整体长轴应变检测射血分数正常的重度主动脉瓣反流患者的左心室收缩功能不全.docVIP

整体长轴应变检测射血分数正常的重度主动脉瓣反流患者的左心室收缩功能不全 　　【摘要】 目的：探讨二维斑点追踪测量的整体长轴应变检测射血分数（LVEF）正常的慢性重度主动脉瓣反流（AR）患者隐匿的左心室收缩功能不全。方法：选取2013年6月-2015年12月本院收治的140例LVEF正常的慢性重度AR患者（其中有症状者67例，占47.86%）作为AR组，另择49例健康正常人作为对照组。二维斑点追踪超声心动图测量左心室的整体长轴应变（GLS）、整体环向应变（GCS）及整体径向应变（GRS）指标，另外常规测量左心室内径、容积及射血分数。结果：AR组GLS低于对照组，比较差异有统计学意义（P0.05）；有症状AR患者的GLS低于无症状AR患者，比较差异有统计学意义（P0.01）。结论：LVEF正常的慢性重度AR患者左心室GLS下降，且有症状AR患者的GLS低于无症状AR患者。GLS可检测隐匿的心肌功能不全，可能有助于主动脉瓣手术时机的优化。 　　【关键词】 主动脉瓣反流； 斑点追踪； 应变； 左心室功能 　　【Abstract】 Objective：To investigate the two-dimensional speckle tracking detection overall long axis strain of left ventricular systolic dysfunction in patients with normal ejection fraction of severe aortic regurgitation（AR）.Method：From June 2013 to December 2015，140 cases of normal ejection fraction of severe AR（including 67 cases of symptoms，accounted for 47.86%） in our hospital were selected as the AR group，another 49 healthy people were selected as the control group.The left ventricular global longitudinal strain（GLS），global circumferential strain（GCS） and global radial strain（GRS） were measured by two dimensional speckle tracking echocardiography.Result：The GLC in AR group was lower than control group，the difference was statistically significant（P0.05）.The symptomatic AR were lower than those without symptoms AR，the difference was statistically significant（P0.01）.Conclusion：Left ventricular GLS decrease in patients with normal ejection fraction of chronic severe AR，and the symptomatic AR were lower than those without symptoms AR.GLS can detect occult myocardial dysfunction，may help to optimize the timing of aortic valve surgery. 　　【Key words】 Aortic regurgitation； Speckle tracking； Strain； Left ventricular function 　　First-author’s address：Sun Yet-sen Cardiovascular Hospital of Shenzhen City，Shenzhen 518000，China 　　doi：10.3969/j.issn.1674-4985.2016.30.007 　　重度主动脉瓣反流（aortic regurgitation，AR）是左心室容量负荷和压力负荷均过重的瓣膜疾病，起病隐匿，进展缓慢，诊断后仍有10余年的无症状期，唯一有效的治疗手段是主动脉瓣手术[1-2]。然而，手术时机的选择目前存有争议。若手术过早，患者将提前暴露于手术的风险和术后抗凝的风险