Department of Paediatric Cardiology, University Clinic Centre of the Medical University of Warsaw, Warsaw, Poland.
Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Łódź, Poland.
PLoS One. 2021 Apr 29;16(4):e0248862. doi: 10.1371/journal.pone.0248862. eCollection 2021.
The aim of the study was to evaluate left ventricular (LV) remodeling and systolic function using two-dimensional speckle tracking echocardiographic (2D STE) imaging in children at a long-term (more than 36 months, 107.5±57.8 months) after balloon valvuloplasty for aortic stenosis (BAV).
40 patients (mean age 9,68 years, 75% male) after BAV and 62 control subjects matched to the age and heart rate were prospectively evaluated. The 2D STE assessment of LV longitudinal and circumferential strain and strain rate was performed. Left ventricular eccentric hypertrophy (LVEH) was diagnosed in 75% of patients in the study group. Left ventricular ejection fraction (LVEF) was normal in all patients. In study group, global longitudinal strain (GLS), global longitudinal strain rate (GLSr) were significantly lower compared with the controls: GLS (-19.7±2.22% vs. -22.3±1.5%, P< 0.001), GLSr (-0.89±0.15/s vs. -1.04 ±0.12/s, P < 0.001). Regional (basal, middle and apical segments) strain and strain rate were also lower compared with control group. Global circumferential strain (GCS), global circumferential strain rate (GCSr) as well as regional (basal, middle and apical segments) strain and strain rate were normal. Multivariable logistic regression analysis included: instantaneous peak systolic Doppler gradient across aortic valve (PGmax), grade of aortic regurgitation (AR), left ventricular mass index (LVMI), left ventricular relative wall thickness (LVRWT), left ventricular end-diastolic diameter (LVEDd), peak systolic mitral annular velocity of the septal and lateral corner (S'spt, S'lat), LVEF before BAV and time after BAV and showed that the only predictor of reduced GLS was LV eccentric hypertrophy [odds ratio 6.9; (95% CI: 1.37-12.5), P = 0.045].
Patients at long-term observation after BAV present the subclinical LV systolic impairment, which is associated with the presence of its remodeling. Longitudinal deformation is the most sensitive marker of LV systolic impairment in this group of patients.
本研究旨在通过二维斑点追踪超声心动图（2D STE）评估主动脉瓣狭窄（BAV）球囊扩张术后长期（超过 36 个月，107.5±57.8 个月）患儿的左心室（LV）重构和收缩功能。
前瞻性评估了 40 例 BAV 后患儿（平均年龄 9.68 岁，75%为男性）和 62 名年龄和心率匹配的对照组。对 LV 纵向和周向应变及应变率进行 2D STE 评估。研究组中 75%的患者诊断为左室偏心性肥厚（LVEH）。所有患者的左室射血分数（LVEF）均正常。与对照组相比，研究组的整体纵向应变（GLS）和整体纵向应变率（GLSr）明显降低：GLS（-19.7±2.22%比-22.3±1.5%，P<0.001），GLSr（-0.89±0.15/s 比-1.04 ±0.12/s，P<0.001）。与对照组相比，节段应变和应变率也较低。整体圆周应变（GCS）、整体圆周应变率（GCSr）以及节段（基底、中部和心尖段）应变和应变率均正常。多变量逻辑回归分析包括：主动脉瓣瞬时峰值收缩期多普勒梯度（PGmax）、主动脉瓣反流程度（AR）、左心室质量指数（LVMI）、左心室相对壁厚度（LVRWT）、左心室舒张末期直径（LVEDd）、二尖瓣瓣环间隔和侧壁收缩期峰值速度（S'spt、S'lat）、BAV 前 LVEF 和 BAV 后时间，结果显示，唯一预测 GLS 降低的因素是 LV 偏心性肥厚[比值比 6.9；（95%可信区间：1.37-12.5），P=0.045]。
BAV 后长期观察的患者存在亚临床 LV 收缩功能障碍，这与 LV 重构有关。纵向变形是该组患者 LV 收缩功能障碍的最敏感标志物。
