三维斑点追踪成像对左心耳封堵术前后左心室整体应变的定量评价

3D-STI quantitative evaluation of whole strain of left ventricular myocardium before and after left atrial appendage closure

目的探讨三维斑点追踪成像(three-dimensional speckle tracking imaging,3D-STI)技术评价非瓣膜性房颤患者左心耳封堵术前后左心室心肌整体应变的变化特点。方法选取2016年6月至2017年4月在上海长海医院行左心耳封堵术成功的患者30例。30例患者均分别于术前、术后2 d、术后1个月、术后3个月行常规超声心动图和3D-STI测量,分别测量左心室短轴缩短率(left ventricular fractional shortening,LVFS)、左心室射血分数(left ventricular ejection fractions,LVEF)、左心室整体纵向峰值应变(global peak longitudinal strain,GPLS)、左心室整体环向峰值应变(global peak circumferential strain,GPCS)、左心室整体径向峰值应变(global peak radial strain,GPRS)、左心室整体面积峰值应变(global peak area strain,GPAS)。结果30例行左心耳封堵术患者采用常规超声心动图测量LVFS和LVEF结果,并将术前、术后2 d、术后1个月、术后3个月(如GPAS:39.90±10.22/27.80±5.00、26.20±6.05、27.60±7.58)测量结果分别进行两两比较,差异均无统计学意义(P>0.05)。30例行左心耳封堵术患者采用3D-STI技术测量GPLS、GPCS、GPRS、GPCS、GPAS结果,术后2 d测量结果较术前、术后1个月、术后3个月测量结果均明显升高,差异均有统计学意义(P<0.05);而术前、术后1个月、术后3个月的GPLS、GPCS、GPRS、GPAS测量结果分别进行两两比较,差异均无统计学意义(P>0.05)。结论 3D-STI可以定量评价非瓣膜性房颤患者左心耳封堵术前后左心室收缩功能变化,术后2 d患者左心室整体应变明显增强,术后1个月后左心室整体应变恢复至术前。

Objective To investigate the change features of the 3-dimensional speckle tracking imaging（3 D-STI） for quantitative evaluation of whole strain of left ventricular before and after left atrial appendage closure in the patients with non valvular atrial fibrillation and to evaluate its clinical application value. Methods Thirty patients who received left atrial appendage（LAA） closure from June,2016 to April,2017 in Changhai Hospital were enrolled as research subjects. The patients received routine ultrasonic cardiography and 3 D-STI,and left ventricular fractional shortening（LVFS）,left ventricular ejection fractions（ LVEF）,global peak longitudinal strain（ GPLS）,global peak circumferential strain（GPCS）,global peak radial strain（GPRS）as well as global peak area strain（GPAS） were respectively detected before surgery,2 days,1 and 3 months after surgery. Results In the 30 patients who received LAA closure,LVFS and LVEF were evaluated by using routine ultrasonic cardiography and the data detected before surgery,2 days,1 and 3 months after surgery were compared between the two,and results showed that there was no statistical significance,when comparisons were made between them（P〈0. 05）. In the 30 patients who were implemented with LAA closure,GPLS,GPCS,GPRS and GPAS values were detected using 3 D-STI. The detected data 2 days after surgery were significantly higher as compared with those before surgery and 1 and 3 months after surgery（e. g. GPAS：39. 90 ± 10. 22/27. 80 ±5. 00,26. 20 ± 6. 05,27. 60 ± 7. 58）,and there was statistical significance,when comparisons were made between them（P〉0. 05）. However,there was no statistical significance in the data of GPLS,GPRS,GPCS and GPAS detected before surgery and 1 and 3 months after surgery,when comparisons were made between the two（P〉0. 05）. Conclusion 3 D-STI could be used for quantitative evaluation of the changes in left ventricular systolic function before and after LAA closure. The whole strain of the left ventricle of the patient was considerably increased 2 days after surgery,and the whole strain of the left ventricle recovered to pre-surgical level one month after surgery.