Evaluation of left ventricular myocardial function in patients with severe aortic stenosis underwent aortic valve replacement with preserved left ventricular ejection fraction by three-dimensional speckle tracking imaging

doi:10.3877/cma.j.issn.1672-6448.2017.04.010

Abstract

Abstract:

Objective

To evaluate left ventricular myocardial function alternation by three-dimensional speckle tracking imaging (3D-STI) after surgical aortic valve replacement (AVR) in severe aortic stenosis (AS) patients with preserved left ventricular ejection fraction (LVEF), and discuss its clinical value.

Methods

Forty patients with severe aortic stenosis who were hospitalized or outpatient in Nanjing First Hospital Affiliated to Nanjing Medical University during the period of October 2014 to October 2016 (AS group), and forty healthy volunteers (normal control group) were enrolled in this study. Normal control group underwent conventional echocardiography and 3D-STI measurement, while the AS group underwent conventional echocardiography and 3D-STI measurement at preoperative, 1 week postoperative and 3 months postoperative, then we obtained left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septum thickness diameter (IVSd), left ventricular posterior wall thickness diameter (LVPWd), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS) strain and 3D-strain. The independent sample t test was used to compare the difference of conventional ultrasound parameters and 3D-STI parameters between AS preoperative patients and healthy controls, AS patients at 3 months postoperative and healthy controls. The single factor analysis of variance was used to compare the difference of conventional ultrasound parameters and 3D-STI parameters in severe patients at preoperative, 1 week postoperative and 3 months postoperative. LSD-t test was used to compare in different AS groups.

Results

Compared with normal control group, IVSD, LVPWD and GCS of severe AS patients increased significantly (t=13.824, 11.298 and -6.584, all P<0.001), GLS, GRS and 3D-Strain decreased significantly (t=10.221, -6.237 and -5.674, all P<0.001), LVEDD, LVESD and GAS had no significant difference. Compared with preoperative AS patients, LVEF, GLS, GAS and GCS decreased significantly (t=-2.205, -2.093, -2.034 and -3.152, all P<0.05 or 0.01) at 1 week postoperative, LVEDD, LVESD, IVSD, LVPWD, GRS and 3D-strain had no significant difference at 1 week postoperative; GLS, GRS and 3D-strain increased significantly (t=5.446, -4.923 and -4.388, all P<0.05 or 0.01) at 3 months postoperative, GCS, IVSD and LVPWD decreased significantly (t=-3.988, 4.794 and 4.211, all P<0.05 or 0.01) at 3 months postoperative, LVEDD, LVESD, LVEF and GAS had no significant difference at 3 months postoperative. Compared with AS patients at 1 week postoperative, LVEF, GLS, GRS, GAS and 3D-strain increased significantly (t=-2.631, 7.383, -4.719, 2.923 and -4.154, all P<0.05 or 0.01) at 3 months postoperative, GCS, IVSD and LVPWD decreased significantly (t=-2.109, 4.747 and 4.323, all P<0.05 or 0.01) at 3 months postoperative. But in AS patients at 3 months postoperative, IVSD, LVPWD, GLS and GCS were still higher than those of normal control group (t=9.809, 7.066, 4.752 and -2.553, all P<0.001 or <0.05), LVEDD, LVESD, LVEF, GRS, GAS and 3D-strain had no significant difference.

Conclusion

The alternation of left ventricular myocardial function have a certain characteristic before and after aortic valve replacement in severe aortic stenosis patients with preserved LVEF, and 3D-STI can evaluate it more accurately.

Key words: Three-dimensional speckle tracking, Left ventricular ejection fraction, Aortic valve stenosis, Aortic valve replacement, Myocardium

Qianshan Ding, Pingyang Zhang, Jing Dong, Xiaowu Ma, Lingling Fang, Lin Li. Evaluation of left ventricular myocardial function in patients with severe aortic stenosis underwent aortic valve replacement with preserved left ventricular ejection fraction by three-dimensional speckle tracking imaging[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(04): 285-291.

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References 16

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组别	例数	年龄（岁，±s）	性别（例，男性/女性）	LVEDD（mm，±s）	LVESD（mm，±s）	LVEF（%，±s）	心率（次/min，±s）
重度AS组	40	58.10±12.32	25/15	47.51±3.53	29.55±3.12	63.31±4.01	69.78±10.21
健康对照组	40	59.76±11.53	25/15	48.57±3.67	28.62±3.13	63.96±3.69	72.41±8.12
检验值	?	t=-0.234	χ²=0.000	t=1.162	t=1.327	t=-0.754	t=0.794
P值	?	0.818	1.000	0.249	0.188	0.453	0.464

组别	例数	年龄（岁，±s）	性别（例，男性/女性）	LVEDD（mm，±s）	LVESD（mm，±s）	LVEF（%，±s）	心率（次/min，±s）
重度AS组	40	58.10±12.32	25/15	47.51±3.53	29.55±3.12	63.31±4.01	69.78±10.21
健康对照组	40	59.76±11.53	25/15	48.57±3.67	28.62±3.13	63.96±3.69	72.41±8.12
检验值	?	t=-0.234	χ²=0.000	t=1.162	t=1.327	t=-0.754	t=0.794
P值	?	0.818	1.000	0.249	0.188	0.453	0.464

组别	例数	LVEDD（mm）	LVESD（mm）	IVSD（mm）	LVPWD（mm）	LVEF（%）
重度AS组	40	47.51±3.53	29.55±3.12	14.95±1.46	13.11±1.36	63.31±4.01
健康对照组	40	48.57±3.67	28.62±3.13	9.33±1.53	8.67±1.36	63.96±3.69
t值	?	1.162	1.327	13.824	11.298	-0.754
P值	?	0.249	0.188	<0.001	<0.001	0.453
组别	例数	GLS（%）	GCS（%）	GRS（%）	GAS（%）	3D-strain（%）
重度AS组	40	-15.17±2.25	-26.93±3.19	28.66±7.64	-39.52±3.72	30.40±7.92
健康对照组	40	-20.94±2.78	-22.23±3.20	39.49±7.89	-39.57±3.01	40.56±8.10
t值	?	10.221	-6.584	-6.237	0.056	-5.674
P值	?	<0.001	<0.001	<0.001	0.955	<0.001

组别	例数	LVEDD（mm）	LVESD（mm）	IVSD（mm）	LVPWD（mm）	LVEF（%）
重度AS组	40	47.51±3.53	29.55±3.12	14.95±1.46	13.11±1.36	63.31±4.01
健康对照组	40	48.57±3.67	28.62±3.13	9.33±1.53	8.67±1.36	63.96±3.69
t值	?	1.162	1.327	13.824	11.298	-0.754
P值	?	0.249	0.188	<0.001	<0.001	0.453
组别	例数	GLS（%）	GCS（%）	GRS（%）	GAS（%）	3D-strain（%）
重度AS组	40	-15.17±2.25	-26.93±3.19	28.66±7.64	-39.52±3.72	30.40±7.92
健康对照组	40	-20.94±2.78	-22.23±3.20	39.49±7.89	-39.57±3.01	40.56±8.10
t值	?	10.221	-6.584	-6.237	0.056	-5.674
P值	?	<0.001	<0.001	<0.001	0.955	<0.001

时间	例数	LVEDD（mm）	LVESD（mm）	IVSD（mm）	LVPWD（mm）	LVEF（%）
术前	40	47.51±3.53	29.55±3.12	14.95±1.46	13.11±1.36	63.31±4.01
术后1周	40	47.05±3.77	29.30±3.31	14.83±1.27	13.14±1.35	61.35±3.75^c
术后3个月	40	47.72±3.69	29.24±3.64	13.46±1.32^a	11.82±1.37^b	63.48±3.49
F值	?	0.349	0.094	15.042	12.166	3.971
P值	?	0.706	0.910	<0.001	<0.001	0.021
时间	例数	GLS（%）	GCS（%）	GRS（%）	GAS（%）	3D-strain（%）
术前	40	-15.17±2.25	-26.93±3.19	28.66±7.64	-39.52±3.72	30.40±7.92
术后1周	40	-14.11±2.27^d	-25.53±2.97^f	28.15±9.46	-37.06±3.23ⁱ	30.32±9.14
术后3个月	40	-18.11±2.56^e	-24.07±3.24^g	38.15±9.50^h	-39.33±3.67	38.98±9.51^j
F值	?	30.651	8.363	15.993	5.922	12.572
P值	?	<0.001	<0.001	<0.001	0.004	<0.001

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