Department of Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Eur Heart J. 2009 Dec;30(24):3037-47. doi: 10.1093/eurheartj/ehp351.
To evaluate myocardial multidirectional strain and strain rate (S-and-SR) in severe aortic stenosis (AS) patients with preserved left ventricular (LV) ejection fraction (EF), using two-dimensional speckle-tracking strain imaging (2D-STI). The long-term effect of aortic valve replacement (AVR) on S-and-SR was also evaluated.
Changes in LV radial, circumferential, and longitudinal S-and-SR were evaluated in 73 severe AS patients (65 +/- 13 years; aortic valve area 0.8 +/- 0.2 cm2) with preserved LVEF (61 +/- 11%), before and 17 months after AVR. Strain and strain rate data were compared with data from 40 controls (20 healthy individuals and 20 patients with LV hypertrophy) matched by age, gender, body surface area, and LVEF. Compared with controls, severe AS patients had significantly decreased values of LV S-and-SR in the radial (33.1 +/- 14.8%, P = 0.2; 1.7 +/- 0.5 s(-1), P = 0.003), circumferential (-15.2 +/- 5.0%, P = 0.001; -0.9 +/- 0.3 s(-1), P < 0.0001), and longitudinal (-14.6 +/- 4.1%, P < 0.0001; -0.8 +/- 0.2 s(-1), P < 0.0001) directions. At 17 months after AVR, LV S-and-SR significantly improved in all the three directions, whereas LVEF remained unchanged (60 +/- 12%, P = 0.7).
In severe AS patients, impaired LV S-and-SR existed although LVEF was preserved. After AVR, a significant S-and-SR improvement in all the three directions was observed. These subtle changes in LV contractility can be detected by 2D-STI.
应用二维斑点追踪应变成像（2D-STI）评估左心室射血分数（LVEF）正常的重度主动脉瓣狭窄（AS）患者的心肌各向应变和应变率（S 和 SR）。还评估了主动脉瓣置换（AVR）对 S 和 SR 的长期影响。
评估了 73 例 LVEF 正常（61±11%）的重度 AS 患者（65±13 岁；主动脉瓣口面积 0.8±0.2cm2）左心室径向、周向和纵向 S 和 SR 的变化，这些患者在 AVR 前和 17 个月后接受了检查。将应变和应变率数据与年龄、性别、体表面积和 LVEF 匹配的 40 名对照者（20 名健康个体和 20 名左心室肥厚患者）的数据进行比较。与对照组相比，重度 AS 患者的左心室 S 和 SR 径向（33.1±14.8%，P=0.2；1.7±0.5s-1，P=0.003）、周向（-15.2±5.0%，P=0.001；-0.9±0.3s-1，P<0.0001）和纵向（-14.6±4.1%，P<0.0001；-0.8±0.2s-1，P<0.0001）方向的 S 和 SR 值明显降低。在 AVR 后 17 个月，所有三个方向的左心室 S 和 SR 均显著改善，而 LVEF 保持不变（60±12%，P=0.7）。
尽管 LVEF 正常，但重度 AS 患者仍存在左心室 S 和 SR 受损。AVR 后，所有三个方向的 S 和 SR 均有显著改善。2D-STI 可检测到左心室收缩功能的这些细微变化。
