二维斑点追踪成像评价胸主动脉腔内修复术后升主动脉纵向应变

Two-dimensional speckle tracking echocardiography for evaluation on longitudinal strain of ascending aorta after thoracic endovascular aortic repair

目的观察胸主动脉腔内修复术(TEVAR)后升主动脉纵向应变(LS)变化。方法回顾性分析82例以TEVAR作为一线治疗的胸主动脉疾病患者,根据术前升主动脉收缩末期内径(AoS)≥35 mm或<35 mm分为A组(n=37)及B组(n=45),以20名健康人作为对照组。比较组间基本资料差异,测量A、B组术前、术后及对照组AoS和舒张末期内径(AoD),计算升主动脉应变(Aortic Strain)及动脉硬化指数β。以二维斑点追踪成像(2D-STE)获取升主动脉前、后壁LS(LS-AW/PW),将其均值记为平均LS(LS mean)。采用偏相关分析评价各指标间相关性。结果A组收缩压(SBP)、脉压(PP)均高于对照组(P均<0.05);B组PP高于对照组(P<0.05);A组PP及吸烟史比例均高于B组(P均<0.05)。3组间AoD、AoS、Aortic Strain及β差异均有统计学意义(P均<0.05)。A组及B组LS-AW、LS mean均较对照组降低(P均<0.05);A组LS-PW较对照组降低(P<0.05),B组LS-PW与对照组差异无统计学意义(P>0.05)。随升主动脉内径增加,各LS参数均进一步降低(P均<0.05)。胸主动脉疾病患者术后1个月心率较术前增快(P<0.05);术后7天及1个月LS-AW、LS mean较术前降低(P均<0.05);术后7天与1个月升主动脉应变各参数差异均无统计学意义(P均>0.05);其LS-AW与SBP、PP、AoS、AoD均呈负相关(r=-0.22、-0.25、-0.32、-0.30,P均<0.05),LS-PW与PP、AoS、AoD呈负相关(r=-0.24、-0.24、-0.23,P均<0.05)。结论TEVAR术后早期,胸主动脉疾病患者升主动脉纵向弹性功能降低。

Objective To investigate changes of the longitudinal strain(LS)of ascending aorta after thoracic endovascular aortic repair(TEVAR).Methods Data of 82 patients with thoracic aortic disease and underwent TEVAR were retrospectively analyzed.According to the end systolic diameter(AoS)of ascending aorta before TEVAR,the patients were divided into group A(n=37,AoS≥35 mm)and group B(n=45,AoS<35 mm).Meanwhile,20 healthy subjects were taken as controls(control group).The basic data were compared among 3 groups.AoS and ascending aortic end-diastole diameter(AoD)were measured before and after TEVAR in group A and B,and ascending aorta M-mode strain(Aortic Strain)and arteriosclerosis indexβwere calculated.LS-anterior/posterior wall(LS-AW/PW)of the ascending aorta were obtained with two-dimensional speckle tracking echocardiography(2D-STE),and the mean were denoted as LS mean.Partial correlation analysis was used to explore the correlations of the indicators.Results The systolic blood pressure(SBP)and pulse pressure(PP)of group A were both higher than those of control group(both P<0.05).PP of group B was higher than that of control group(P<0.05).PP and the ratio of smoking history of group A were both higher than those of group B(both P<0.05).Significant differences of AoD,AoS,Aortic Strain andβwere found among 3 groups(all P<0.05).LS-AW and LS mean of group A and B were all lower than those of control group(all P<0.05).LS-PW of group A was lower than that of control group(P<0.05),but there was no significant difference of LS-PW between group B and control group(P>0.05).LS parameters decreased with the increase of ascending aorta diameter(all P<0.05).The heart rate of patients with thoracic aortic disease 1 month after TEVAR was higher than that before(P<0.05).LS-AW and LS mean of ascending aorta in group A and B decreased 7 days and 1 month after TEVAR than before(all P<0.05),while there was no significant difference of LS parameters between 7 days and 1 month after TEVAR(all P>0.05).LS-AW was negatively correlated with SBP,PP,AoS,AoD(r=-0.22,-0.25,-0.32,-0.30,all P<0.05),while LS-PW was negatively correlated with PP,AoS and AoD(r=-0.24,-0.24,-0.23,all P<0.05).Conclusion The longitudinal elastic function of ascending aorta patients decreased early after TEVAR.