Delgado Mónica, Ruiz Martín, Mesa Dolores, de Lezo Cruz Conde José Suárez, Pan Manuel, López José, Villanueva Elena, Cejudo Laura
Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain.
Echocardiography. 2013 Jan;30(1):37-44. doi: 10.1111/j.1540-8175.2012.01808.x. Epub 2012 Sep 18.
To assess changes in myocardial deformation and ejection fraction (EF) by two-dimensional speckle tracking echocardiography (2DSTE) after transcatheter aortic valve implantation (TAVI).
A total of 24 patients (50% males, age 78 ± 4 years) were selected for TAVI because of severe aortic stenosis. A comprehensive echocardiographic study was performed before TAVI, at discharge, and after 1-month follow-up. EF was assessed by 2D conventional echocardiography with Simpson method and by 2DSTE. Radial and circumferential strains were evaluated in six segments in the short-axis view at the level of the papillary muscles, and longitudinal strain in six segments in the four-chamber apical view, by means of 2DSTE. All studies were performed with an iE-33 echocardiography device (Philips).
At discharge, the mean EF estimated by 2DSTE improved significantly when compared with the basal one (56 ± 7% vs. 51 ± 8%, P < 0.01), while EF by Simpson method did not change (67 ± 9% vs. 64 ± 16%, P = 0.2). At that time, global radial (21.4 ± 9% vs. 11.5 ± 7.6%, P = 0.000), circumferential (-20.7 ± 8% vs. -15.2 ± 7%, P = 0.02), and longitudinal strains (-14.8 ± 6.2% vs. -12 ± 6%, P = 0.02) improved significantly when compared with the basal one. At 1-month follow-up, global radial (20.1 ± 5.6% vs. 21.4 ± 9%, P = 0.88) and circumferential (-20 ± 8% vs. -20.7 ± 8%, P = 0.35) strains did not vary and a new significant improvement was observed in longitudinal global strain (-19.2 ± 6.5% vs. -14.8 ± 6.2%, P = 0.002).
A new echocardiographic technique, such as 2DSTE, shows a significant early improvement in global and segmental left ventricular systolic function after TAVI, which could not be detected by conventional methods.
通过二维斑点追踪超声心动图（2DSTE）评估经导管主动脉瓣植入术（TAVI）后心肌变形和射血分数（EF）的变化。
共选取24例因严重主动脉瓣狭窄而行TAVI的患者（男性占50%，年龄78±4岁）。在TAVI术前、出院时及随访1个月后进行全面的超声心动图检查。采用Simpson法通过二维传统超声心动图和2DSTE评估EF。通过2DSTE在乳头肌水平短轴视图的六个节段中评估径向和圆周应变，在四腔心尖视图的六个节段中评估纵向应变。所有检查均使用iE-33超声心动图设备（飞利浦）进行。
出院时，与基线相比，2DSTE评估的平均EF显著改善（56±7%对51±8%，P<0.01），而Simpson法评估的EF无变化（67±9%对64±16%，P=0.2）。此时，与基线相比，整体径向应变（21.4±9%对11.5±7.6%，P=0.000）、圆周应变（-20.7±8%对-15.2±7%，P=0.02）和纵向应变（-14.8±6.2%对-12±6%，P=0.02）均显著改善。随访1个月时，整体径向应变（20.1±5.6%对21.4±9%，P=0.88）和圆周应变（-20±8%对-20.7±8%，P=0.35）无变化，而整体纵向应变出现新的显著改善（-19.2±6.5%对-14.8±6.2%，P=0.002）。
一种新的超声心动图技术，如2DSTE，显示TAVI后左心室整体和节段收缩功能有显著早期改善，而传统方法无法检测到这种改善。
