重度主动脉瓣狭窄瓣膜置换术后左室舒张功能的超声评价

目的应用常规超声心动图及斑点追踪二维应变技术研究EF正常的单纯重度主动脉瓣狭窄患者，评价瓣膜置换术后左室重构与左室舒张功能改善的情况并进行相关性分析。方法20例单纯重度主动脉瓣狭窄患者于手术前、术后平均7．5个月行经胸超声心动图检查。比较术前与术后左室舒张末期容积指数（LVEDVI）、左室心肌质量指数（LVMI）、室壁相对厚度（RWT）、左室充盈压（E／E’m）、等容舒张期左室整体应变率（SRIVRT）、舒张早期左室整体应变率（SRE）及其变化的相关性。结果主动脉瓣置换术后LVEDVI、LVMI、LVMI／LVEDVI均较术前减低（P均〈0．05），SRIVRT、SRE均较术前升高（P均〈0．05）；RWT、E／E’m较术前改变不显著（P均〉0.05）。SRIVRT与SRE正相关（r=0．403，P〈0．05），术前的SRIVRT与E／Em’及LVMI／LVEDVI呈负相关（P均〈0．05）。结论EF正常的单纯主动脉瓣狭窄患者在主动脉瓣置换术后左室重构的主要变化为左室容量减小，左室壁心肌质量下降，虽然左室充盈压无明显下降，但SRIVRT和SRE在术后有所升高，可作为补充指标更敏感地反映左室整体舒张功能的变化。

The Effect of Aortic Valve Replacement on Left Ventricular Diastolic Function Assessed by Echocardiography in Sever Aortic Stenosis Patients

Objective To evaluate the left ventricular remodeling and improvement of left ventricular diastolic function after the aortic valve replacement（AVR） in severe aortic stenosis（AS） patients with preserved left ventricular（LV） ejection fraction（EF）. Methods In 20 severe AS patients with normal EF, we acquired apical four-,three-,and two-chamber views.Changes in global LV peak strain rate（SR） during isovolumic relaxation （SRIVRT）, global LV peak SR during early relaxation period（SRE）. LV mass index（LVMI） . LV end-diastolic volume index（LVEDV1）, LV filling pressure （E/E＇ m） were evaluated before and after surgery （mean follow-up period of 7.5 months） . Results After AVR, there is significant reduction in LVEDV, LVMI, LVMI/LVEDVI,（P all〈0.05）. There is no significant change in RWT and E/E＇ m （P all〉 0.05）,while SRIVRT and SRE were improved（P〈0.05）.There were correlations between SRIVRT and SRE.The correlations among preoperation SRIVRT and E/E＇ m, LVMI/ LVEDVI were significant.Conclusions After AVR surgery ,the LV remodeling changes in LVEDV decreases, the reduction of the LVMI.Although no significant decline in left ventricular filling pressure, but SRIVRT and SRE was increased after the change, as a supplement can be more sensitive to reflect the global left ventricular diastolic function.