组织多普勒技术检测主动脉瓣环运动评估主动脉瓣置换术后左心室整体功能改变

Aortic annulus motion detected by tissue Doppler imaging for evaluation of left ventricular global function in patients with aortic valve replacement

目的探讨组织多普勒检测主动脉瓣环运动评估主动脉瓣置换术后患者左心室整体功能的价值。方法收集2014年3至5月主动脉瓣膜置换术后患者20例(观察组)和健康对照者20例(对照组),于组织多普勒成像(TDI)模式下获取心尖五腔切面(A5C)和心尖三腔切面(A3C)测定主动脉瓣环4个壁的组织速度,测量收缩期峰速(AASa)、舒张早期峰速(AAEa)、舒张晚期峰速(AAAa)。结果观察组与对照组比较,主动脉瓣环直径(ARD)、主动脉内径(AO)、心率(HR)、右心室(RV)、E差异均无统计学意义(均P>0.05),而舒张期室间隔厚度(IVSd)、舒张期左心室后壁厚度(LVPWs)、左心室舒张末期内径(LVIDd)、左心室收缩末期内径(LVIDs)、A、E/Ea、Tei指数均升高(P<0.05或0.01),主动脉瓣环TDI参数均减低(均P<0.01)。相关性分析显示,LVEF与Tei指数呈显著负相关(r=-0.514,P<0.01)。结论主动脉瓣置换术后患者主动脉瓣环运动明显降低,术后左心室功能LVEF明显降低,E/Ea、Tei指数升高,主动脉瓣环运动可以评估左心室功能整体功能改变。

Objective To evaluate the global left ventricular function by means of aortic annulus motion using tissue Doppler imaging （TDI） in patients with aortic valve replacement. Methods Twenty patients with aortic valve replacement and 20 normal subjects were enrolled in the study. Basic parameters were detected by two-dimensional and M-mode echocardiogra- phy, regional aortic annulus motion profiles of apical 5 chamber view （A5C） and apical three chamber view （A3C） were obtained in TDI-mode. The peak systolic velocity （AASa）,early diastolic velocity （AAEa） and late diastolic velocity （AAAa） of aortic annu- lus were measured. Results Compared with control group, the ARD, AO, HR, RV, E in patients with aortic valve replacement did not alter significantly （P 〉0.05）, while IVSd, LVPWd, LVIDd, LVIDs, A, E/Ea and Tel index were significantly increased （P〈0.01or 0.05）, aortic annulus TDI parameters were significantly lower （P〈0.01）. LVEF was and negatively correlated with Tel index （r=-0.514, P〈0.01）. Conclusion After aortic valve replacement, the aortic annulus motion of patients is significantly reduced, LVEF is significantly lower and Tel index, E/Ea are increased, indicating that the aortic annulus motion can used to assess the changes of global left ventricular function in patients with aortic valve replacement.