Dobutamine Stress Testing To Assess The Feasibility Of The Operation On The Patients Of Valvular Heart Disease With Left Ventricular Dysfunction

Purpose:Dobutamine stress echocardiogrphy and two-dimensional speckle tracking imaging were applied to evaluate the change of left ventricular systolic function and the feasibility of the operation on the patients of valvular heart disease with left ventricular dysfunction, as to discuss the feasibility of the operation. Methods: Valvular heart disease patients23 patients with left ventricular ejection fraction< 50% have been diagnosed as valvular heart disease during January 2014- December 2015, all patients met the standards, eventually there were 20 cases who conformed to the image standard and completed the visit,(men 13, age 40-65 years,mean age 54.2±7.2 years).Valvular disease in AS 2, AR 8, MS 3, MR 13, including 7 cases of combined valvular disease, eventually had AVR 7, MVR 5,MVP 9; in addition,6 cases patients gave up surgery. Controls 1:20 patients(men 10, age 45-68 years,mean age 57.4±5.2 years) with left ventricular ejection fraction>50% had been diagnosed as valvular heart disease during January 2014- December 2015, all patients met the standards,Valvular disease in AS 5, AR 8, MS 13, MR 8,including 12 cases of combined valvular disease, eventually had AVR 10, MVR 13,MVP 7. Controls 2:20 healthy volunteers(men 11,age 43-67 years, mean age 55.4±6.2 years) were recruited. Procedures:All Groups of patients conducted conventional echocardiography in the quiet breathing and get six planes of two-dimensional gray-scale dynamic images(left ventricular mitral valve axis, left ventricular papillary muscle short axis, left ventricular apex short axis and two cavity section, four cavity section, three cardic section), the frame rate was more than 100 frames per second, each section recorded more than three cardiac cycles. The conventional twodimensional echocardiography parameters had LVIDd, EDV, SV, LVEF whcich were obtained from biplanar Simpson method,and EDVI,SVI which were quantitated by the surface area. The same method were adpted for experimental group and valvular disease control groups.The CMQ of QLAB 9.0 software program was used to collect images and analysis GLSs, GRSs, GCSs. Select TMAD options, TMAD midpt and TMAD midpt% were determined in each group at different periods. Results:Compared with two control groups, GLSs and TMAD Midpt, TMAD Midpt% among experimental groups under the resting conditions were significantly reduced(P < 0.05), and had correlations with LVEF(P < 0.05);when LVEF increase >15% in 11 cases and TMAD midpt increase >8%, there were contraction reserve function,then myocardial injury were reversible and operative treatment were feasible. In 3 months after the operation, if GLSs and TMAD midpt、TMAD midpt% increased comparing with the preoperative(P < 0.05), the prognosis was good. Conculsions:1.Valvular heart disease can cause myocardial cell damage and my-ocardial interstitial fibrosis. DSE can give a guidence to the feasibility of the operation through extent of myocardial damage estimated by the myocardium reaction under stress.2.DSE can be used to evaluate the left ventricular contraction function of patients and the feasibility of the operation with valvular heart disease,TMAD Midpt and TMAD Midpt% have highly correlations with LVEF. Especilally, TMAD Midpt% is sensitive to LVEF and can be use d to early diagnosis the decline of Left ventricular contraction function. GLSs has negative correlation with TMAD midpt, TMAD midpt%, LV EF, whcih can be used to evaluate whether the feasible and estimating prognosis of the operation.3. In DSE, patients with LVEF increased by 10% and TMAD Midpt % increased by 8 % in peak doses have left ventricular contraction function.They are fit for surgical treatment to remove the myocardial damage and the prognosis is good.However,prognosis will be poor when these patients accept conservative treatment.