应用多模态超声心动图技术分析瓣膜功能正常的二叶式主动脉瓣畸形患者的主动脉结构和功能变化

Aortic Structure and Function Changes in Individuals With Normally Functioning Bicuspid Aortic Valve Assessed by Multi-mode Ultrasound

目的:应用二维、M型及速度向量成像(VVI)等多模态超声心动图技术评价瓣膜功能正常的二叶式主动脉瓣畸形(BAV)患者的主动脉结构和功能变化,并探讨其与左心室收缩功能的相关性。方法:连续纳入2018年1月至2021年12月就诊于我院的瓣膜功能正常的BAV患者25例作为BAV组,另收集年龄、性别相匹配的30例健康体检者作为对照组。比较两组间一般临床资料及主动脉二维、M型、VVI超声心动图参数的差异,并探讨升主动脉内径与左心室收缩期整体纵向应变(GLS)的相关性。结果:与对照组相比,常规超声心动图显示,BAV组主动脉瓣收缩期峰值流速增快,主动脉瓣瓣口面积减小,左心室质量指数增大(P均<0.05);二维超声心动图显示,BAV组主动脉根部复合体(包括主动脉瓣瓣环、主动脉窦部、主动脉窦管交界)内径差异均无统计学意义(P均>0.05),升主动脉内径增大(P<0.05);M型超声心动图显示,BAV组升主动脉应变、扩张性减小,僵硬指数增大(P均<0.05);VVI超声心动图显示,BAV组升主动脉前壁和后壁最大纵向运动速度、最大纵向位移、最大纵向应变、最大纵向应变率均减低(P均<0.05)。与对照组相比,BAV组左心室收缩期GLS减低(P<0.05),GLS与升主动脉内径不相关(r=0.060,P=0.641)。结论:BAV患者即使瓣膜功能正常,主动脉结构和功能已发生改变,多模态超声心动图技术能够检测到这些变化并指导临床诊疗。

Objectives:To evaluate aortic changes in individuals with normally functioning bicuspid aortic valve(BAV)by 2D,M-mode and velocity vector imaging(VVI)and to investigate the correlation between the aortic diameter and left ventricular systolic function in this cohort.Methods:25 consecutive cases with normally functioning BAV attended our hospital from January 2018 to December 2021 were included as the case group and 30 normal cases matched with age and sex were collected as the control group.The differences of the general clinical data and 2D,M-mode and VVI parameters of aorta were compared between the 2 groups.The correlation between ascending aorta inner diameter and left ventricular systolic global longitudinal strain(GLS)were explored.Results:Compared with the control group,increased aortic valve systolic peak flow velocity(PFV),decreased aortic valve area(AVA)and increased left ventricular mass index(LVMI)were evidenced in the BAV group by routine echocardiography(all P<0.05).2D derived aortic root complex diameters were similar between the two groups(all P>0.05),but ascending aorta inner diameter widened in the BAV group(P<0.05).M-mode derived ascending aorta strain and distensibility decreased,stiffness index increased in the BAV group(all P<0.05).VVI derived maximum velocity,displacement,strain,and strain rate of systolic longitudinal motion of anterior and posterior walls of the ascending aorta were significantly decreased in the BAV group(all P<0.05).Left ventricular systolic GLS decreased in the BAV group(P<0.05)and there was no significant correlation between the ascending aorta inner diameter and GLS(r=0.060,P=0.641).Conclusions:In this BAV cohort,even if the valve function is normal,there are evidences of aortic structure and function changes,multi-mode ultrasound is valuable to assess these changes and guide the clinical diagnosis and treatment in individuals with BAV.