摘要
目的应用超声心动图左心室无创压力-应变环对接受经导管主动脉瓣置换术(TAVR)的主动脉瓣重度狭窄患者心肌做功(MW)进行定量研究。资料与方法前瞻性选取接受TAVR的11例主动脉瓣重度狭窄患者,在术前1周左右和术后10 d左右进行常规超声心动图测量左心房前后径(LAD)、左心室舒张末期前后径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)、主动脉瓣口面积、主动脉瓣峰值流速、主动脉瓣峰值跨瓣压差、主动脉瓣平均跨瓣压差等参数,并将图像储存在EchoPAC工作站进行描记分析,绘制压力-应变曲线,计算超声分层应变参数[峰值应变离散度、整体纵向应变(GLS)]和MW参数[整体做功指数(GWI)、整体有用功(GCW)、整体无用功、整体做功效率],比较术前和术后短期内常规超声心动图参数、分层应变参数和MW参数的变化,并分析GLS与MW参数、LVEF与MW参数的相关性。结果与接受TAVR前相比,术后短期内的主动脉瓣峰值流速[(4.61±0.49)m/s比(2.32±0.37)m/s;t=12.764,P<0.001]、主动脉瓣峰值跨瓣压差[(85.55±18.61)mmHg比(21.73±7.00)mmHg;t=10.799,P<0.001]和主动脉瓣平均跨瓣压差[(56.27±12.45)mmHg比(13.18±5.19)mmHg;t=11.388,P<0.001]均显著下降;GWI[(1958.91±655.47)mmHg%比(1643.09±557.57)mmHg%;t=2.411,P<0.05]、GCW[(2419.00±641.53)mmHg%比(2039.36±634.41)mmHg%;t=2.664,P<0.05]明显下降。术前及术后,GWI、GCW与GLS分别呈负相关(r=-0.907、-0.895,-0.868、-0.875,P均≤0.001);术后GCW与LVEF呈正相关(r=0.608,P<0.05)。结论左心室无创压力-应变环可定量评估主动脉瓣重度狭窄患者接受TAVR前后的MW改变,为此类患者的心脏功能评价提供新方法。
Purpose To quantitatively evaluate left ventricular myocardial work(MW)in patients with severe aortic stenosis received transcatheter aortic valve replacement(TAVR)used by the echocardiographic non-invasive pressure-strain loops(PSL).Materials and Methods Eleven patients with severe aortic stenosis undergoing TAVR were selected for the study prospectively.All patients received conventional echocardiography measurements about 1 week before surgery and postoperative 10 days or so.Some parameters,like left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular end diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),aortic valve area,peak aortic valve flow velocity,peak aortic valve transvalvular pressure difference and average aortic valve transvalvular pressure difference and so on,were recorded for statistical purposes,and dynamic images were stored in the EchoPAC workstation for tracing analyze.The pressure-strain loop curve was drawn to calculate the ultrasonic stratified strain parameters,including peak strain dispersion(PSD)and global longitudinal strain(GLS),and myocardial work parameters,which include global work index(GWI),global useful work(GCW),global wasteful work(GWW)and global work efficiency(GWE).The changes of all parameters between pre-operation and post-operation were compared,and correlated the GLS and myocardial work parameters.Results Compared with the pre-operation,the peak aortic valve flow rate[(4.61±0.49)m/s vs.(2.32±0.37)m/s;t=12.764,P<0.001],the peak pressure gradient[(85.55±18.61)mmHg vs.(21.73±7.00)mmHg;t=10.799,P<0.001],and the mean pressure gradient[(56.27±12.45)mmHg vs.(13.18±5.19)mmHg;t=11.388,P<0.001]in the post-operation were significantly decreased;GWI[(1958.91±655.47)mmHg%vs.(1643.09±557.57)mmHg%;t=2.411,P<0.05]and GCW[(2419.00±641.53)mmHg%vs.(2039.36±634.41)mmHg%;t=2.664,P<0.05]were also statistically decreased.GWI and GCW were negatively correlated with GLS respectively both before and after surgery(r=-0.907,-0.895,-0.868,-0.
作者
孟旭阳
郭颖
张瑞生
王翔
杨晨光
汪芳
MENG Xuyang;GUO Ying;ZHANG Ruisheng;WANG Xiang;YANG Chenguang;WANG Fang(Department of Cardiovascular Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Graduate School of Peking Union Medical College,Beijing 100730,China)
出处
《中国医学影像学杂志》
CSCD
北大核心
2021年第11期1078-1083,共6页
Chinese Journal of Medical Imaging
基金
国家重点研发计划资助项目(2020YFC2008106)
北京医院院级科研课题项目(No.BJ-2019-133)。
