| Objective: Two-dimensional speckle tracking imaging(2D-STI)was applied to investigate the changes in left ventricular longitudinal systolic function in patients with hepatitis B cirrhosis and cirrhosis after transjugular intrahepatic portosystemic shunt(TIPS).Methods: There were 30 patients with hepatitis B cirrhosis,29 patients with hepatitis B cirrhosis after TIPS,and 31 normal controls.The following ultrasound measurements were acquired and stored for 3 consecutive cardiac cycles in each standard echocardiographic section: left atrial anteroposterior diameter(LAAPD),left ventricular end-diastolic diameter(LVEDD),and interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPW),aortic valve velocity(AV),pulmonary valve velocity(PV),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),and left ventricular end-systolic volume(LVESV).and left ventricular ejection fraction(LVEF).The speckle-tracking AFI software was used to analyze the stored images and to obtain the peak longitudinal systolic strain of the whole left ventricular and the local left ventricular.The specific indicators of GLS were(global longitudinal strain-long axis,GLS-Lax),(global longitudinal strain-4 chamber,GLS-4C),(global longitudinal strain-2 chamber,GLS-2C),(global longitudinal strain-average,GLS-Avg).The changes in the measurements in the cirrhosis group(hepatic cirrhosis,HC),the post-TIPS group,and the normal control group(normal contrast,NC)were compared.Results:1 Comparison of transthoracic echocardiographic parameters between groupsThe anteroposterior left atrial diameter 35.00(32.50,39.00)mm and end-diastolic left ventricular internal diameter 55.00(49.50,61.00)mm were increased in the post-TIPS group compared with the normal group 28.00(25.00,36.00)mm and the end-diastolic left ventricular internal diameter 42.00(40.00,49.00)mm,and the left ventricular posterior wall thickness 7.00(6.00,8.50)mm,and left ventricular posterior wall thickness 7.00(6.00,8.25)mm in the cirrhotic group became thinner compared with the normal control group.The left ventricular end-diastolic internal diameter55.00(49.50,61.00)mm and volume 122.00(95.50,152.50)m L were increased in the post-TIPS group compared with the cirrhotic group.Left ventricular ejection fraction was slightly lower in the post-TIPS group(59.59±10.27)% and the cirrhotic group(60.77±10.96)% compared with the normal group(65.94±10.75)%,but the difference was not statistically significant.The left ventricular ejection fraction in all three groups was within the reference range of normal values.2 Comparison between groups of peak longitudinal left ventricular systolic strain2.1 The overall longitudinal strain values in the left ventricular apical long-axis view(19.54±4.64)%,the overall longitudinal strain values in the left ventricular four-chamber view 20.50(18.58,23.47)%,the overall longitudinal strain values in the left ventricular two-chamber view(20.24±4.61)%,and the overall mean longitudinal strain values in the left ventricle 20.10(18.00,21.82)% in the cirrhotic group were compared with the overall longitudinal strain values in the normal group in the left ventricular apical long-axis view(15.61±3.91)%,the overall longitudinal strain in the left ventricular four-chamber view 15.40(12.50,17.60)%,the overall longitudinal strain in the left ventricular two-chamber view(15.41±3.43)%,and the overall mean longitudinal strain in the left ventricle 14.90(13.00,17.30)% were higher compared with the normal group.2.2 The overall longitudinal strain values in the apical long-axis view of the left ventricle(21.22±5.91)%,the overall longitudinal strain values in the four-chamber view of the left ventricle 20.00(17.60,21.90)%,the overall longitudinal strain values in the two-chamber view of the left ventricle(21.96±5.29)%,and the overall mean longitudinal strain values in the left ventricle 20.40(18.80,23.40)% were higher in the post-TIPS group compared with the normal group were higher compared to the normal group.2.3 Longitudinal strain values in the posterior septal basal segment 16.00(13.75,18.00)%,basal segment of left ventricular posterior septum(19.33±4.59)%,anterior septal intermediate segment(20.37±4.46)%,posterior septal intermediate segment(22.53±4.64)%,anterior wall apical segment 26.50(22.00,31.00)%,ventricular septal apical segment(25.77±5.92)%,inferior wall apical segment longitudinal strain values22.00(19.75,25.00)%,lateral wall apical segment longitudinal strain values(21.37±7.65)%,apical longitudinal strain values 23.50(20.00,28.00)%;anterior septal basal segment longitudinal strain values(21.37±7.65)%,left ventricular posterior septal basal segment longitudinal strain values(18.79±3.77)%,anterior septal intermediate segment longitudinal strain values(21.34±3.19)%,and posterior septal intermediate segment longitudinal strain values(21.90±4.23)%,anterior wall apical segment longitudinal strain values 27.00(24.00,31.00)%,septal apical segment longitudinal strain values(28.28±6.99)%,inferior wall apical segment longitudinal strain values 23.00(18.00,25.50)%,lateral wall apical segment longitudinal strain values(24.52±7.94)%,and apical longitudinal strain values 24.00(22.00,29.50)%.Compared with the control group,the longitudinal strain of the medial segment of the lower lateral wall in the cirrhosis group was higher(16.73±6.66)%.Compared to the post-TIPS group,the basal segment values of the anterior left ventricular wall(19.65±4.27)%,the basal segment values of the inferior wall 20.00(15.50,22.00)%,and the anterior wall intermediate segment longitudinal strain values 23.00(18.50,26.00)% were higher than those of the normal control group.There was a statistically significant difference in the local anterior wall basal segment strain values(19.65 ±4.27)% in the cirrhotic group compared to the post-TIPS group(16.80±4.99)%.Conclusions:1 Transthoracic echocardiography showed changes in left ventricular morphology,structure and volume in patients with hepatitis B cirrhosis and TIPS.However,the left ventricular systolic function measured by Simpson biplane method is in the normal range,so the abnormal indicators that can be detected by transthoracic echocardiography are relatively limited.2 Two dimensional speckle tracking imaging can detect abnormalities in longitudinal left ventricular systolic function in patients with hepatitis B cirrhosis and post-TIPS.3 Two dimensional speckle tracking imaging can detect changes in global and local longitudinal systolic function of the left ventricle much earlier than the abnormal measurements of the left ventricular systolic function by the Simpson biplane method. |
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