二维应变成像评价慢性重度二尖瓣反流术后左室收缩功能改变

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1、2O15，3l临床心血管病杂志·l270·JournalofClinicalCardiology(China)(12)：1270一l275·Ilf影#Y-学专栏·维应变成像评价慢性重度二尖瓣反流术后左室收缩功能改变李贺谢明星覃小娟贺林方凌云姚梦云[摘要]目的：探讨超声二维应变成像预测重度二尖瓣反流患者术后左室收缩功能改变的应用价值。方法：重度二尖瓣反流行置换术患者41例，术前二维应变成像测量左室整体纵向峰值应变(GIS)及应变率(GISRs)、乳头肌水平左室整体径向峰值应变(midGRs)及应变率(m

2、idGRSRs)；PISA法测量有效反流口面积(ERO)；双平面Simpson法测量左室容积和左室射血分数(LVEF)。术后两周内复查LVEF，根据LVEF下降程度将患者分为两组：A组术前术后LVEF下降<1O，B组术前术后LVEF下降>1O。以LVEF下降<10为因变量0，LVEF下降>10为因变量l，采用Logistic逐步回归筛选预测术后左窒收缩功能下降>1O的指标，并对筛选指标绘制ROC血线。结果：多因素logistic回归分析显示，midGRSRs减低是术后左心收缩功能下降>10的独立危险因

3、素。ROC曲线显示最佳截断点为midGRSRs<1．652s，曲线下面积为0．847，灵敏度、特异度分别为7O．O0、88．24。结论：二维应变技术可预测二尖瓣反流患者术后左室收缩功能下降，术前进行midGRSRs测量能有效判断术后左室收缩功能恢复情况。[关键词]二尖瓣反流；斑点追踪；左室doi10．13201／i．issn。1001—1439．2015．12．006[中图分类号]R541．1[文献标志码]AChronicmitralregurgitation：pilotstudytopredictp

4、ostoperativeleftventricularcontractilefunctionusingspeckle—trackingechOcardi0graphyL1HeXIEMingxingQINXiaojuanHELinFANGLingyunYAOMengyun(DepartmentofUltrasound，InstituteofCardiovascularDisease，UnionHospital，TongjiMedi—calCollege．HuazhongUniversityofScien

5、ceandTechnology，Wuhan，China，430022)Correspondingauthor：XIEMingxing，E—mail：xiemx64(126．CO1TIAbstractOective：ToevaluatethepredictivevalueofpreoperativeLVcontractilefunctionassessmentusing—speckle—trackinganalysisinpatientswithchronicseveremitralregurgitat

6、ion(MR)．Method：Forty-oneconsecutivepatientswithchronicsevereMRscheduledformitralvalvereplacement．Two-dimensionalspeckle-trackingima—gingwasperformedtoobtainLVgloballongitudinal，radialstrainandstrainratesbeforesurgery．MRseveritywasquantifiedbyusingthepro

7、ximalisovelocitysurfaceareamethod．andtheeffectiveregurgitantorifice(ER())wasestimated．IVend—diastollcvoIume(EDV)，LVend～systolicvolume(ESV)，andLVejectionfraction(IVEF)weremeasuredusingthemodifiedbiplaneSimpsofsmethod．Echocardiographywasrepeatedinallpatie

8、ntswithin2weeksaftersurgery．Thestudypopulationwasdividedintotwogroups，accordingtopostoperativedecreaseinLVEF：groupA，withpostoperativeLVEFdecreases<10，andgroupB，withpostoperativeLVEFdecreases>1O．ThevaluespredictingapostoperativeLV