斑点组织追踪对体外膜氧合辅助下经导管主动脉瓣植入术的疗效评价

  目的  探讨二尖瓣环位移斑点组织追踪技术(TMAD)在体外膜氧合(ECMO)辅助下经导管主动脉瓣植入(TAVI)治疗重症主动脉瓣狭窄(AS)患者的应用价值。  方法  对2019年9月—2021年3月在河南省胸科医院ECMO辅助下行TAVI手术的16例左室射血分数(LVEF)＜25%重症AS患者进行回顾分析。统计分析该组患者TAVI治疗前、ECMO撤除后即刻、术后1个月斑点组织追踪参数二尖瓣环平均位移(TMADmid)、二尖瓣环平均位移率(TMADmid%)、整体纵向收缩期峰值应变(GLS)]及常规超声心动图参数LVEF、左心室舒张末期内径(LVEDd)、每搏输出量(SV)]的变化，分析斑点组织追踪技术对ECMO辅助下TAVI术后疗效的评价价值。  结果  本组患者TAVI术前、ECMO撤除后即刻、术后1个月斑点组织追踪参数TMADmid(3.2±1.3)mm，(6.9±1.3)mm, (11.2±2.5)mm]、TMADmid%(3.5±2.6)%，(7.0±3.8)%, (10.1±2.1)%]和GLS(5.9±3.5)%，(8.9±2.7)%, (13.2±3.9)%]逐渐增高，组间差异均有统计学意义(均P < 0.05)；术后1个月LVEF(42.2±5.3)%]较术前(22.2±5.5)%]及ECMO撤除后即刻(23.8±2.5)%]升高, 差异有统计学意义(均P < 0.05)；与术前LVEF相比，ECMO撤除后即刻LVEF升高，差异无统计学意义(P>0.05)。TMADmid、TMADmid%与GLS呈正相关关系(r=0.499、0.586，均P < 0.05)。  结论  二尖瓣斑点组织追踪技术可作为评价AS患者TAVI诊疗效果的敏感参考指标，ECMO辅助下TAVI治疗重症AS患者安全有效。 

Evaluation of the efficacy of extracorporeal membrane oxygenation assisted transcatheter aortic valve implantation by speckle tracking

  Objective  To investigate the application value of tissue mitral annular displacement (TMAD) speckle tracking technique in extracorporeal membrane oxygenation (ECMO) assisted transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis (AS).  Methods  A total of 16 patients with severe AS with left ventricular ejection fraction (LVEF) < 25% underwent ECMO assisted TAVI in Henan Provincial Chest Hospital from September 2019 to March 2021 were retrospectively analyzed. The changes of speckle tracking parameters tissue motion tracking of mitral annular average displacement (TMADmid), tissue motion tracking of mitral annular average displacement rate (TMADmid%), global longitudinal strain (GLS)] and conventional echocardiographic parameters LVEF, left ventricular diastolic end diameter (LVEDd), stroke volume (SV)] were statistically analyzed before TAVI treatment, immediately after ECMO removal and 1 month after operation. The evaluation value of speckled tracking technique in the postoperative efficacy of ECMO assisted TAVI was analyzed.  Results  The TMADmid (3.2±1.3) mm, (6.9±1.3) mm, (11.2±2.5) mm], TMADmid% (3.5±2.6) %, (7.0±3.8) %, (10.1±2.1) %] and GLS (5.9±3.5) %, (8.9±2.7) %, (13.2±3.9) %] increased gradually before TAVI treatment, immediately after ECMO removal and 1 month after operation, and the differences were statistically significant (all P < 0.05). One month after operation, LVEF (42.2±5.3) %] was significantly higher than that before operation (22.2±5.5) %] and immediately after ECMO removal (23.8±2.5) %, P < 0.05]. Compared with pre-operation, LVEF increased immediately after ECMO removal, with no significant difference (P>0.05). The TMADmid and TMADmid% were positively correlated with GLS (r=0.499, 0.586, all P < 0.05).  Conclusion  The tissue mitral annular displacement speckle tracking technique can be used as a sensitive reference index to evaluate the diagnosis and treatment effect of TAVI in patients with AS. The ECMO assisted TAVI is safe and effective in the treatment of severe AS.