斑点组织追踪对体外膜氧合辅助下经导管主动脉瓣植入术的疗效评价

纪淑姣; 李玉珍; 孙佳; 冯艳芬

doi:10.16766/j.cnki.issn.1674-4152.002761

斑点组织追踪对体外膜氧合辅助下经导管主动脉瓣植入术的疗效评价

doi: 10.16766/j.cnki.issn.1674-4152.002761

河南省胸科医院(郑州大学附属胸科医院)超声科, 河南郑州 450000

基金项目:

河南省医学科技攻关项目 2018020540

详细信息

通讯作者:
纪淑姣，E-mail：shujiaoji@126.com

中图分类号: R543.1 R445.1
计量
- 文章访问数: 135
- HTML全文浏览量: 72
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-29
- 网络出版日期: 2023-02-07

Evaluation of the efficacy of extracorporeal membrane oxygenation assisted transcatheter aortic valve implantation by speckle tracking

Department of Ultrasound, Henan Provincial Chest Hospital, Chest Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, China

摘要

摘要: 目的探讨二尖瓣环位移斑点组织追踪技术(TMAD)在体外膜氧合(ECMO)辅助下经导管主动脉瓣植入(TAVI)治疗重症主动脉瓣狭窄(AS)患者的应用价值。方法对2019年9月—2021年3月在河南省胸科医院ECMO辅助下行TAVI手术的16例左室射血分数(LVEF)＜25%重症AS患者进行回顾分析。统计分析该组患者TAVI治疗前、ECMO撤除后即刻、术后1个月斑点组织追踪参数[二尖瓣环平均位移(TMADmid)、二尖瓣环平均位移率(TMADmid%)、整体纵向收缩期峰值应变(GLS)]及常规超声心动图参数[LVEF、左心室舒张末期内径(LVEDd)、每搏输出量(SV)]的变化，分析斑点组织追踪技术对ECMO辅助下TAVI术后疗效的评价价值。结果本组患者TAVI术前、ECMO撤除后即刻、术后1个月斑点组织追踪参数TMADmid[(3.2±1.3)mm，(6.9±1.3)mm, (11.2±2.5)mm]、TMADmid%[(3.5±2.6)%，(7.0±3.8)%, (10.1±2.1)%]和GLS[(5.9±3.5)%，(8.9±2.7)%, (13.2±3.9)%]逐渐增高，组间差异均有统计学意义(均P < 0.05)；术后1个月LVEF[(42.2±5.3)%]较术前[(22.2±5.5)%]及ECMO撤除后即刻[(23.8±2.5)%]升高, 差异有统计学意义(均P < 0.05)；与术前LVEF相比，ECMO撤除后即刻LVEF升高，差异无统计学意义(P>0.05)。TMADmid、TMADmid%与GLS呈正相关关系(r=0.499、0.586，均P < 0.05)。结论二尖瓣斑点组织追踪技术可作为评价AS患者TAVI诊疗效果的敏感参考指标，ECMO辅助下TAVI治疗重症AS患者安全有效。
- 二尖瓣环位移 /
- 经导管主动脉瓣植入 /
- 体外膜氧合 /
- 主动脉瓣狭窄 /
- 超声心动图
Abstract: Objective To investigate the application value of tissue mitral annular displacement (TMAD) speckle tracking technique in extracorporeal membrane oxygenation (ECMO) assisted transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis (AS). Methods A total of 16 patients with severe AS with left ventricular ejection fraction (LVEF) < 25% underwent ECMO assisted TAVI in Henan Provincial Chest Hospital from September 2019 to March 2021 were retrospectively analyzed. The changes of speckle tracking parameters [tissue motion tracking of mitral annular average displacement (TMADmid), tissue motion tracking of mitral annular average displacement rate (TMADmid%), global longitudinal strain (GLS)] and conventional echocardiographic parameters [LVEF, left ventricular diastolic end diameter (LVEDd), stroke volume (SV)] were statistically analyzed before TAVI treatment, immediately after ECMO removal and 1 month after operation. The evaluation value of speckled tracking technique in the postoperative efficacy of ECMO assisted TAVI was analyzed. Results The TMADmid [(3.2±1.3) mm, (6.9±1.3) mm, (11.2±2.5) mm], TMADmid% [(3.5±2.6) %, (7.0±3.8) %, (10.1±2.1) %] and GLS [(5.9±3.5) %, (8.9±2.7) %, (13.2±3.9) %] increased gradually before TAVI treatment, immediately after ECMO removal and 1 month after operation, and the differences were statistically significant (all P < 0.05). One month after operation, LVEF [(42.2±5.3) %] was significantly higher than that before operation [(22.2±5.5) %] and immediately after ECMO removal [(23.8±2.5) %, P < 0.05]. Compared with pre-operation, LVEF increased immediately after ECMO removal, with no significant difference (P>0.05). The TMADmid and TMADmid% were positively correlated with GLS (r=0.499, 0.586, all P < 0.05). Conclusion The tissue mitral annular displacement speckle tracking technique can be used as a sensitive reference index to evaluate the diagnosis and treatment effect of TAVI in patients with AS. The ECMO assisted TAVI is safe and effective in the treatment of severe AS.
- Mitral annular displacement /
- Transcatheter aortic valve implantation /
- Extracorporeal membrane oxygenation /
- Aortic stenosis /
- Echocardiography

HTML全文

图 1 左心室收缩期峰值应变

下载: 全尺寸图片幻灯片

图 2 左心室四腔心二尖瓣环位移

下载: 全尺寸图片幻灯片

图 3 左心室两腔心二尖瓣环位移

下载: 全尺寸图片幻灯片

表 1 重症AS患者各时间点一般资料比较(x±s)

时间	例数	心率 (次/min)	SBP (mm Hg)	DBP (mm Hg)	AV_max (m/s)	AVPG_pk (mm Hg)	LVEDd (mm)	SV (mL)	IVST (mm)	LVPWT (mm)
术前	16	72±10	130±10	72±12	4.5±4.2	80±12	52±4	35±9	13.3±1.7	13.1±1.7
ECMO撤除后即刻	16	69±10	129±11	75±14	1.7±3.3^a	12±6^a	51±4	37±6	12.5±2.0	13.2±1.9
术后1个月	16	70±7	126±10	70±11	1.6±2.9^a	11±3^a	45±3^ab	45±5^ab	12.7±1.1	12.5±1.0
F值		2.317	1.321	3.246	50.130	35.048	210.043	44.319	3.437	1.435
P值		0.063	0.090	0.071	< 0.001	0.001	0.016	0.003	0.570	0.485

下载: 导出CSV

表 2 重症AS患者各时间点二尖瓣环位移TMAD参数及LVEF比较(x±s)

时间	例数	TMADmid (mm)	TMADmid% (%)	GLS (%)	LVEF (%)
术前	16	3.2±1.3	3.5±2.6	5.9±3.5	22.2±5.5
ECMO撤除后即刻	16	6.9±1.3^a	7.0±3.8^a	8.9±2.7^a	23.8±2.5
术后1个月	16	11.1±2.5^ab	10.1±2.1^ab	13.2±3.9^ab	42.2±5.3^ab
F值		83.142	72.829	75.274	58.321
P值		< 0.001	< 0.001	< 0.001	0.001
注：与术前比较，^aP < 0.05；与ECMO撤除后即刻比较，^bP < 0.05。

下载: 导出CSV

参考文献(16)

[1]	FREDERIC M, LERAKIS S, BARBOSA R H, et al. Outcomes from transcatheter aortic valve replacement in patients with low-flow, low-gradient aortic stenosis and left ventricular ejection fraction less than 30%: A substudy from the TOPAS-TAVI registry[J]. JAMA Cardiology, 2019, 4(1): 64-70. doi: 10.1001/jamacardio.2018.4320
[2]	MALKIN C J, LONG W R, BAXTER P D, et al. Impact of left ventricular function and transaortic gradient on outcomes from transcatheter aortic valve implantation: Data from the UK TAVI registry[J]. Euro Intervention, 2016, 11(10): 1161-1169.
[3]	金屏, 刘洋, 唐嘉佑, 等. 体外膜肺氧合辅助下经导管主动脉瓣置换术的临床应用研究[J]. 精准医学杂志, 2018, 33(2): 110-114. https://www.cnki.com.cn/Article/CJFDTOTAL-SPAN201802005.htm
[4]	IWAKURA K, OKAMURA A, KOYAMA Y, et al. Assessment of left ventricular global systolic franction by tissue mitral annular displacement: Comparison with global longitudinal strain[J]. J Am Coll Cardiol, 2016, 67(13): 1716-1723. doi: 10.1016/S0735-1097(16)31717-X
[5]	NISHIMURA R A, OTTO C M, BONOW R O, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. Circulation, 2017, 135(25): 1159-1195.
[6]	张金辉, 蔡淑女. 右美托咪定全程泵注对体外循环下心脏瓣膜置换术患者的心肌保护作用[J]. 中华全科医学, 2020, 18(5): 752-756. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202005014.htm
[7]	YOUNG M N, INGLESSIS I. Transcatheter aortic valve replacement: Outcomes, indications, complications, and innovations[J]. Curr Treat Options Cardiovasc Med, 2017, 19(10): 81. doi: 10.1007/s11936-017-0580-0
[8]	DOLMATOVA E, MOAZZAMI K, COCK T P, et al. Extracorporeal membrane oxygenation in transcatheter aortic valve replacement[J]. Asian Cardiovasc Thorac Ann, 2017, 25(1): 31-34. doi: 10.1177/0218492316683061
[9]	SINGH V, DAMLUJ A A, MENDIRICHAGA R, et al. Elective or emergency use of mechanical circulatory support devices during tran-scatheter aortic valve replacement[J]. J Interv Cardiol, 2016, 29(5): 513-522. doi: 10.1111/joic.12323
[10]	邓茗丹, 魏薪, 唐红, 等. 超声心动图在主动脉瓣反流患者经心尖主动脉瓣植入术中的应用[J]. 四川大学学报(医学版), 2017, 48(6): 941-945. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYK201706031.htm
[11]	陈小果, 舒先红, 潘翠珍, 等. 斑点追踪显像技术评价经导管主动脉瓣植入术患者左室心肌力学变化[J]. 中华超声影像学杂志, 2017, 26(4): 277-281. doi: 10.3760/cma.j.issn.1004-4477.2017.04.001
[12]	李茜, 唐红. 纵向应变评估主动脉瓣狭窄置换术后心肌功能[J]. 中国医学影像技术, 2020, 36(4): 499-502. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202004006.htm
[13]	AMZULESCU M S, LANGET H, SALOUX E, et al. Improvements of myocardial deformation assessment by three-dimensional speckle-tracking versus two-dimensional speckle-tracking revealed by cardiac magnetic resonance tagging[J]. J Am Soc Echocardiogr, 2018, 31(9): 1021-1033. e1. DOI: 10.1016/j.echo.2018.04.009.
[14]	NAEIM H A, ABUELATTA R, ALATAWI F O, et al. Assessment of left ventricular mechanics in patients with severe aortic stenosis after transcatheter aortic valve implantation: 2-D speckle tracking imaging study[J]. J Saudi Heart Assoc, 2020, 32(2): 248-255.
[15]	ALENEZI F, FUDIM M, RYMER J, et al. Predictors and changes in cardiac hemodynamics and geometry with transcatheter aortic valve implantation[J]. Am J Cardiol, 2019, 123(5): 813-819.
[16]	张维辛, 马春燕, 王永槐, 等. 组织二尖瓣环位移评价冠状动脉慢血流患者左心室收缩功能[J]. 中国超声医学杂志, 2017, 33(2): 114-117. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY201702007.htm