二维斑点追踪评估经导管主动脉瓣置换术对左心房应变的影响

Impact of transcatheter aortic valve replacement on left atrial strain by two-dimensional speckle-tracking imaging

目的应用二维斑点追踪超声评估经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)对左心房应变的影响。方法选取2015年9月至2018年7月复旦大学附属中山医院35例行TAVR患者,分别于术前1 d及术后1年采集二维超声心动图图像,记录主动脉瓣瓣口面积(AVA)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心房容积指数(LAVI)、三尖瓣反流峰值速度(Vtr)、舒张早期二尖瓣环侧壁峰值速度(e′)及舒张早期二尖瓣口峰值流速与二尖瓣环侧壁峰值速度比值(E/e′)等常规超声心动图指标,以及二维斑点追踪超声所测左心房应变,包括存储功能(LASr)、管道功能(LAScd)和收缩功能(LASct),分析手术前后差异。结果术后1年,TAVR患者AVA增大(P<0.001);左心室收缩功能较术前显著改善(LVEDV、LVESV减小,LVEF增加,均P<0.001);左心室舒张功能各指标中LAVI及Vtr较术前减小(均P<0.05),但e′及E/e′变化不明显(均P>0.05);左心房应变LASr、LAScd及LASct较术前改善(均P<0.01)。结论左心房应变能够评估左心房存储、管道及收缩功能,有望作为评估TAVR疗效的参考指标。

Objective To evaluate the influence of transcatheter aortic valve replacement(TAVR)on left atrial strain by two-dimensional speckle tracking echocardiography.Methods Thirty-five patients,who were admitted for TAVR in Zhongshan Hospital of Fudan University from September 2015 to July 2018,were recruited.Echocardiography was performed 1 day before and 12 months after TAVR.Traditional ultrasound results,including aortic valve area(AVA),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left atrial volume index(LAVI),peak velocity of tricuspid regurgitation(Vtr),peak velocity of the lateral wall of mitral annulus in early diastolic period(e′)and the ratios of peak mitral orifice velocity in early diastolic period to e′(E/e′),were recorded.Two-dimensional speckle tracking imaging derived left atrial strain,which included reservoir(LASr),conduction(LAScd)and contraction(LASct),were recorded as well.The differences between pre-operation and post-operation were analyzed.Results Compared to pre-operation,aortic valve area was increased(P<0.001).Left ventricular systolic function was improved significantly(LVEDV and LVESV were decreased,LVEF was increased,all P<0.001).As to the left ventricular diastolic function,although LAVI and Vtr were decreased(both P<0.05),e′and E/e′were hardly changed(both P>0.05).Meanwhile,left atrial strain,including LASr,LAScd and LASct,were improved significantly 1 year post-TAVR(all P<0.01).Conclusions Left atrial strain is able to evaluate the left atrial function of reservoir,conduction and contraction.Left atrial strain can be a promising tool of assessing left atrial function in patients underwent TAVR.