| Objective (s):To evaluate the left ventricular global and regional systolic function by measuring the left ventricle global and regional strain in patients with rheumatic mitral stenosis before and after valve replacement using the real-time three-plane speckle tracking imaging.Materials and Methods:30 patients who were diagnosed rheumatic mitral stenosis in the First Affiliated Hospital of Kunming Medical University and underwent valve replacement from September 2015 to February 2016 were selected as experimental group (pre operation as A Group, after operation for Group B):among them,13 were male,17 were female, average age (45.43±12.47) years old, with or without atrial fibrillation (AF). Normal control group (Group C):a total of 20 cases,11 males,9 females, mean age (42.70±8.99) years old, Who has a healthy physical examination, and voluntary entry, has ruled out the impact of experimental results of cardiovascular disease and other systems of serious disease, such as:renal failure, COPD and respiratory failure and so on. All patients in the experimental group were informed and agreed to enter the group. Exclusion criteria:1)Severe combined rheumatic valvular disease, involved aortic valve replacement; 2) patients with coronary heart disease (CHD), congenital heart disease, hypertension, dilated cardiomyopathy, restrictive cardiomyopathy, hypertrophic cardiomyopathy, diabetes, severe heart failure and other cardiac disease; 3) non rheumatic heart valvular disease who need mitral valve replacement; 4) complicated patients with severe the liver, lung and kidney disease affecting the surgical prognosis; 5) three plane image quality is poor, and cannot be further analysts.Two dimensional and real-time three plane echocardiography were performed in preoperative 1-3D and post-operative 1 month. Collect and storage images of two-dimensional cardiac static map of the parasternal long axis of the left ventricle, the dynamic map of apical four chamber, two chamber and the dynamic map of real-time three plane:apical four chamber, two chamber and three chamber view of the dynamic. The normal control group was also collected the corresponding images. Simpson double plane method was used to analyze two-dimensional apical four chamber and two chamber dynamic images, then the left ventricular ejection fraction (LVEF) of the experimental group (GroupA and Group B) and control group (Group C) was obtained. Left ventricular end diastolic diameter (LV) was obtained by measuring left ventricular long axis view.Using speckle tracking imaging (STI) to analysis the image of real-time tri -plane dynamic graph, the left ventricular 17 segments (the level of the mitral valve 6 segments, papillary muscle level 6 segments, the apical level four segments and apical cap), corresponding myocardial longitudinal peak strain’s-bovine map can be obtained (Figure 1), and the average peak of longitudinal strain of the three planes of left ventricle:apical four chamber view of longitudinal strain average peak (GLPS-A4C),left ventricular apical long axis view average peak(GLPS-Lax) (three chambered heart) strain, apical two chamber view of long axis of the mean peak strain (GLPS-A2C) and left ventricular average peak strain (GLPS)(Figurel-1.1-2).Pearson correlation analysis was used to get the correlation coefficient between the left ventricular long axis mean peak value (GLSP) and the left ventricular ejection fraction (LVEF), Detect whether both can be combined to assess the function of contraction. Using SPSS 17 statistical software to analyze data, making charts using Prism GraphPad 5, the longitudinal peak strain value, the longitudinal strain average peak value, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LV) were compared among the control group (Group A and Group B) and the control group (Group C). The compare between the experimental group B and experimental group A was used paired T test. The compare among the experimental A group and the normal control group, the experimental B group and the normal control group were used in group t test. The data are expressed as mean±tandard deviation.Results:1.The peak value of longitudinal peak strain of left ventricular segment in the normal control Group C was higher than that in the experimental Group A (P<0.01) There was no significant difference in the longitudinal peak strain of left ventricular lateral wall between the Group C and Group B (P>0.05), but the longitudinal peak strain of the other wall was less than that of Group C (P<0.05).2.The mean peak value of longitudinal strain (GLPS) in the normal control group was higher than that in the experimental Group A and Group B (P<0.01)3.The longitudinal peak strain values of each segment of the left ventricle in experimental Group A were less than that in the experimental Group B (P<0.01), but the longitudinal peak strain in the posterior ventricular septum of the experimental B Group was not significantly improved compared with the experimental A Group.4. The mean peak value of longitudinal strain (GLPS) in the experimental Group B was larger than that in the experimental Group A.5. The left ventricular ejection fraction (LVEF) of normal control group were greater than the experimental Group A and Group B (P<0.05). The left ventricular ejection fraction (LVEF) of experimental Group B was improved compared with the experimental Group A.6. In normal control group, the longitudinal peak strain of left ventricular segment was gradually increasing trend from basal segment to apical segmen.7.In patients with rheumatic mitral stenosis, the left ventricular end diastolic diameter at the end of the 1 month after valve replacement was increased compared with that before surgery.8. The mean peak value of left ventricular long axis (GLSP) was significantly positively correlated with ejection fraction, and the two can jointly assess left ventricular systolic function.Conclusion(s):1.The real-time three-plane speckle tracking imaging can be used to evaluate left ventricular global and regional systolic function in patients with rheumatic mitral stenosis before and after valve replacement. The technique has a certain clinical significance to judge the curative effect.2.After mitral valve replacement, the systolic function of the left ventricle was improved by the operation, but the systolic function of the posterior septum was not significantly improved. However, it was not considered that the left ventricular posterior septum was better in short period after surgery, the global or local systolic function of left ventricle after the operation was lower than that in normal subjects. |
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