Quantitative Evaluation Of Left Ventricular Global Strain Before And After Closure Of Simple Patent Ductus Arteriosus With And Without Pulmonary Hypertension By Three Dimensional Speckle Tracking Technique

ObjectiveObjective to evaluate left ventricular three-dimensional global strain in simple PDA with and without pulmonary hypertension before and after occlusion by three-dimensional speckle tracking technique,and assess the value of quantitative evaluation of left ventricular systolic function before and after occlusion in these patients.Method60 cases of patent ductus arteriosus(case group)were selected randomly in the Department of Cardiology of our hospital in October 2015-September 2017.According to the method(pulmonary artery pressure = systolic blood pressure-the catheter Pressure gradient)to calculate pulmonary artery pressure,and define the pulmonary artery pressure ?40mmHg as the increase of pulmonary artery pressure.The final selected PDA combined with pulmonary hypertension subgroup 25 cases(group A),simple PDA subgroup 35 cases(B group).At the same time,35 healthy persons with matching sex and age were selected as the control group(group C).The patients in the case groups received conventional echocardiography and 3D-STI examination before operation,2 days,1 months,3 months,6 months after operation as well as the control group.All the subjects obtained LVDD and LVDS at the level of the papillary muscles by the parasternal long axis of the left ventricle,PAD from the long axis of the pulmonary artery,LVEDV,LVESV and LVEF in the four cavities of the left ventricular apex with Simpson biplane,GPLS,GPCS,GPRS and GPAS by 3D-STI technology,and then Statistical analysis.Result(1)In group A,LVDD,LVEDV,LVESV each time points before and after operation,the difference was statistically significant(P <0.05),and showed a gradual decline trend.There was no significant difference in PAD between 3months and 1months,6months after operation,but the rest of the time nodes are significantly different.There was no significant difference in LVDS between 3months and 6months after operation,but different significantly in the other time nodes.(2)In group B,the difference of PAD in each time nodes before and after occlusion was statistically significant.There was no statistically significant difference in LVDD,LVDS,LVEDV and LVESV between 3 months and 6 months after operation.However,there was a statistically significant difference between the other time points(P <0.05),and showed a gradual downward trend.(3)There was no significant difference in LVEF between group A and group B before and after occlusion(P >0.05).(4)In group A,GPLS,GPCS and GPAS decreased 2 days after closure,but the difference was not significant(P>0.05),1 month after closure increased gradually,and the difference was statistically significant(P <0.05).GPRS decreased at 2 days and 1 months after closure,and increased gradually at 3 months after operation.The difference of each time points was significant(P <0.05).(5)The differences of each points before and after occlusion of GPLS,GPCS,GPRS and GPAS in group B were statistically significant(P <0.05),2 days and 1 months after closure decreased first,and increased in 3 months after the operation.(6)In group A and group B,PAD,LVDD,LVDS,LVEDV and LVESV were all significantly higher than those in C group except for LVEF(P <0.05).In addition to LVDD and LVEF,the other indexes in group A were larger than those in group B,and the difference was statistically significant(P <0.05).(7)GPCS and GPAS in group A before operation were lower than those in C group(P <0.05),GPLS and GPRS were not significantly different from those in C group(P >0.05).The above indexes in group B were significantly higher than those in A and C group,and the difference was significant(P <0.05).(8)After 6 months of follow-up,the range of change of GPRS in group A was lower than that of group B,and the changes of GPLS,GPCS and GPAS were all greater than those in group B.The difference was significant in GPLS and GPCS(P <0.05),but the difference of GPAS was not obvious(P >0.05).(9)In group A and group B,LVDS,LVEDV and LVESV returned to normal range after 6 months compared with group C(P >0.05),LVDD was still larger than group C,the difference was statistically significant(P <0.05).(10)At 6 months after operation,the GPLS in group A and group B was larger than that in group C(P <0.05),GPCS in B group was larger than that in A group and C group(P<0.05).However,there was no statistical significance in GPRS and GPAS between 3 groups.ConclusionNo change of LVEF in each time nodes before and after occlusion of PDA with and without pulmonary hypertension by routine echocardiography,however,3D-STI can comprehensively and accurately evaluate the changes of left ventricular global strain before and after occlusion,and it will decrease firstly and increase subsequently.Compared with conventional echocardiography,it can objectively and effectively assess the change of left ventricular systolic function in these patients.