射血分数保留与降低状态下重度主动脉瓣狭窄患者左心室整体及分层纵向应变与圆周应变的超声特征

doi:10.3877/cma.j.issn.1672-6448.2025.12.003

中华医学超声杂志（电子版） ›› 2025, Vol. 22 ›› Issue (12) : 1115 -1122. doi: 10.3877/cma.j.issn.1672-6448.2025.12.003

心血管超声影像学

射血分数保留与降低状态下重度主动脉瓣狭窄患者左心室整体及分层纵向应变与圆周应变的超声特征

贾琪琪¹, 木合塔江·吾布利哈斯木², 吴生林³, 关丽娜¹, 吴治胜¹, 穆玉明¹^,^†(

)

¹　830054　乌鲁木齐，新疆医科大学第一附属医院心脏超声诊断科
²　844000　喀什，喀什地区第一人民医院超声诊断科
³　831100　新疆昌吉，昌吉州回族自治州中医医院超声诊断科

收稿日期:2025-07-26 出版日期:2025-12-01
通信作者: 穆玉明

Echocardiographic assessment of global/regional longitudinal and circumferential left ventricular strain in patients with severe aortic stenosis with preserved versus reduced ejection fraction

Qiqi Jia¹, Wubulihasimu Muhetajiang², Shenglin Wu³, Lina Guan¹, Zhisheng Wu¹, Yuming Mu¹^,^†()

¹ Department of Cardiac Ultrasound, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
² Department of Ultrasound, the First People's Hospital of Kashi Region, Kashi 844000, China
³ Department of Ultrasound, Changji Hui Autonomous Prefecture Hospital of Traditional Chinese Medicine, Changji 831100, China

Received:2025-07-26 Published:2025-12-01
Corresponding author: Yuming Mu

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引用本文：

贾琪琪, 木合塔江·吾布利哈斯木, 吴生林, 关丽娜, 吴治胜, 穆玉明. 射血分数保留与降低状态下重度主动脉瓣狭窄患者左心室整体及分层纵向应变与圆周应变的超声特征[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(12): 1115-1122.

Qiqi Jia, Wubulihasimu Muhetajiang, Shenglin Wu, Lina Guan, Zhisheng Wu, Yuming Mu. Echocardiographic assessment of global/regional longitudinal and circumferential left ventricular strain in patients with severe aortic stenosis with preserved versus reduced ejection fraction[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(12): 1115-1122.

目的

评价射血分数保留与降低2种不同状态下的重度主动脉瓣狭窄（AS）患者左心室整体及分层纵向应变与圆周应变的变化特点。

方法

纳入2021年6月至2024年9月于新疆医科大学第一附属医院就诊的重度AS患者73例，按照左心室射血分数≥50%和＜50%将患者分为射血分数保留组（50例）和射血分数降低组（23例），收集同期健康志愿者作为对照组（50名）。应用常规超声心动图及斑点追踪成像技术获取左心室相关参数与左心室整体及分层心肌纵向应变、圆周应变与左心室-动脉偶联等参数。采用单因素方差分析或Kruska-Wallis H检验比较3组研究对象以上参数的差异。

结果

2组重度AS组患者较对照组各节段纵向应变均降低（P均<0.001），射血分数降低组较射血分数保留组约55%（10/18）的节段纵向应变降低[基底段-后间隔：（-7.85±2.88）% vs （-9.47±4.37）%；中间段-后间隔：（-8.90±3.30）% vs （-12.74±3.24）%；中间段-下壁：（-9.23±3.370% vs （-11.76±3.58）%；中间段-前侧壁：（-7.66±2.89）% vs （-10.05±3.12）%；尖段-前间隔：（-12.56±6.04）% vs （-16.17±5.11）%；尖段-后间隔：（-12.31±4.53）% vs （-17.62±3.57）%；尖段-下壁：（-11.71±4.01）% vs （-15.88±4.71）%；尖段-后壁：（-8.90±3.40）% vs （-13.26±4.84）%；尖段-前侧壁：（-8.91±3.83）% vs （-13.40±3.48）%；尖段-前壁：（-10.36±3.67）% vs （-13.80±7.19）%，P均<0.05]。2组重度AS患者组较对照组各节段圆周应变均降低（P均<0.001），射血分数降低组较射血分数保留组约83%（15/18）的节段圆周应变降低[基底段-前间隔：（-13.61±6.08）% vs （-19.47±5.59）%；基底段-后间隔：（-14.60±5.30）% vs （-18.58±4.66）%；基底段-下壁：（-14.35±7.59）% vs （-19.02±5.54）%；基底段-后壁：（-14.70±6.78）% vs （-18.72±5.90）%；基底段-前侧壁：（-12.82±5.39）% vs （-16.58±4.88）%；基底段-前壁：（-14.12±6.51）% vs （-18.81±6.14）%；中间段-前间隔：（-14.29±7.56）% vs （-19.71±4.51）%；中间段-后间隔：（-15.53±6.88）% vs （-20.89±5.37）%；中间隔-下壁：（-16.48±7.36）% vs （-21.70±5.32）%；中间隔-后壁：（-15.80±7.75）% vs （-19.64±5.18）%；中间段-前侧壁：（-14.04±5.87）% vs （-17.69±5.62）%；尖段-后间隔：（-16.54±7.72）% vs （-20.71±5.17）%；尖段-下壁：（-16.06±7.75）% vs （-21.51±5.39）%；尖段-前侧壁：（-15.47±7.56）% vs （-19.79±5.59）%；尖段-前壁：（-15.49±6.99）% vs （-20.66±5.34）%；P均<0.05]。与对照组相比，射血分数保留组与射血分数降低组的纵向应变及圆周应变跨壁梯度均降低，且射血分数降低组的跨壁梯度降低更为显著；2组重度AS患者左心室-动脉偶联指数[射血分数保留组：0.67（0.62，0.79），射血分数降低组：1.26（1.07，1.68）]较对照组[0.56（0.53，0.62）]增加，射血分数降低组较射血分数保留组左心室-动脉偶联指数增加（H=78.275，P<0.001）。重度AS患者随着左心室射血分数降低，整体纵向应变与整体圆周应变均呈下降趋势，左心室射血分数下降至40%~50%时，二者下降幅度最显著。

结论

重度AS患者左心室整体及分层纵向应变及圆周应变较对照组均降低，左心室-动脉偶联升高；射血分数降低组较射血分数保留组以上应变参数降低更显著，左心室-动脉偶联指数进一步升高。

关键词: 主动脉瓣狭窄，重度, 分层应变, 整体应变, 左心室-动脉偶联指数

Objective

To quantify and compare the changes in global/regional longitudinal and circumferential left ventricular strain in patients with severe aortic stenosis with preserved versus reduced ejection fraction (EF).

Methods

A total of 73 patients with severe aortic stenosis who were diagnosed and treated at the First Affiliated Hospital of Xinjiang Medical University between June 2021 and September 2024 were enrolled. The patients were divided into an EF-preserved group (n=50) and an EF-reduced group (n=23) based on an ejection fraction cutoff of 50%. A third group of 50 healthy volunteers, enrolled during the same period, served as controls. Conventional echocardiography and speckle tracking were utilized to obtain left ventricular parameters, global and regional longitudinal myocardial strain, circumferential strain, and left ventricular-arterial coupling parameters. Differences in these parameters among the three groups were evaluated using one-way ANOVA or the Kruskal-Wallis H test.

Results

Both groups of severe aortic stenosis patients showed decreased longitudinal strain in all segments compared to the control group (P＜0.001). The reduced EF group showed decreased longitudinal strain in approximately 55% (10/18) of segments compared to the preserved EF group [basal anteroseptal segment: (-7.85±2.88)% vs (-9.47±4.37)%; mid inferoseptal segment: (-8.90±3.30)% vs (-12.74±3.24)%; mid inferior segment: (-9.23±3.37)% vs (-11.76±3.58)%; mid anterolateral segment: (-7.66±2.89)% vs (-10.05±3.12)%; apical anteroseptal segment: (-12.56±6.04)% vs (-16.17±5.11)%; apical inferoseptal segment: (-12.31±4.53)% vs (-17.62±3.57)%; apical inferior segment: (-11.71±4.01)% vs (-15.88±4.71)%; apical posterior segment: (-8.90±3.40)% vs (-13.26±4.84)%; apical anterolateral segment: (-8.91±3.83)% vs (-13.40±3.48)%; apical anterior segment: (-10.36±3.67)% vs (-13.80±7.19)%, P＜0.001]. Both groups of severe aortic valve stenosis patients showed decreased circumferential strain in all segments compared to the control group (P＜0.001). The reduced EF group showed decreased circumferential strain in approximately 83% (15/18) of segments compared to the preserved EF group [basal anteroseptal segment: (-13.61±6.08)% vs (-19.47±5.59)%; basal inferoseptal segment: (-14.60±5.30)% vs (-18.58±4.66)%; basal inferior segment: (-14.35±7.59)% vs (-19.02±5.54)%; basal posterior segment: (-14.70±6.78)% vs (-18.72±5.90)%; basal anterolateral segment: (-12.82±5.39)% vs (-16.58±4.88)%; basal anterior segment: (-14.12±6.51)% vs (-18.81±6.14)%; mid anteroseptal segment: (-14.29±7.56)% vs (-19.71±4.51)%; mid inferoseptal segment: (-15.53±6.88)% vs (-20.89±5.37)%; mid inferior segment: (-16.48±7.36)% vs (-21.70±5.32)%; mid posterior segment: (-15.80±7.75)% vs (-19.64±5.18)%; mid anterolateral segment: (-14.04±5.87)% vs (-17.69±5.62)%; apical inferoseptal segment: (-16.54±7.72)% vs (-20.71±5.17)%; apical inferior segment: (-16.06±7.75)% vs (-21.51±5.39)%; apical anterolateral segment: (-15.47±7.56)% vs (-19.79±5.59)%; apical anterior segment: (-15.49±6.99)% vs (-20.66±5.34)%; P＜0.001]. In In terms of transmural gradient strain, both longitudinal and circumferential transmural gradients were reduced in the EF-preserved group and EF-reduced group compared with the control group. Furthermore, a more pronounced reduction in the transmural gradient was observed in the EF-reduced group than in the EF-preserved group. In both groups of patients with severe aortic stenosis [EF-preserved group: 0.67 (0.62, 0.79); EF-reduced group: 1.26 (1.07, 1.68)], the left ventricular-arterial coupling index was increased compared with the control group [0.56 (0.53, 0.62)], and the increase was more significant in the EF-reduced group than in the EF-preserved group (H=78.275, P＜0.001). In patients with severe aortic stenosis, both global longitudinal strain (GLS) and global circumferential strain (GCS) showed a decreasing trend as the ejection fraction decreased. Among these, when left ventricular ejection fraction decreased from 50% to 40%, the decrease in GLS and GCS was most marked.

Conclusion

Compared with normal controls, the global/regional longitudinal strain and circumferential strain of the left ventricular wall are reduced in patients with severe aortic stenosis, while left ventricular-arterial coupling is elevated. In patients with reduced EF, the above strain parameters are reduced more significantly than in those with preserved EF, while the index of left ventricular-arterial coupling is further elevated.

Key words: Severe aortic stenosis, Regional strain, Global strain, Left ventricle-artery coupling

图1 重度主动脉狭窄患者斑点追踪成像分析图。当分析左心室时，选择以左心室为主的心尖四腔（图a）、三腔（图b）、两腔观（图c）图像，同样的方法选择二尖瓣（图d）、乳头肌（图e）和心尖（图f）水平左心室短轴的切面，手动确定左心室内膜，系统自动生成感兴趣区域

表1 2组重度主动脉瓣狭窄患者与健康对照组基础临床资料比较[

x ¯

±s/M（Q₁，Q₃）]

组别	例数	年龄（岁）	体质量指数（kg/m²）	收缩压（mmHg）	舒张压（mmHg）	平均压差（mmHg）
对照组	50	69.92±6.69	25.29（23.55，27.94）	124.90±9.08	75.78±4.32	92.15±4.38
射血分数保留组	50	72.22±8.11	24.00（22.12，26.21）	125.56±20.85	78.28±8.28	94.04±10.36
射血分数降低组	23	71.96±6.47	23.89（21.67，25.88）^a	122.13±20.63	77.22±8.17	92.52±8.94
统计值		F=2.348	H=9.263	F=2.443	F=2.525	F=0.895
P值		0.309	0.010	0.295	0.283	0.639

表1 2组重度主动脉瓣狭窄患者与健康对照组基础临床资料比较[

x ¯

±s/M（Q₁，Q₃）]

组别	例数	年龄（岁）	体质量指数（kg/m²）	收缩压（mmHg）	舒张压（mmHg）	平均压差（mmHg）
对照组	50	69.92±6.69	25.29（23.55，27.94）	124.90±9.08	75.78±4.32	92.15±4.38
射血分数保留组	50	72.22±8.11	24.00（22.12，26.21）	125.56±20.85	78.28±8.28	94.04±10.36
射血分数降低组	23	71.96±6.47	23.89（21.67，25.88）^a	122.13±20.63	77.22±8.17	92.52±8.94
统计值		F=2.348	H=9.263	F=2.443	F=2.525	F=0.895
P值		0.309	0.010	0.295	0.283	0.639

表2 2组重度主动脉瓣狭窄患者与健康对照组心脏常规超声参数比较[

x ¯

±s/M（Q₁，Q₃）]

组别	E/e'	LVM（g）	LVMI（g/m²）	RWT	LVPWT（mm）	IVST（mm）
对照组	7.97±1.42	168.98（128.77，189.39）	91.66±19.00	0.35±0.04	8.28±1.13	8.14±1.07
射血分数保留组	15.12±5.13^a	351.13（274.21，436.84）^a	215.28±65.00^a	0.44±0.07^a	11.46±1.85^a	14.38±2.96^a
射血分数降低组	19.69±7.63^a	414.04（380.81,481.92）^a	260.35±64.50^a	0.42±0.10^ab	13.04±2.62^a	14.35±2.12^a
统计值	F=66.562	H=87.489	F=90.722	F=64.848	F=77.676	F=56.022
P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

表2 2组重度主动脉瓣狭窄患者与健康对照组心脏常规超声参数比较[

x ¯

±s/M（Q₁，Q₃）]

组别	E/e'	LVM（g）	LVMI（g/m²）	RWT	LVPWT（mm）	IVST（mm）
对照组	7.97±1.42	168.98（128.77，189.39）	91.66±19.00	0.35±0.04	8.28±1.13	8.14±1.07
射血分数保留组	15.12±5.13^a	351.13（274.21，436.84）^a	215.28±65.00^a	0.44±0.07^a	11.46±1.85^a	14.38±2.96^a
射血分数降低组	19.69±7.63^a	414.04（380.81,481.92）^a	260.35±64.50^a	0.42±0.10^ab	13.04±2.62^a	14.35±2.12^a
统计值	F=66.562	H=87.489	F=90.722	F=64.848	F=77.676	F=56.022
P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

表3 主动脉瓣狭窄组患者与健康对照组各节段纵向应变的比较（%，

x ¯

±s）

组别	例数	基底段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-16.39±4.27	-16.50±3.73	-18.00±4.21	-16.90±7.51	-17.49±6.33	-17.94±7.31
射血分数保留组	50	-7.64±3.63^a	-9.47±4.37^a	-11.11±3.50^a	-9.40±4.03^a	-10.49±3.41^a	-10.69±3.68^a
射血分数降低组	23	-6.85±4.31^a	-7.85±2.88^ab	-9.93±3.37^a	-9.20±3.47^a	-9.73±3.66^a	-9.17±3.54^a
F值		73.566	71.652	55.304	56.603	59.006	56.030
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	中间段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-19.46±5.01	-19.36±4.29	-19.47±3.90	-18.38±4.84	-17.49±3.61	-17.60±6.26
射血分数保留组	50	-10.77±3.60^a	-12.74±3.24^a	-11.76±3.58^a	-10.44±3.28^a	-10.05±3.12^a	-10.83±3.70^a
射血分数降低组	23	-8.49±4.25^a	-8.90±3.30^ab	-9.23±3.37^ab	-8.12±4.32^a	-7.66±2.89^ab	-9.08±3.41^a
F值		73.327	73.594	83.360	71.425	96.130	71.981
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	尖段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-20.83±6.41	-21.23±4.54	-21.51±5.77	-20.10±6.46	-18.01±5.10	-18.88±5.60
射血分数保留组	50	-16.17±5.11^a	-17.62±3.57^a	-15.88±4.71^a	-13.26±4.84^a	-13.40±3.48^a	-13.80±7.19^a
射血分数降低组	23	-12.56±6.04^ab	-12.31±4.53^ab	-11.71±4.01^ab	-8.90±3.40^ab	-8.91±3.83^ab	-10.36±3.67^ab
F值		28.067	42.817	42.752	54.599	52.629	32.964
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

表3 主动脉瓣狭窄组患者与健康对照组各节段纵向应变的比较（%，

x ¯

±s）

组别	例数	基底段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-16.39±4.27	-16.50±3.73	-18.00±4.21	-16.90±7.51	-17.49±6.33	-17.94±7.31
射血分数保留组	50	-7.64±3.63^a	-9.47±4.37^a	-11.11±3.50^a	-9.40±4.03^a	-10.49±3.41^a	-10.69±3.68^a
射血分数降低组	23	-6.85±4.31^a	-7.85±2.88^ab	-9.93±3.37^a	-9.20±3.47^a	-9.73±3.66^a	-9.17±3.54^a
F值		73.566	71.652	55.304	56.603	59.006	56.030
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	中间段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-19.46±5.01	-19.36±4.29	-19.47±3.90	-18.38±4.84	-17.49±3.61	-17.60±6.26
射血分数保留组	50	-10.77±3.60^a	-12.74±3.24^a	-11.76±3.58^a	-10.44±3.28^a	-10.05±3.12^a	-10.83±3.70^a
射血分数降低组	23	-8.49±4.25^a	-8.90±3.30^ab	-9.23±3.37^ab	-8.12±4.32^a	-7.66±2.89^ab	-9.08±3.41^a
F值		73.327	73.594	83.360	71.425	96.130	71.981
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	尖段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-20.83±6.41	-21.23±4.54	-21.51±5.77	-20.10±6.46	-18.01±5.10	-18.88±5.60
射血分数保留组	50	-16.17±5.11^a	-17.62±3.57^a	-15.88±4.71^a	-13.26±4.84^a	-13.40±3.48^a	-13.80±7.19^a
射血分数降低组	23	-12.56±6.04^ab	-12.31±4.53^ab	-11.71±4.01^ab	-8.90±3.40^ab	-8.91±3.83^ab	-10.36±3.67^ab
F值		28.067	42.817	42.752	54.599	52.629	32.964
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

表4 主动脉瓣狭窄组与对照组各节段圆周应变的比较（%，

x ¯

±s）

组别	例数	基底段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-24.46±5.41	-21.99±7.85	-23.47±6.16	-22.71±6.35	-21.27±6.83	-25.59±6.71
射血分数保留组	50	-19.47±5.59^a	-18.58±4.66^a	-19.02±5.54^a	-18.72±5.90^a	-16.58±4.88^a	-18.81±6.14^a
射血分数降低组	23	-13.61±6.08^ab	-14.60±5.30^ab	-14.35±7.59^ab	-14.70±6.78^ab	-12.82±5.39^ab	-14.12±6.51^ab
F值		30.580	21.328	17.930	13.733	18.278	28.513
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	中间段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-27.54±7.86	-26.17±7.70	-28.01±8.34	-28.23±8.55	-26.07±8.42	-28.15±7.86
射血分数保留组	50	-19.71±4.51^a	-20.89±5.37^a	-21.70±5.32^a	-19.64±5.18^a	-17.69±5.62^a	-19.43±4.97^a
射血分数降低组	23	-14.29±7.56^ab	-15.53±6.88^ab	-16.48±7.36^ab	-15.80±7.75^ab	-14.04±5.87^ab	-15.63±7.64^a
F值		46.662	31.688	34.195	43.905	42.847	45.758
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	尖段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-29.42±10.41	-28.04±9.94	-29.75±10.67	-30.06±10.62	-28.71±10.60	-29.64±10.57
射血分数保留组	50	-20.12±4.76^a	-20.71±5.17^a	-21.51±5.39^a	-20.69±4.45^a	-19.79±5.59^a	-20.66±5.34^a
射血分数降低组	23	-14.53±8.02^a	-16.54±7.72^ab	-16.06±7.75^ab	-16.33±9.70^ab	-15.47±7.56^ab	-15.49±6.99^ab
F值		3.999	30.837	32.990	36.693	35.410	39.602
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

表4 主动脉瓣狭窄组与对照组各节段圆周应变的比较（%，

x ¯

±s）

组别	例数	基底段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-24.46±5.41	-21.99±7.85	-23.47±6.16	-22.71±6.35	-21.27±6.83	-25.59±6.71
射血分数保留组	50	-19.47±5.59^a	-18.58±4.66^a	-19.02±5.54^a	-18.72±5.90^a	-16.58±4.88^a	-18.81±6.14^a
射血分数降低组	23	-13.61±6.08^ab	-14.60±5.30^ab	-14.35±7.59^ab	-14.70±6.78^ab	-12.82±5.39^ab	-14.12±6.51^ab
F值		30.580	21.328	17.930	13.733	18.278	28.513
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	中间段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-27.54±7.86	-26.17±7.70	-28.01±8.34	-28.23±8.55	-26.07±8.42	-28.15±7.86
射血分数保留组	50	-19.71±4.51^a	-20.89±5.37^a	-21.70±5.32^a	-19.64±5.18^a	-17.69±5.62^a	-19.43±4.97^a
射血分数降低组	23	-14.29±7.56^ab	-15.53±6.88^ab	-16.48±7.36^ab	-15.80±7.75^ab	-14.04±5.87^ab	-15.63±7.64^a
F值		46.662	31.688	34.195	43.905	42.847	45.758
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	尖段
组别	例数	前间隔	后间隔	下壁	后壁	前侧壁	前壁
对照组	50	-29.42±10.41	-28.04±9.94	-29.75±10.67	-30.06±10.62	-28.71±10.60	-29.64±10.57
射血分数保留组	50	-20.12±4.76^a	-20.71±5.17^a	-21.51±5.39^a	-20.69±4.45^a	-19.79±5.59^a	-20.66±5.34^a
射血分数降低组	23	-14.53±8.02^a	-16.54±7.72^ab	-16.06±7.75^ab	-16.33±9.70^ab	-15.47±7.56^ab	-15.49±6.99^ab
F值		3.999	30.837	32.990	36.693	35.410	39.602
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

表5 健康对照组与2组重度主动脉瓣狭窄患者心肌分层应变参数及TMSG比较（%，

x ¯

±s）

变量	对照组	射血分数保留组	射血分数降低组	F值	P值
GLSendo	-16.09±2.13	-12.29±2.06^a	-8.48±2.10^a	152.877	＜0.001
GLSmid	-13.75±2.47	-11.06±1.88^a	-7.77±1.85^ab	92.980	＜0.001
GLSepi	-11.86±2.27	-9.24±1.59^a	-7.03±1.80^ab	70.441	＜0.001
GCSendo	-25.06±5.45	-22.61±5.21^a	-12.20±2.44^ab	42.093	＜0.001
GCSmid	-19.12±4.88	-16.67±3.82^a	-9.49±2.58^ab	50.073	＜0.001
GCSepi	-13.52±3.34	-11.82±2.92^a	-8.07±2.27^ab	41.434	＜0.001
TMSG-GLS（mid-epi）	-1.90±1.35	-1.82±0.86	-0.74±0.65^ab	21.234	＜0.001
TMSG-GLS（endo-mid）	-2.34±1.95	-1.23±0.57^a	-0.71±0.84^ab	27.409	＜0.001
TMSG-GLS（endo-epi）	-4.23±1.95	-3.05±1.07^a	-1.45±1.11^ab	41.440	＜0.001
TMSG-GCS（mid-epi）	-5.60±2.90	-4.84±2.50	-1.42±2.12^ab	35.137	＜0.001
TMSG-GCS（endo-mid）	-5.94±2.43	-5.94±2.13	-2.70±1.80^ab	30.166	＜0.001
TMSG-GCS（endo-epi）	-11.53±4.17	-10.78±4.13	-4.13±2.30^ab	46.734	＜0.001

表5 健康对照组与2组重度主动脉瓣狭窄患者心肌分层应变参数及TMSG比较（%，

x ¯

±s）

变量	对照组	射血分数保留组	射血分数降低组	F值	P值
GLSendo	-16.09±2.13	-12.29±2.06^a	-8.48±2.10^a	152.877	＜0.001
GLSmid	-13.75±2.47	-11.06±1.88^a	-7.77±1.85^ab	92.980	＜0.001
GLSepi	-11.86±2.27	-9.24±1.59^a	-7.03±1.80^ab	70.441	＜0.001
GCSendo	-25.06±5.45	-22.61±5.21^a	-12.20±2.44^ab	42.093	＜0.001
GCSmid	-19.12±4.88	-16.67±3.82^a	-9.49±2.58^ab	50.073	＜0.001
GCSepi	-13.52±3.34	-11.82±2.92^a	-8.07±2.27^ab	41.434	＜0.001
TMSG-GLS（mid-epi）	-1.90±1.35	-1.82±0.86	-0.74±0.65^ab	21.234	＜0.001
TMSG-GLS（endo-mid）	-2.34±1.95	-1.23±0.57^a	-0.71±0.84^ab	27.409	＜0.001
TMSG-GLS（endo-epi）	-4.23±1.95	-3.05±1.07^a	-1.45±1.11^ab	41.440	＜0.001
TMSG-GCS（mid-epi）	-5.60±2.90	-4.84±2.50	-1.42±2.12^ab	35.137	＜0.001
TMSG-GCS（endo-mid）	-5.94±2.43	-5.94±2.13	-2.70±1.80^ab	30.166	＜0.001
TMSG-GCS（endo-epi）	-11.53±4.17	-10.78±4.13	-4.13±2.30^ab	46.734	＜0.001

图2 重度主动脉瓣狭窄患者整体纵向应变与整体圆周应变随左心室射血分数的变化趋势

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[1]	蔡璐, 尹立雪, 王斯佳, 周婕, 徐芸, 郭智宇. 超声分层应变成像技术对阿霉素致大鼠急性左心室心肌早期毒性损伤的评价[J/OL]. 中华医学超声杂志（电子版）, 2019, 16(05): 386-392.

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Echocardiographic assessment of global/regional longitudinal and circumferential left ventricular strain in patients with severe aortic stenosis with preserved versus reduced ejection fraction

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Echocardiographic assessment of global/regional longitudinal and circumferential left ventricular strain in patients with severe aortic stenosis with preserved versus reduced ejection fraction