心肌分层应变评估重度主动脉瓣狭窄患者左室心肌收缩功能变化

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摘要目的：应用心肌分层应变定量分析左室射血分数（LVEF）正常的单纯重度主动脉瓣狭窄（AS）患者左室心肌各层收缩功能改变。方法：选择温州医科大学附属黄岩医院2012年1月至2017年9月经超声心动图确诊的重度AS患者57例（其中AS左室壁增厚组36例，AS左室壁不厚组21例），所有患者LVEF≥55%，对照组30例。测量左室内膜（Endo）、中层（Mid）及外膜（Epi）整体纵向峰值应变（GLS）与整体圆周峰值应变（GCS）；比较分析左室Endo、Mid及Epi的GLS和GCS的差异。随机抽取20例，对同一观察者内和2位观察者间GLS和GCS测量值进行重复性检验。结果：和对照组比，AS左室壁不厚组和AS左室壁增厚组左室的Endo-GLS、Mid-GLS、Epi-GLS均明显减低，差异有统计学意义（P＜0.05）；和AS左室壁不厚组比，AS左室壁增厚组左室Endo-GLS、Mid-GLS、Epi-GLS均明显减低，差异有统计学意义（P＜0.05）。3组间左室Endo-GCS、Mid-GCS、Epi-GCS变化差异无统计学意义（P>0.05）。结论：随着左室壁厚度的增加，AS患者Endo-GLS、Mid-GLS、Epi-GLS逐渐减低，左室的Endo-GLS、Mid-GLS、Epi-GLS可以检测LVEF正常的AS患者左室心肌收缩功能的早期改变。

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	林洁
	严志汉

关键词 ：心肌分层应变, 主动脉瓣狭窄, 心室功能, 左, 超声心动描记术

Abstract：Objective: To quantitatively evaluate left ventricular (LV) systolic function in severe aortic stenosis (AS) with normal left ventricular ejection fraction (LVEF) using layer-specific strain (LSS). Methods: Fifty-seven patients with severe AS (including 36 cases with LV wall thickness and 21 cases with normal wall thickness, all patients had LVEF≥55%) and 30 controls from January 2012 to September 2017 in Huangyan Hospital of Wenzhou Medical University were included in this study. The global endocardial (Endo), mid-wall (Mid), epicardial (Epi) longitudinal peak strain (GLS) and circumferential peak stain (GCS) were analyzed. The repeatability of GLS and GCS was evaluated in 20 cases randomly selected from the investigated subjects as the AS and controls. Results: Endo-GLS, Mid-GLS, Epi-GLS in AS with and without wall thickness were significantly reduced compared with the controls (P<0.05); and Endo-GLS, Mid-GLS, Epi-GLS in AS with wall thickness were statistically lower than that with LV normal wall thickness (P<0.05). There was no significant difference in Endo-GCS, Mid-GCS, Epi-GCS between the above three groups (P>0.05). Conclusion: With the increase of LV wall thickness, Endo-GLS, Mid-GLS, Epi-GLS gradually decrease in the AS patients. Endo-GLS, Mid-GLS, Epi-GLS can be used to identify subtle contractile dysfunction triggered by increased LV wall thickness in severe AS with normal LVEF.

Key words： layer-specific strain aortic valve stenosis ventricular function, left echocardiography

收稿日期: 2017-11-08

通讯作者: 严志汉，教授，主任医师，Email：yanzhihanwz@163.com。

作者简介: 林洁（1983-），女，浙江台州人，主治医师，在职硕士生

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I4/289

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