三维斑点追踪技术评估主动脉瓣狭窄患者左室整体应变及扭转运动

目的应用超声三维斑点追踪技术(3D-STE)测量主动脉瓣狭窄(AS)患者左室整体应变及扭转运动,进而评估AS患者左心功能。方法选取不同程度AS患者63例,按照狭窄程度分为轻度狭窄组18例、中度狭窄组20例、重度狭窄组25例;另选取22例健康人作为对照组。经胸采集存储左室三维全容积动态图像,应用Echo PAC工作站进行脱机分析;获得左室长轴纵向应变(GLS)、短轴径向应变(GRS)及短轴环向应变(GCS),左室整体及心尖段、中间段、基底段扭转角度峰值(Twist)及扭矩(Torsion)。结果与对照组相比,AS组GLS、GRS及GCS数值明显减低(P<0.01);AS组整体及各节段Twist、Torsion数值增加,差异有统计学意义(P<0.05)。AS组亚组分析中,随主动脉瓣狭窄程度增加,GLS、GRS、GCS逐渐降低,各组GLS、GRS均较对照组差异有统计学意义(P<0.05),GCS仅重度狭窄组较对照组差异有统计学意义(P<0.05);随狭窄程度增加,左室收缩期整体及各节段Twist、Torsion均呈现出增加趋势。结论三维斑点追踪技术可以反映射血分数正常的主动脉瓣狭窄患者左室心肌应变及扭转运动的特征。

Assessment on the Left Ventricular Global Strain and Torsion in Aortic Stenosis Patients Using Three-dimensional Speck Tracking Technique

Objective To measure the left ventricular global strain and torsion in patients with aortic stenosis using three-dimensional speck tracking technique(3D-STE),and to evaluate the left ventricular function in patients with different degrees of AS.Methods Sixty-three patients with different degrees of aortic stenosis were enrolled,including 18 cases of mild stenosis,20 cases of moderate stenosis and 25 cases of severe stenosis;twenty-two normal people were enrolled as the control group.Real-time three-dimensional full volume dynamic images of left ventricular were acquired using transthoracic echocardiography and were analysed off-line with Echo PAC software;left ventricular global longitudinal strain(GLS)、global radial strain(GRS)and global circumferential strain(GCS),the twist and torsion of left ventricular overall and left ventricular apex,middle and basal segment torsional peak were acquired.Results Compared with the control,The overall GLS,GRS and GCS values in the AS group were significantly decreased(P<0.01).Left ventricular systolic overall and each segment twist and torsion were increased in the AS group(P<0.05).In the subgroup analysis of the AS group,GLS,GRS and GCS decreased compared with the control group,and the differences of GLS and GRS in each group were statistically significant(P<0.05).There were statistically significant differences in GCS between the severe stenosis group and the control group(P<0.05).Both left ventricular twist and torsion showed an increasing trend as the stenosis goes up.Conclusions Three-dimensional speckle tracking technology can evaluate the left ventricular myocardial strain and left ventricular torsion in patients with aortic stenosis with preserved left ventricular ejection fraction.