三维斑点追踪技术评价不同程度主动脉瓣狭窄患者左室收缩功能

Three-dimensional speckle tracking imaging in evaluation of left ventricular systolic function in patients with different degrees of aortic stenosis

目的探讨三维斑点追踪(3D-STI)技术在评价不同程度主动脉瓣狭窄患者左室收缩功能中的应用价值。方法选取66例左室射血分数(LVEF)正常的主动脉瓣狭窄患者,根据狭窄程度分为轻度狭窄组(25例)、中度狭窄组(21例)及重度狭窄组(20例),另选年龄、性别相匹配的健康志愿者30例为对照组。各组均行常规超声心动图和3D-STI检查,获取LVEF、左室整体峰值纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)及径向应变(GRS),结果进行比较分析。采用Pearson相关分析法分析LVEF与各应变参数间的相关性。结果与对照组比较,轻度狭窄组GLS降低(P<0.05),GRS、GCS及GAS差异均无统计学意义;与对照组和轻度狭窄组比较,中度狭窄组GLS、GRS均降低,GCS增加(均P<0.05),GAS差异无统计学意义;与对照组、轻度狭窄组及中度狭窄组比较,重度狭窄组GLS、GRS均降低,GCS增加(均P<0.05),GAS差异无统计学意义。相关性分析显示,LVEF与GLS、GCS、GAS及GRS均呈正相关(r=0.71、0.59、0.79、0.57,均P<0.01)。结论主动脉瓣轻度狭窄时心脏功能已受损,且随着狭窄程度的增加心脏功能受损越明显。3D-STI可对其进行早期评价,具有较好临床应用价值。

Objective To explore the application value of three-dimensional speckle tracking imaging(3D-STI)in the evaluation of left ventricular systolic function in patients with different degrees of aortic stenosis(AS).Methods Sixty-six AS patients with normal left ventricular ejection fraction(LVEF)were divided into mild(25 cases),moderate(21 cases)and severe(20 cases)AS group.Another 30 healthy volunteers with matched age and sex were selected as control group.Routine echocardiography and 3D-STI were performed on each group.LVEF,global longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS)and global radial strain(GRS)were obtained,and the results were compared and analyzed.Pearson correlation analysis was used to analyze the correlation between LVEF and strain parameters.Results Compared with the control group,GLS in mild AS group was decreased(P<0.05),and the differences in GRS,GCS and GAS were not statistically significant.Compared with control group and mild AS group,GLS and GRS in moderate AS group were decreased,GCS was increased(all P<0.05),GAS were not statistically significant.Compared with control group,mild and moderate AS groups,GLS and GRS in severe AS group were decreased,GCS was increased(all P<0.05),GAS was not statistically significant.Correlation analysis showed that LVEF was positively correlated with GLS,GCS,GAS and GRS(r=0.71,0.59,0.79,0.57,all P<0.01).Conclusion The myocardial function has been impaired when AS is mild,and the impairment of cardiac function is more obvious with the increase of stenosis degree.3D-STI can be used for early evaluation and has good clinical application value.