Assessment Of Left Ventricular Function By Three-dimensional Speckle-tracking Imaging In Patients With Preserved Left Ventricular Ejection Fraction And Undergoing Surgical Aortic Valve Replacement

Objectives To evaluate left ventricular global strain before and after aortic valve replacement using three-dimensional speckle tracking technique.Objective to investigate whether the three-dimensional strain can detect the left ventricular systolic dysfunction more early and more sensitive,and to provide help for the choice of the timing of aortic valve replacement surgery.Method Thirty-eight patients with severe aortic stenosis and severe aortic regurgitation were enrolled,and the healthy control group of 20 patients。After echocardiography,LV end-diastolic diameter（LVIDd）、Interventricular septum end-diastolic thickness（IVSd）、Left ventricular posterior wall end-diastolic thickness（LVPWd）in Left ventricular long axis view.Left ventricular outflow tract diameter、left ventricular outflow tract velocity(V_LOVT)and aortic valve orifice peak flow velocity were measured by apical five chamber or apical long axis view,the maximal instantaneous pressure gradient of aortic valve was obtained by simplifying the Bernoulli equation.Three dimensional full volume image is collected and three dimensional full volume image acquisition and storage,and then sent to the workstation for offline analysis.Left ventricular end diastolic volume index（LVEDVI）、Left ventricular end systolic volume index（LVESVI）、Left ventricular ejection fraction（LVEF）、Left ventricular mass index（LVMI）、Left ventricular remodeling index（LVRI）、Left ventricular global longitudinal peak strain（GPSL）,Left ventricular global peak circumferential strain（GPSC）、Left ventricular global peak area strain（GPSA）,Left ventricular global radial peak strain（GPSR）。Results GPSL,GPSC,GPSA and GPSR in patients with severe aortic stenosis and severe aortic regurgitation were significantly lower than those in the control group.GPSL,GPSC,GPSA and GPSR were significantly increased in patients with severe aortic stenosis and severe aortic regurgitation after aortic valve replacement,but were still lower than those in the control group.Conclusion aortic stenosis patient and aortic incompetence patient with preserved le ft ventricular ejection fraction have impaired Left ventricular function.Postoperative fo llow-up,Left ventricular function improved significantly.These subtle changes in left ventricular function can be well detected by 3D-STI.Therefore,3D-STI may also be helpful in selecting the timing of aortic valve replacement surgery,and evaluating the improvement of left ventricular function in the early postoperative period.