预测慢性二尖瓣反流患者术后左心室功能障碍：二维多层斑点追踪超声心动图评估心肌变形
Predicting Left Ventricular Dysfunction after Surgery in Patients with Chronic Mitral Regurgitation: Assessment of Myocardial Deformation by 2-Dimensional Multilayer Speckle Tracking Echocardiography.
作者信息
Cho Eun Jeong, Park Sung-Ji, Yun Hye Rim, Jeong Dong Seop, Lee Sang-Chol, Park Seung Woo, Park Pyo Won
机构信息
Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Cardiology, Department of Internal Medicine, Cardiology Clinic, National Cancer Center, Goyang, Korea.
Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Korean Circ J. 2016 Mar;46(2):213-21. doi: 10.4070/kcj.2016.46.2.213. Epub 2016 Mar 21.
BACKGROUND AND OBJECTIVES
The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral valve regurgitation (MR) and portends a poor prognosis. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. The aim of the present study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional multilayer speckle-tracking echocardiography (2D MSTE) analysis in patients with chronic severe MR with preserved LV systolic function.
SUBJECTS AND METHODS
Forty-three consecutive patients with chronic severe MR with preserved LV systolic function scheduled for mitral valve replacement (MVR) or MV repair were prospectively enrolled. Serial echocardiographic studies were performed before surgery, at 7 days follow-up, and at least 3 months follow-up postoperatively. The conventional echocardiographic parameters were analyzed. Global longitudinal strain (GLS) was obtained quantitatively by 2D MSTE.
RESULTS
The mean age of patients was 51.7±14.3 years and 25 (58.1%) were male. In receiver-operating characteristic curve analysis, the most useful cutoff value for discriminating postoperative LV remodeling in severe MR with normal LV systolic function was -20.5% of 2D mid-layer GLS. Patients were divided into two groups by the baseline GLS -20.5%. Preoperative GLS values strongly predicted postoperative LV remodeling or LV dysfunction. The postoperative degree of decrease in LV end-diastolic dimension might be an additive predictive factor.
CONCLUSION
STE can be used to predict a decrease in LV function after MVR in patients with chronic severe MR. This promising method could be of use in the clinic when trying to decide upon the optimum time to schedule surgery for such patients.
背景与目的
术后左心室（LV）功能障碍的发生是慢性重度二尖瓣反流（MR）患者常见的并发症，且预后不良。心肌形变评估能够准确估计心肌收缩力。本研究旨在评估二维多层斑点追踪超声心动图（2D MSTE）分析术前区域左心室收缩功能评估对慢性重度MR且左心室收缩功能保留患者的预测价值。
对象与方法
前瞻性纳入43例计划行二尖瓣置换术（MVR）或二尖瓣修复术且左心室收缩功能保留的慢性重度MR患者。术前、术后7天随访以及术后至少3个月随访时进行系列超声心动图检查。分析常规超声心动图参数。通过2D MSTE定量获取整体纵向应变（GLS）。
结果
患者平均年龄为51.7±14.3岁，男性25例（58.1%）。在受试者工作特征曲线分析中，鉴别左心室收缩功能正常的重度MR患者术后左心室重构最有用的截断值为二维中层GLS的-20.5%。根据基线GLS -20.5%将患者分为两组。术前GLS值强烈预测术后左心室重构或左心室功能障碍。术后左心室舒张末期内径减小程度可能是一个附加预测因素。
结论
STE可用于预测慢性重度MR患者MVR术后左心室功能下降。在试图为此类患者确定最佳手术时机时，这种有前景的方法可能在临床上有用。
Zotero 插件