应用二维斑点追踪技术评估慢性中重度主动脉瓣反流患者主动脉窦部的纵向应变

Evaluation of longitudinal strain of Valsalva sinus in patients with chronic moderate to severe aortic regurgitation by two-dimensional speckle tracking echocardiography

目的:应用二维斑点追踪技术(2D-STE)评估慢性中重度主动脉瓣反流(AR)患者主动脉窦部的纵向力学特征。方法:连续收集慢性中重度AR患者102例为病例组,80例健康志愿者为对照组。病例组再根据主动脉窦部是否扩张(男性>38.0 mm,女性>35.4 mm定义为扩张)进一步分为扩张组和非扩张组。超声心动图测量主动脉瓣环内径(AO-a)、主动脉窦部内径(ValS)、窦管交界内径(STJ)及每搏量指数(SVI)等参数。应用2D-STE软件分析受试者主动脉窦部前壁、后壁(AW-LS、PW-LS)及二者均值为平均纵向应变(M-LS)。分析AW-LS、PW-LS与血压、主动脉根部内径、SVI的相关性。结果:与对照组相比,慢性中重度AR患者主动脉窦部的AW-LS、PW-LS均显著减低(P<0.001);与非扩张组比较,扩张组主动脉窦部AW-LS、PW-LS均更小(P<0.001);主动脉窦部的LS与主动脉根部内径、脉压和SVI呈显著负相关(P<0.001)。结论:2D-STE能够用于评估主动脉窦部的LS,其重复性较好。与健康人相比,慢性中重度AR患者加速了主动脉根部的变性和硬化,并且随着主动脉根部的扩张逐渐加剧。

Objective:To evaluate the longitudinal mechanical characteristics of the Valsalva sinus(ValS)in patients with chronic moderate to severe aortic regurgitation(AR)using two-dimensional speckle tracking echocardiography(2D-STE).Meth-ods:102 patients with chronic moderate to severe AR were collected as the case group and 80 healthy volunteers as the control group.The case group was further divided into dilated and non-dilated groups according to whether the ValS was di-lated(defined as dilated in men>38.0 mm and in women>35.4 mm).Parameters such as diameter of aortic annulus(AO-a),Vals,sinotubular junction(STJ)and stroke volume index(SVI)were measured by echocardiography.2D-STE software was used to analyze the longitudinal strain of anterior and posterior walls of the ValS(AW-LS,PW-LS),and the mean value of them was the mean longitudinal strain(M-LS).The correlation of AW-LS and PW-LS with blood pressure,aortic root diameter and SVI were analyzed.Results:Compared with the control group,AW-LS and PW-LS of the ValS in patients with chronic mod-erate to severe AR were significantly reduced(P<0.001).Compared with the non-dilated group,the AW-LS,PW-LS of the ValS were lower in the dilated group.LS of the ValS was significantly negatively correlated with aortic root diameter,pulse pressure and SVI(P<0.001).Conclusion:2D-STE can be used to evaluate LS of the ValS with good reproducibility.Compared with healthy people,patients with chronic moderate and severe AR accelerated the degeneration and sclerosis of aortic root,and gradually aggravated with the expansion of aortic root.