsv Dif)of left ventricular segments 6,12 and 16,time standard deviation(Tmsv SD)and other parameters are used to evaluate the left ventricular functional status.The changes in left ventricular function before and after TAVR in patients with moderate to severe aortic stenosis,and the impact of left ventricular functional status after TAVR on postoperative cardiovascular outcomes were compared.Results The left ventricular functional indicators including LVEDVI,LVESVI,LVMI,LVRI,Tmsv-6SD/R-R(Tmsv-6SD%),Tmsv-12Dif/R-R(Tmsv-12Dif%),Tmsv-12SD/R-R(Tmsv-12SD%),Tmsv-16Dif/R-R(Tmsv-16Dif%),Tmsv-16SD/R-R(Tmsv-16SD%)in the study group after surgery one month and one week were lower than before surgery,while LVEF was higher than before surgery,the differences were statistically significant(P<0.05).A total of 110 patients with moderate to severe aortic stenosis were fully followed up after surgery,35 patients with cardiovascular events were included in the poor p

关 键 词：实时三维超声心动图 主动脉瓣中-重度狭窄 经导管主动脉瓣置换术 左心室功能 

分 类 号：R541.1[医药卫生—心血管疾病] R445.1[医药卫生—内科学]