三维斑点追踪成像技术评价重度二尖瓣反流瓣膜置换术后左心室整体收缩功能

Evaluation of left ventricular systolic function after replacement in patients with severe mitral regurgitation by threedimensional speckle-tracking echocardiography

目的应用三维斑点追踪成像技术评价重度二尖瓣反流(MR)患者瓣膜置换术后短期患者左心室整体收缩功能。方法选择因重度MR行瓣膜置换术患者(重度MR组) 32例,其中男性19例,女性13例;年龄49~73岁,平均年龄60.71岁。同期另选取32例健康志愿者作为对照组,其中男性15例,女性17例;年龄41~79岁,平均年龄60.00岁。所有患者术前1 d及术后7 d进行常规二维超声心动图及实时三维斑点追踪成像数据的采集。采取新建全容积图像,应用三维斑点追踪超声心动图(3D-STE)获得两组三维参数左心室整体纵向收缩期应变(GLS)、左心室整体圆周收缩期应变(GCS)、左心室整体径向收缩期应变(GRS)、左心室整体面积收缩期应变(GAS);并对其进行脱机分析。结果与对照组比较,重度MR组患者术前左心室收缩末期内径(LVEDD)、左心室舒张末期内径(LVESD)、三维左心室舒张末期容积(LVEDV3D)、三维左心室收缩末期容积(LVESV3D)值明显增大[LVEDD:(56.00±3.82) mm vs (49.62±3.92) mm;LVESD:(37.87±4.17) mm vs (33.59±3.48) mm;LVEDV3D:(147.78±36.87) m L vs (103.71±17.32) m L;LVESV3D:(54.74±13.31) m L vs (39.41±7.14) m L],差异有显著统计学意义(P <0.01);重度MR组术前与术后相比,LVEDD、LVESD、LVEDV3D、LVESV3D、IVSD、LVPWD、LVEF3D差异无统计学意义(t=0.841、1.160、-0.316、-0.322、0.239、-0.551、0.301,P> 0.05)。与对照组相比,重度MR组术前患者的左心室GLS、GRS、GCS及GAS明显减低(GLS:14.53%±3.35%vs 17.75%±3.72%;GRS:26.15%±7.24%vs 32.56%±8.00%;GCS:14.44%±4.48%vs 21.79%±3.37%;GAS:16.62%±4.33%vs37.71%±5.87%)(P <0.01);重度MR组与术前比较,术后GLS、左心室GCS、左心室GAS明显减低(GLS:9.31%±3.15%vs 14.53%±3.35%;GCS:10.25%±3.18%vs 14.44%±4.48%;GAS:9.62%±3.79%vs 16.62%±4.33%)(P <0.01),但左心室GRS无显著变化(t=0.423,P> 0.05)。结论三维斑点追踪成像技术能准确评价重度MR行瓣膜置换术后短期内左心室收缩功能,有助于评估疗效与短期预后。

Objective To evaluate left ventricular systolic function of short-term postoperative valve replacement after severe mitral regurgitation(MR) by three-dimensional speckle tracking echocardiography(3D-STE). Methods A total of 32 patients with severe MR valve replacement(severe MR group) were enrolled, which included 19 males and 13 females, aged 49-73 years old with mean age of 60.71 years old. Meantime, 32 healthy volunteers were enrolled as control group, which included 15 males and 17 females, aged 41-79 years old with mean age of 60.00 years old. All of them were perform conventional 2 D e-chocardiography and real-time 3D spot tracking imaging data at 1-day before operation and 7-day postoperation. The full volume image was created, and three-dimensional speckle tracking echocardiography(3D-STE) was used to obtain three-dimensional parameters of 2 groups: left ventricular global longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS) and global area strain(GAS), and above parameters were analyzed offline. Results Compared with control group, the left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), three-dimensional left ventricular end diastolic volume(LVEDV3D), three-dimensional left ventricular end systolic volume(LVEDV3D) of severe MR group was significantly increased before operation[LVEDD:(56.00 ± 3.82) mm vs(49.62 ± 3.92) mm;LVESD:(37.87 ± 4.17) mm vs(33.59 ± 3.48) mm;LVEDV3D:(147.78 ± 36.87) mL vs(103.71 ± 17.32) mL;LVEDV3D:(54.74 ± 13.31) mL vs(39.41 ±7.14) mL], and the difference was statistically significant(P < 0.01). There was no statistically significance in LVEDD, LVESD,LVEDV3D, LVEDV3D, interventricular septal thickness(IVSD), left ventricular posterior wall diastolic thickness(LVPWD) and threedimensional left ventricular ejection fraction(LVEDV3D) before and after operation in severe MR group(t = 0.841, 1.160,-0.316,-0.322, 0.239,-0.551, 0.301, P > 0.05). Compared with control group, the GLS, GRS, GCS and GAS of left ventricular in severe MR group were significantly reduced before operation(GLS: 14.53 % ± 3.35 % vs 17.75 % ± 3.72 %;GRS: 26.15 % ±7.24 % vs 32.56 % ± 8.00 %;GCS: 14.44 % ± 4.48 % vs 21.79 % ± 3.37 %;GAS: 16.62 % ± 4.33 % vs 37.71 % ± 5.87 %)(P < 0.01);After operation, the GLS, GCS and GAS of left ventricular in severe MR group after operation were significantly reduced(GLS: 9.31 % ± 3.15 % vs 14.53 % ± 3.35 %;GCS: 10.25 % ± 3.18 % vs 14.44 % ± 4.48 %;GAS: 9.62 % ± 3.79 %vs 16.62 % ± 4.33 %)(P < 0.01), and there was no significant change in left ventricular GRS(t = 0.423, P > 0.05) before and after operation in sever MR group. Conclusion It is demonstrated that 3D-STE could accurately identify the short-term left ventricular global systolic function after mitral valve replacement, which help to evaluate efficacy and short-term prognosis.