Echocardiographic Study Of Aortic Disease And Early Left Ventricular Systolic Strain And Synchronization In Patients With Bicuspid Aortic Valve

Objective To apply M-mode and three-dimensional speckle tracking imaging technology to evaluate the aortic disease and early left ventricular systolic strain and synchronization in BAV patients with mild aortic valve insufficiency,and to explore whether aortic disease is associated with impaired left ventricular systolic function.Methods According to the inclusion criteria,41 BAV patients who were admitted to the outpatient and inpatient departments of our hospital from January 2019 to January 2021 were selected as the case group.1.According to the type of aortic valve insufficiency,they were divided into mild aortic regurgitation.There were 25 cases in the flow group（AR group）,16cases with mild aortic stenosis（AS group）,and 30 healthy volunteers matched in age and gender were selected as the control group.The differences and correlations of general clinical data,M-mode and conventional two-dimensional echocardiographic parameters,and left ventricular three-dimensional contraction strain and synchronization parameters of each group were compared.Results 1.Comparison between BAV group and healthy control group（1）Comparison of aortic parametersCompared with the control group,the maximum inner diameter of the aortic root,the aortic sinus and the ascending aorta during systole and the minimum diameter of the ascending aorta during diastole were significantly increased in the BAV group（P<0.01）,and the inner diameter of the descending aorta increased（P<0.05）The aortic root index increased（P<0.05）,the ascending aorta index increased significantly（P<0.01）,the blood flow velocity on the aortic valve and the maximum transvalvular pressure difference increased significantly（P<0.01）,The stiffness index of the ascending aorta increased significantly（P<0.01）,the strain of the ascending aorta decreased significantly（P<0.01）,and the dilatation of the ascending aorta decreased（P<0.05）.（2）Comparison of left ventricular parametersCompared with the control group,the BAV group GLS,GRS,GCS were significantly reduced（P<0.01）,TWIST,TORSION°/s no difference（P>0.05）;BAV group TLS-diff,TRS-diff significantly longer than the control group,The TLS-SD and TRS-SD of the BAV group were significantly larger than those of the control group,and the difference was statistically significant（P<0.01）.2.Comparison between BAV subgroups（1）M-type and two-dimensional aortic parametersCompared with the control group,Ao-a,Ao-s,Ao D,and Ao S in the AR group were significantly expanded（P<0.01）,Aortic strain and Ao SI were significantly reduced（P<0.01）,PFV was significantly accelerated（P<0.01）,and the AS group Ao-a,Ao D,significant expansion（P<0.01）,Ao-d,Ao-s and Ao S expansion（P<0.05）,Aortic strain and Ao SI were significantly reduced（P<0.01）,Ao DIS was reduced（P<0.05）.Compared with the AS group,the Ao D and Ao S of the AS group were wider than those of the AR group,and the difference was statistically significant（P<0.05）.The PFV and PPG of the AS group were significantly higher than those of the AR group.（2）Comparison of left ventricular systolic strain and synchronization parameters_A○1_{E A}Comparison of left ventricular systolic strainCompared with the control group:GLS,GRS,GCS in AS patients were significantly reduced（P<0.01）,Twist and Torsion were not significantly different,and the difference was not statistically significant（P>0.05）.Compared with the AS group,GLS,GRS,GCS,Twist,Torsion were not significantly different,and the difference was not statistically significant（P>0.05）._A○2_{E A}Comparison of synchronization of left ventricular movementCompared with the control group,AR group TLS peak time and standard deviation were significantly prolonged（P<0.01）,TCS-SD was significantly increased（P<0.01）,AS group TLS,TRS,TCS peak time and standard deviation were all Significantly prolonged（P<0.01）,Compared with the AS group,the maximum difference in TLS peak time and the standard deviation of peak time and the standard deviation of TRS peak time in AS group were larger than those in AR group.The difference was statistically significant（P<0.01）.TCS peak time in AS group The maximum difference and the standard deviation of peak time were significantly larger than the AR group,and the difference was statistically significant（P<0.01）.There was little difference in the left ventricular asynchrony index（SDI%）between the two groups,and the difference was not statistically significant（P>0.05）.3.Correlation analysis（1）Ao D and Ao S are negatively correlated with Aortic strain and Ao DIS,and positively correlated with Ao SI.Ao-s is positively correlated with Ao SI.（2）GLS is negatively correlated with Aortic strain and Ao DIS,and positively correlated with Ao SI.Conclusion1.The aortic strain capacity of BAV patients is reduced,and there is no significant difference in the aortic strain damage combined with mild AR and AS.2.The left ventricular systolic strain and synchronization of BAV patients are reduced,and the left ventricular movement synchronization of patients with mild AS is more severely impaired than AR patients.3.The aortic strain capacity of BAV patients is related to the overall long axis contraction strain of the left ventricle;the aortic strain capacity of BAV patients decreases with the increase of the inner diameter of the aorta;echocardiography should be used as soon as possible to dynamically monitor the aortic and left ventricular strain and other parameters.