二维斑点追踪成像技术对二尖瓣关闭不全成形术患者左心功能的研究

Study on left ventricular function in patients undergoing mitral valvuloplasty using two-dimensional speckle tracking imaging

目的应用二维斑点追踪成像技术(2D-STI)测量二尖瓣成形术患者左室各节段心肌应变值,探讨2D-STI定量评价二尖瓣成形术患者心功能的临床价值。方法选取行二尖瓣成形术患者25例,在术前(A组)、术后1周(B组)、术后6个月(C组),分别对其进行常规超声心动图测量,包括:左房径(LAD)、左室舒张末内径(LVIDd)、左室射血分数(LVEF)。采集标准切面分别测量各组患者各节段心肌收缩期峰值纵向应变(LS)、径向应变(RS)、网周应变(CS)值。选取25例健康志愿者作为对照组(N组),两组间各参数进行比较。结果(1)术后各期LVEF与术前LVEF比较,差异无统计学意义。B、C组与A组比较,LAD、LVIDd均下降,差异有统计学意义(均为P<0.05);(2)A组与N组各节段比较,纵向峰值应变明显减低(均为P<0.05);B组与A组比较,各节段纵向峰值应变变化不明显(均为P>0.05);C组与A组各节段比较,收缩期纵向峰值应变有所增加(均为P<0.05);(3)基底水平及乳头肌水平A组与N组比较,收缩期峰值圆周应变明显减低(均为P<0.01);(4)左室短轴乳头肌水平B、C组与A组比较,径向应变峰值均增加(均为P<0.05);C组基底水平及乳头肌水平各节段峰值径向应变均基本接近N组,差异无统计学意义(均为P>0.05)。结论2D-STI在左室整体收缩功能改变以前能够早期发现左室局部心肌收缩功能异常,斑点追踪成像技术能够定量评价二尖瓣成形术患者左心功能的改变。

Objective To investigate the clinical value of two-dimensional speckle tracking imaging （2D-STI） technique for quantitative evaluation of cardiac function in patients with mitral valvuloplasty using 2D-STI measuring left ventricular myocardial strain of each segments. Methods Twenty five patients with successful mitral valvuloplasty were enrolled and accepted 2D echocardiography and 2D-STI measurements including left atrial diameter （LAD）, left ventricular end-diastolic diameter （LVIDd）, left ventricular ejection fraction （LVEF） and left ventricular systolic peak longitudinal strain （LS）, systolic peak circumferential strain （CS） and systolic peak radial strain （RS） ; which were performed at pre-operation （group A） , a week （group B） and 6 months （group C） after operation, respectively. Twenty five healthy subjects were selected as control group （ group N）. Results （ 1 ） Compared with group A, LAD and LVIDd in both group B and group C decreased significantly （ all P 〈 0. 05 ）. （ 2 ） Compared with group N, the values of l.S of different segments in group A decreased significantly （ all P 〈 0. 05 ） ; while the values of LS in group B and group A were similar. （3） The CS in group A decreased significantly comparing to that in group N （P 〈 0. 01 ）. （4） The RS of the papillary muscle increased significantly in group B and group C comparing to that in group A （ P 〈 0. 05 ）, ItS in group C and group N were similar （ P 〉 0. 05 ） . Conclusions 2D STI can detect the regional myocardial systolic dysfunction before the change of left ventricular ejection fraction. In addition, it can quantitatively evaluate the change of left ventricular function in patients post the mitral valvuloplasty.