三维斑点追踪技术评价经导管主动脉瓣植入术患者左心室整体及局部收缩功能

Assessment of left ventricular global and regional systolic function after transcatheter aortic valve implantation by three-dimensional speckle tracking imaging

目的 应用三维斑点追踪显像（three-dimensional speckle tracking imaging,3D-STI）技术评估主动脉瓣狭窄（aortic stenosis,AS）患者经导管主动脉瓣植入（transcatheter aortic valve implantation,TAVI）术后左室整体及局部收缩功能变化.方法 20例在我院行TAVI术的重度AS患者,采集术前、术后7d及术后1月标准心尖四腔观三维图,运用TomTec脱机软件对左室纵向整体峰值应变（global longitudinal strain,GLS）,左室纵向、径向、环向节段收缩期峰值应变等三维参数进行分析,比较不同时间点间上述指标的变化.结果 术后7d及术后1月主动脉瓣前向血流峰值血流速度（aortic valve blood flow velocity,AV）、平均跨瓣压差（mean aortic valve pressure gradient,mPAG）均较术前明显降低;术前三维左室射血分数（three-dimensional left ventricular ejection fraction,3D-LVEF）＜50％的患者,术后7 d 3D-LVEF改善明显,术前3D-LVEF＞50％的患者则变化不显著;术后1月不论3D-LVEF是否＜50％,3D-LVEF均有明显提高.术后7d左室GLS及各节段纵向峰值应变均有明显改善,术后1月改善更加明显.结论 TAVI术后早期左室收缩功能已有所改善.3D-STI为TAVI术后早期左室整体及节段心肌收缩功能评估提供了一种新型、简便的方法.

Objective To investigate the alternation of left ventricular systolic function in patients underwent transcatheter aortic valve implantation operation（TAVI） by three-dimensional speckle tracking technology （3D-STI）.Methods Totally 20 patients with severe aortic stenosis were enrolled.All the subjects underwent successful TAVI operation.The real-time 3D full volume datasets on apical four-chamber view were acquired on before,7 days and 1 month after TAVI.Left ventricular global longitudinal strain（GLS）,regional peak systolic longitudinal strain（LS）,regional peak systolic circumferential strain（CS） and regional peak systolic radial strain（RS）,were analysed using off-line TomTec software,the differences among the three groups were compared.Results Compared with the preoperation,aortic valve blood flow velocity （AV）,mean aortic valve pressure gradient（mPAG） of 7 days after operation decreased significantly.Threedimensional left ventricular ejecation fraction（3D-LVEF） among the patients whose 3D-LVEF under 50%had a remarkable increase and whose 3D-LVEF exceed 50% before operation had no significant change,while 1 month after operation the 3D-LVEF had a significant improvement compared with the preoperational data regardless of 3D-LVEF under 50% or not.The GLS and LS of all segments of 7 days after TAVI were higher than pre-operation（all P 〈0.05）,and it had a further improvement 1 month after TAVI.Conclusions LV systolic function had improvement early after TAVI.3D-STI is a new,convenient way to detect the global and regional left ventricular systolic function of TAVI patients.