| 摘要: |
| 目的：本研究旨在应用三维斑点追踪技术评价慢性重度主动脉瓣反流患者左心室扭转运动以及主动脉瓣置换手术前后左室扭转指标变化,分析心肌力学改变与心室结构和功能的关系。方法：76例经二维超声心动图诊断为慢性重度主动脉瓣反流患者,根据左室射血分数(LVEF)分为AR-A组(LVEF ≥55%)40例和AR-B组(LVEF＜55%)36例,正常对照组30例。76例患者中31例行主动脉瓣置换手术(AVR)。所有研究对象均行二维和三维超声心动图检查,31例手术患者于术后两周行二维和三维超声心动图检查。应用Tomtec工作站进行脱机分析,获得左室基底部旋转角度(RoB)及旋转达峰时间、心尖部旋转角度 (RoA)及旋转达峰时间,整体扭转力(Torsion)及整体扭转达峰时间。结果 ：(1)AR-A组RoA和Torsion低于正常组(P＜0.05),而RoB与正常组无显著差异(p＞0.05)；AR-B组RoB、RoA和Torsion均低于正常组(P＜0.05), RoB和Torsion小于AR-A组(P＜0.05),RoA与AR-A组无显著差异(p＞0.05)；(2)与正常组相比,AR-A组基底部旋转达峰时间、整体扭转达峰时间延长(P＜0.05),AR-B组基底部旋转达峰时间、心尖部旋转达峰时间、整体扭转达峰时间缩短(P＜0.05)； (3)多元线性回归分析显示左室球形化指数(LVSI)是RoA的独立影响因素,Torsion受LVEF和LVSI共同影响, RoB受LVEF和左室重构指数(LVRI)共同影响。(4)手术患者术后2周Torsion较术前增大(p＜0.01),但仍低于正常组(p＜0.05),RoA较术前增大(p＜0.05),与正常组无显著差异(p＞0.05),RoB与术前相比无明显变化(p＞0.05)。结论：三维斑点追踪技术获得的左室心肌扭转和旋转指标可有效评价慢性重度主动脉瓣反流患者左室整体和局部功能,可敏感地反应主动脉瓣置换手术对左室心肌功能的影响。 |
| 关键词: 三维斑点追踪技术 主动脉瓣反流 主动脉瓣置换 扭转 旋转 |
| DOI： |
| 投稿时间：2019-12-12修订日期：2019-12-17 |
| 基金项目: |
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| Assessment of left ventricular torsional dynamics in patients with chronic severe aortic regurgitation by three dimensional strain imaging |
| MI SULIN,ZHOU SHULIANG |
| () |
| Abstract: |
| Objective To assess left ventricular torsional mechanics in patients with chronic severe aortic regurgitation(AR) by three dimensional strain imaging and to assess the effect of aortic valve replacement (AVR) on left ventricular (LV) twist function. Method we studied with two dimentional echocardioraphy 30 normal subject, 40 patients with chronic severe AR with LVEF≥55%(AR-A), 36 patients with LVEF＜55%(AR-B). Conventional LV volume, function, geometry indexes including LVEDD, LVESD, LVEDVI, LVESVI, LVMI , LVEF, LV sphericity index(LVSI), LV remodeling index(LVRI) were measured and calculated by 2D echocardioraphy. LV basal rotation, apical rotation and time to peak rotation, LV torsion and time to peak twist by Tomtec workstation 3D-STI were analyzed and compared among subgroups. Among all patients,31 have undergone aortic valve replacement, 2D and 3D echocardiography were performed 2 weeks after operation. Result (1)As compared to normal control, Torsion and RoA was significantly reduced in AR-A(p＜0.05), while RoB was preserved(p＞0.05).LV torsion,RoA and RoB were all significantly decreased in AR-B(p＜0.05). (2)As compared to normal control, time to peak twist and time to peak RoB were longer in AR-A(P＜0.05), Time to peak twist ,time to peak RoA and RoB were shortened in AR-B(P＜0.05). (3)Multiple linear regression analysis confirmed that Torsion was affected by LVEF and LVSI.RoA wasSindependentlySassociatedSwith LVSI. RoB was affected by both LVEF and LVRI. (4) 2 weeks after aortic valve replacement, left ventricular volume , dimensions and EF decreased significantly(all p＜0.01). Torsion and ROA were significantly increased(p＜0.05), but RoB did not differ from preoperation. Conclusion Three dimensional speckle tracking could quantitatively assess the left ventricular torsional dynamics in severe AR patients and contribute to a deeper understanding of subtle mechanic changes of left ventricular which couldn’t be detected by conventional echocardiography parameters. Parameters of torsional dynamics can sensitively reflect the improvement of left ventricular myocardial function after operation. |
| Key words: Three dimensional speckle tracking aortic regurgitation Aortic valve replacement Torsion Rotation |
