应变率成像技术评价风湿性二尖瓣狭窄患者换瓣前后心肌收缩功能

Strain rate imaging evaluation of myocardial systolic function in patients with rheumatic mitral stenosis before and after valve replacement

目的应用应变率成像(SRI)技术对风湿性二尖瓣狭窄患者换瓣前后心肌收缩功能进行测量,并评价其判断二尖瓣换瓣术预后的价值。方法42例风湿性二尖瓣狭窄患者按术后恢复情况分为A、B两组:A组30例为恢复良好组,B组12例为恢复较差组;健康对照组26例。术前及术后常规超声心动图检测二尖瓣瓣口面积、左心房和左心室大小、左心室射血分数、左心室短轴缩短率;应用SRI技术测量左心室各壁基底段和中间段收缩期峰值应变率(SRs)参数,比较术前、术后1个月的SRs变化情况。结果术前A、B两组左心室壁各节段SRs均小于对照组相应节段(P<0.05);B组各节段SRs均小于A组对应节段(P<0.05)。术后A组左心室壁各节段明显改善(P<0.05)。B组术后左心室壁各节段SRs改善不明显(P>0.05)。结论SRI技术可定量评价风湿性MS患者心肌收缩功能,对判断手术预后具有一定的临床意义。

Objective To assess value of strain rate imaging （SRI） in evaluation of myocardial systolic function in patients with rheumatic mitral stenosis （RMS） before and after valve replacement and of prognosis of RMS patients after valve replacement. Methods Forty-two patients with RMS were divided into A and B groups according to the recovery of the patients after operation; Group A （n= 30） with fine recovery, Group B （n= 12） with poor recovery. Twenty-six matched healthy individuals were enrolled as control group. Area of MV orifice （MVOA）, left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （FS） were measured with routine echocardiography before and after operation. The parameters of myocardial systolic movement were measured with SRI. The values of systolic strain rate （SRs） of basal and middle segments were measured in study groups with RMS before and one month after valve replacement. SRs in preopera- tive period was compared with those in post-operative period. Results The SRs of patients in two groups before operation were lower than those of control group （P〈0. 05）, while the SRs of group B were lower than those of group A. The SRs peak values of group A increased one month after operation, but did not change significantly of group B. Conclusion SRI can evaluate myocardial systolic function in patients with RMS before and after valvular replacement, and might be used as one predictor of the prognosis of the RMS patients after operation.