Evaluation Of Left Ventricular Function In Patients With Aortic Valve Stenosis And After TAVI By 4D Strain

Objective 1?To observe left ventricular contraction and diastole function in patients with AS of different degrees with normal ejection fraction by using 4-dimension myocardial strain to provide effective reference for clinical stratification treatment and surgical timing.2?To assese left ventricular function in patients with normal ejection fraction after TAVI by using 4-dimension myocardial strain to accurately evaluate surgical curative effect,for clinical summing up experience,help to better carry out intervention operation.Method 1?The application value of 4D myocardial strain in patients with aortic stenosis of different degrees : A total of 69 cases with normal LVEF was choiced in changhai hospital between September 2013 to June 2015.Based on peak and average trans-valvular pressure,69 AS patients were divided into mild,moderate,severe three AS groups,choose 30 cases of age matched healthy volunteers as control group.Using 4D-Auto LVQ software to measure 4-D myocardial strain,the results were compared with 30 normal controls.2?The application value of 4D myocardial strain in patients after TAVI: select 18 patients with normal LVEF after TAVI in December 2013 to June 2015 in our hospital,measure 4D strain parameters preoperative and 3 days,1 month,3 month,6 month after TAVI by using 4 D-Auto LVQ software.To discusses the value of 4D strain parameters in TAVI postoperative follow-up.Result 1?The study of left ventricular function with 4D strain in mild,moderate,severe AS groups: Ventricular configuration aspects: control group,mild,moderate,severe AS set in the left ventricular diastolic and systolic diameter and volume of no significant difference(P > 0.05);Medium and severe stenosis group room wall thickness and left ventricular mass index(LVMI),and with the narrow degree aggravating and further increased(P < 0.05),indicating altered left ventricular centripetal refactoring and hypertrophy;While mildly AS group did not change significantly compared with control group(P > 0.05).Left ventricular systolic function: the control group,mild,moderate,severe AS group left ventricular ejection fraction was not obvious difference(P > 0.05);4D systolic strain,mild AS leader of the Global longitudinal strain(GLSs)lower than the control group,and with the narrow degree aggravating further reduce(P < 0.05),while the moderate,severe AS group the systolic Global area strain and Global radial strain(GASs,GRSs)is lower than the control group and mild stenosis group,and with narrow degree aggravating decline further,the difference was statistically significant(P < 0.05),systolic Global circumferential strain(GCSs)only in severe AS group appeared to reduce(P < 0.05).Left ventricular diastolic function: severe AS group E compared to the other three groups,E/A,E peak speed decreased,E/e increases,the difference was statistically significant(P < 0.05),the difference of the control group,mild and moderate AS group had no statistical significance(P > 0.05);While mild AS group the diastolic Globle longitudinal and circumferential strain(GLSd,GCSd)set down,and with the stenosis degree of serious decline further,the difference was statistically significant(P < 0.05);Medium and severe AS group diastolic Global area strain,Global radial strain(GASd,GRSd)is lower than the control group and mild stenosis group,and with the decline on aggravating the degree of stenosis,the difference was statistically significant(P < 0.05).Correlation analysis: 4 d strain parameters and aortic stenosis degree,relative room wall thickness(RWT),left ventricular mass index(LVMI)was significantly negative correlation.Multiple regression analysis showed that systolic myocardial 4D strain significant influence factors include age,peak trans-valvular pressure(PGmax),left ventricular mass index(LVMI)and relative wall thickness(RWT);4D myocardial diastolic strain significant influence factors include PGmax,LVMI,RWT,E/A.2.The study of left ventricular function with 4D strain in patients after TAVI with normal EF: Ventricular configuration aspects: TAVI postoperative left ventricular diastolic and systolic diameter and volume no significant change(p > 0.05);3 month after TAVI relative wall thickness(RWT)and left ventricular mass index(LVMI),further reduce postoperative June(P < 0.05).Left ventricular systolic function: there was no significant difference in ejection fraction(P > 0.05);In addition to systolic Global radial strain(GRSs)is a rise in 1 month after TAVI,the other three groups of systolic strain parameters GLSs,GCSs and GASs is risen on three days after TAVI,and the four strain parameters with extended follow-up time and improved further,the difference was statistically significant(P < 0.05).Left ventricular diastolic function: 6 month after TAVI when E/A,E peak speed rise,E/e decreased,the difference was statistically significant(P < 0.05);In addition to the diastolic radial strain(GRSd)rise in 6month after TAVI,the other three diastolic strain parameters GLSd,GCSd and GASd is risen on three days after TAVI,and the three strain parameters with extended follow-up time and improved further,the difference was statistically significant(P < 0.05).Correlation analysis:4D systolic strain parameters and aortic stenosis degree,RWT,LVMI was significantly negative relationship,Global area strain is the highest correlation coefficient.Only Global area strain of diastolic(GASd)and E/A were positively,and negatively correlated with E/e.Conclusion 1?4D strain can be more early,accurate and true to evaluate left ventricular systolic and diastolic function in patient with different degrees of aortic stenosis,and is closely related to the AS degree and the left ventricular configuration,so 4D strain can be used as a clinical regular follow-up index of left ventricular myocardial motion of patients with aortic stenosis.2?4D strain can assessment TAVI postoperative left ventricular myocardial systolic and diastolic function earlier before there was any change in EF,the Global area strain is expected to become a new index of postoperative follow-up.