| 摘要: |
| 目的 应用无创心肌做功评估左室射血分数保留（LVEF>50%）的慢性主动脉瓣关闭不全患者及其在主动脉瓣置换或修复 (AVR)术后的改变。方法 纳入2019年4月至 2021年5月确诊为中度或重度主动脉瓣关闭不全并通过AVR治疗的保留左室射血分数的患者52例，应用左室压力－应变环（PSL）评价患者左心室整体纵向应变 (GLS)及左室心肌做功指数，包括心肌整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GWE)，并与之前报道的正常参考范围及其他超声心动图指数进行比较分析。 结果 ①与正常参考值相比，保留LVEF的慢性主动脉瓣关闭不全患者左心室整体做功指数（GWI）、整体有效做功（GCW）正常或增加，整体做功效率（GWE）正常。② GWI、GCW与主动脉瓣反流（AR）严重程度指标以及左室收缩功能指数呈正相关。③ AVR术后GWI、GCW、GWE减低 (P <0.001)，但是整体无效做功（GWW）无明显变化(P =.28)。④AVR后LV GLS的损伤比LV GWI损伤更为普遍（72%对28%），28%患者出现术后GWI损伤，与左心室不良逆重构密切相关。 结论 在保留LVEF的CAR患者中，无创左室心肌做功可能比其他超声心动图指数更好地了解心肌力学和能量学改变及术后左室逆重构的过程。 |
| 关键词: 主动脉瓣关闭不全 心肌做功 左室重构 主动脉瓣手术 压力－应变环 |
| DOI： |
| 投稿时间：2022-08-22修订日期：2022-09-27 |
| 基金项目: |
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| Application of Noninvasive Left Ventricular Myocardial Work in patients with chronic aortic valve insufficiency who preserve left ventricular ejection fraction |
| shuangwenjuan |
| (Yizheng Hospital,Nanjing Drum Tower Hospital Group) |
| Abstract: |
| Objective: To evaluate noninvasive left ventricular myocardial work in patients with chronic aortic regurgitation(AR) and preserved Left ventricular ejection fraction(LVEF) and its changes after aortic valve replacement or repair (AVR). Methods: Fifty-two patients with moderate or severe chronic AR and preserved LVEF treated by AVR in Northern Jiangsu People''s Hospital were included. Noninvasive LV myocardial work indices and global longitudinal strain were measured at baseline and postoperatively (between 2 and 12 months after surgery) and compared with previously reported normal reference ranges. Results: Based on normal reference values, patients with chronic AR and preserved LVEF had preserved or increased values of LV global work index (GWI; 83% and 17%, respectively) and LV global constructive work (GCW; 75% and 25%, respectively) and preserved LV global work efficiency (GWE). Left ventricular GWI and GCW showed a positive correlation with markers of AR severity and parameters of LV systolic function. Left ventricular GWI, GCW, and GWE decreased after AVR (P < .001), without changes in LV global wasted work (P = .28). The postoperative impairment of LV GWI, observed in 28% of patients, was closely associated with reduced LV reverse remodeling. Conclusions: Noninvasive Left Ventricular myocardial may allow better understanding of myocardial function and energetics than afterload-dependent echocardiographic parameters in chronic AR with preserved LVEF. |
| Key words: aortic regurgitation myocardial work left ventricular remodeling mortic valve surgery pressure-strain loop |
