斑点追踪超声心动图预测慢性主动脉瓣反流保守治疗和手术后的结局。

Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery.

机构信息

Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.

出版信息

JACC Cardiovasc Imaging. 2011 Mar;4(3):223-30. doi: 10.1016/j.jcmg.2010.11.016.

DOI:10.1016/j.jcmg.2010.11.016

PMID:21414568

Abstract

OBJECTIVES

The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation.

BACKGROUND

In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery. Speckle-tracking echocardiography has been proposed for this purpose, but the clinical value of this method in aortic regurgitation has not been established.

METHODS

A longitudinal study was performed in 64 patients with moderate to severe aortic regurgitation. Thirty-five patients were managed conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ± 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography was compared with impaired outcome after surgery (defined as persisting symptoms or persisting LV dilation [LV end-diastolic volume index ≥ 87 ml/m(2)] or dysfunction [LV ejection fraction <50%]) and with disease progression during conservative management (defined as development of symptoms, increase in LV volume >15%, or decrease in LV ejection fraction >10%).

RESULTS

Reduced myocardial systolic strain, systolic strain rate, and early diastolic strain rate by speckle-tracking echocardiography was associated with disease progression during conservative management (-16.3% vs. -19.0%, p = 0.02; -1.04 vs. -1.19 s(-1), p = 0.02; and 1.20 vs. 1.60 s(-1), p = 0.002, respectively) and with impaired outcome after surgery (-11.5% vs. -15.6%, p = 0.01; -0.88 vs. -1.01 s(-1), p = 0.04; and 0.98 vs. 1.33 s(-1), p = 0.01, respectively). Conventional parameters of LV function and size (LV ejection fraction and LV end-diastolic volume index) were associated with outcome after surgery (p = 0.04 and p = 0.01, respectively) but not with outcome during conservative management (p = 0.57 and p = 0.39, respectively).

CONCLUSIONS

Speckle-tracking echocardiography is useful for the early detection of LV systolic and diastolic dysfunction in chronic aortic regurgitation.

摘要

目的

本研究旨在使用斑点追踪超声心动图检测心肌应变来预测慢性主动脉瓣反流的预后。

背景

在慢性主动脉瓣反流中，必须早期发现左心室（LV）功能障碍，以便及时进行手术。斑点追踪超声心动图已被提议用于此目的，但该方法在主动脉瓣反流中的临床价值尚未得到证实。

方法

对 64 例中重度主动脉瓣反流患者进行了一项纵向研究。35 例患者接受保守治疗，定期进行临床随访和连续超声心动图检查，平均随访 19±8 个月，29 例患者因瓣膜病变接受手术治疗，术后随访 6 个月。比较斑点追踪和常规超声心动图的基线 LV 功能与术后不良预后（定义为持续症状或持续 LV 扩张[LV 舒张末期容积指数≥87ml/m2]或功能障碍[LV 射血分数<50%]）和保守治疗期间的疾病进展（定义为出现症状、LV 容积增加>15%或 LV 射血分数降低>10%）。

结果

斑点追踪超声心动图显示心肌收缩应变、收缩应变率和早期舒张应变率降低与保守治疗期间的疾病进展相关（-16.3%对-19.0%，p=0.02；-1.04 对-1.19s-1，p=0.02；和 1.20 对 1.60s-1，p=0.002），与术后不良预后相关（-11.5%对-15.6%，p=0.01；-0.88 对-1.01s-1，p=0.04；和 0.98 对 1.33s-1，p=0.01）。LV 功能和大小的常规参数（LV 射血分数和 LV 舒张末期容积指数）与术后结局相关（p=0.04 和 p=0.01），但与保守治疗期间的结局无关（p=0.57 和 p=0.39）。