RT-3DE与2D-STI评价二尖瓣置换术前后左心房功能的临床价值

目的 应用实时三维超声心动图（RT-3DE）和二维斑点追踪显像技术（2D-STI）评价二尖瓣置换术（mitral valve replacement,MVR）前、后左心房功能的变化及其临床价值.方法 2010年11月-2014年1月在我院住院并拟行二尖瓣置换术的患者40例分别于术前、术后3个月及术后1年进行超声心动图检查,应用RT-3DE测量左心房舒张末容积（LAVmax）、左心房收缩末容积（LAVmin）、左心房收缩前容积（LAVp）、左心房被动射血分数（LAEFp）、左心房主动射血分数（LAEFa）,计算左心房整体射血分数（LAEF）.应用2D-STI测量左心房前壁、后壁、侧壁、下壁及房间隔的应变及应变率.将2D-STI与RT-3DE测得的左心房功能相关指标进行比较,并与40例正常对照组进行比较.结果 STI测得MVR术前左心房应变（Ss）及各时期应变率（mSRs、mSRe、mSRa）均小于正常对照组,术后3个月Ss、mSRs、mSRe较术前低,术后1年左心房Ss、mSRs、mSRe比术前和术后3个月高,但仍低于正常对照组（P＜0.05）.RT-3DE测得MVR术前、术后左心房各容积（LAVmaxLAVmin、LAVp）大于正常对照组,LAEF、LAEFp、LAEFa小于正常对照组（P＜0.05）;MVR术后3个月LAEF、LAEFp较术前降低（P＜0.05）.术后1年左心房LAEF、LAEFp高于术前及术后3个月,但仍低于正常对照组（P＜0.05）.正常对照组、MVR术前、术后3个月、术后1年mSRe与LAEFp呈正相关（r=0.915、0.874、0.813、0.43,P＜0.05）,mSRa与LAEFa呈正相关（r=0.792、0.769、0.705、0.689,P＜0.05）.结论 RT-3DE和2D-STI对二尖瓣置换术疗效的评估具有一定临床价值.

Clinical evaluation of RT-3DE and 2D-STI in assessing left atrial function in patients before and after MVR

Objective To estimate the changes and clinical evaluation of left atrial （LA） function in patients using two-dimensional speckle tracking imaging （2D-STI） and real-time three-dimensional echocardiography （RT-3DE） in pre- and post-mitral valve replacement （MVR）. Methods Forty patients who expected to undertake MVR accepted echocardiography to estimate the LA function at pre-operation, 3 months and 1 year after operation. The LA maximum, minimum and pre-systolic volume （LAV LAVmin and LAVp）, LA passive ejection fraction （LAEFp）, LA active ejection fraction （LAEFa） were measured by RT-3DE respectively, while STI was used to measure strain and strain ratio of left atrial anterior wall, posterior wall, side wall, inferior wall and atrial septal. The correlation analysis was performed between 2D STI and RT 3DE indexes. Forty control subjects provided normal states. Comparative analysis was made between the control and patients group. Results The Ss, mSRs, mSRe and mSRa of left atrial were lower than those of the control group. At 3 months after MVR, the Ss, mSRs and mSRe of left atrial were lower than those before MVR. At 1 year after MVR, the Ss, mSRs and mSRe of left atrial were higher than those before and at 3 months after surgery, but still lower than the normal control （P 〈 0.05）. The LAV LAVmin and LAVp of patients with rheumatic heart disease were higher than those of the control group, whereas LAEF, LAEFp and LAEFa were lower than those of the control group. At 3 months after MVR, the LAEF and LAEFp were lower compared with before MVR （P 〈 0.05）, while at 1 year after MVR, the LAEFa and mSRa of patients had not changed significantly （P 〉 0.05）. mSRe was positively correlated with LAEFp, and mSRa was positively correlated with LAEFa. Conclusion RT-3DE and 2D-STI can evaluate left atrial function and are valuable to assess the efficacy of MVR.