二维斑点追踪技术对主动脉瓣反流患者左心室功能的评价

Assessment of left ventricular function in patients with aortic regurgitation using tow-dimensional speckle-tracking echocardiography

目的探讨主动脉瓣反流(AR)患者左心室纵向及径向应变的改变,同时研究二维应变与左心室充盈及射血的关系。方法选取AR患者45例(中度24例,重度21例),健康对照者30例。采用二维斑点追踪技术测量并计算左心室收缩期径向峰值总应变(GRS)、收缩期纵向峰值总应变(GLS)及各节段收缩期纵向峰值应变(S)、收缩期纵向峰值应变率(SRs)、舒张早期纵向峰值应变率(SRe)。常规多普勒测量二尖瓣口血流频谱舒张早期及晚期峰值速度E、A,计算E/A,组织多普勒测量二尖瓣环舒张早期速度Ea,计算E/Ea。采用Pearson相关分析方法分析AR患者GLS与左心室射血分数(LVEF)及E/Ea的相关性。结果健康对照组、中度AR组、重度AR组受检者GLS分别为(-20.09±1.47)%、(-18.68±1.52)%、(-12.56±3.25)%,GRS分别为(46.71±7.65)%、(43.01±5.95)%、(28.52±6.13)%,差异均有统计学意义(F=82.08、47.69,P均<0.01);重度AR组GLS和GRS与健康对照组及中度AR组比较,差异均有统计学意义(q=17.56、13.60和13.44、10.20,P均<0.01),中度AR组GLS与健康对照组比较,差异亦有统计学意义(q=3.42,P<0.01)。3组受检者心尖段SRs分别为(-1.24±0.22)s-1、(-1.19±0.25)s-1、(-1.04±0.28)s-1,差异有统计学意义(F=4.47,P<0.01);重度AR组与健康对照组及中度AR组比较,差异均有统计学意义(q=4.02、3.28,P均<0.01)。中度AR患者心尖段S、SRe,基底段和中间段S、SRs、SRe均低于健康对照者(q=4.42、5.01、3.48、3.24、4.78、4.12、3.61、6.72,P均<0.01)。Pearson相关分析表明AR患者GLS与LVEF及E/Ea均有相关性(r=-0.73、0.64,P均<0.01)。结论二维斑点追踪技术测得的AR患者左心室纵向应变及应变率的减低能早期识别左心室功能的受损,且GLS能反映左心室舒张期的充盈及收缩期的射血能力。

Objective Analyse the change of left ventricular (LV) longitudinal and radial strain in patients with aortic regurgitation (AR) and discuss the relationship between the 2D strain parameter and the filling and ejection of LV. Methods Thirty healthy controls and 45 patients with AR (24 patients with moderate AR and 21 with severe AR) were enrolled in this study, LV systolic global peak radial strain(GRS), systolic global peak longitudinal strain(GLS) and systolic peak longitudinal strain(S), systolic peak longitudinal strain rate(SRs), early diastolic peak longitudinal strain rate(SRe) of every segment were measured or calculated using 2D-STE, early and late diastolic transmitral flow velocity (E, A) were recorded by pulsed Doppler echocardiography and early diastolic mitral annular velocity (Ea) were assessed by tissue Doppler imaging,the E/A and E/Ea ratio were calculated. Discuss the relationship of GLS and LV ejection fraction (LVEF), GLS and E/Ea using the Pearson correlation analysis. Results The GLS were (-20.09±1.47)%, (-18.68±1.52)%, (-12.56±3.25)%and the GRS were (46.71±7.65)%, (43.01±5.95)%, (28.52±6.13)% in control group, patients with moderate and severe AR (MAR group and SAR group) respectively. There were significant differences among the groups (F =82.08,47.69, both P < 0.01) as following:SAR group with control group and MAR group [ q=17.56,13.60 (GLS), q=13.44, 10.20 (GRS), all P<0.01),MAR group and control group [ q=3.42 (GLS), P<0.01]. The SRs of the apical segment were (-1.24±0.22)s-1, (-1.19±0.25)s-1, (-1.04±0.28)s-1 in control group,MAR group and SAR group respectively. There were significant differences among the groups (F=4.47, P < 0.05) as following:SAR group with control group and MAR group ( q=4.02,3.28, both P<0.01). The S, SRe of apical segment and the S,SRs,SRe of basal and midventricular in MAR group were all lower than the control group ( q=4.42, 5.01, 3.48, 3.24, 4.78, 4.12, 3.61, 6.72, all P < 0.01). Pearson correlation analysis revealed the GLS had a relationship with LVEF and E/Ea ( r=-0.73, 0.64, both P<0.01). Conclusion The reduced longitudinal strain and strain rate could detect LV dysfunction in patients with AR in early stage and the GLS had the ability to reflect the diastolic filling and systolic ejecting of the LV.