Three-dimensional Speckle Tracking Imaging In Evaluating Left Ventricular Systolic Function Before And After Transcatheter Closure Of Atrial Septal Defect

Objective:Atrial septal defet(ASD)is one of the most common structural cardiac disease.Routine cardiac ultrasound not only can clear diagnosis,but also evaluate left ventricular systolic function effectively.However,which detect early anomaly of left ventricular function is not sensitive,whereas three-dimensional speckle tracking(3D-STI)as a new technology can more comprehensive and accurate assess left ventricular systolic function.The purpose of this study is to investigate three-dimensional speckle tracking imaging evaluating left ventricular systolic function before and after interventional closure in patients with atrial septal defect,and then using three-dimensional volumes and strain parameters evaluate the global and regional function of the left ventricle,to clarify the effect of adult ASD on left ventricular systolic function and the improvement of short-term left ventricular function after operation.Methods:A total of 30 patients with secundum atrial septal defect who successfully intervened in our hospital from April 1,2019 to May 31,2019 were selected as the case group,to perform conventional echocardiography and three-dimensional speckle tracking imaging before and after one day transcatheter closure.In addition,three-dimensional transesophageal echocardiography and right heart catheter manometry were performed before occlusion;30 healthy volunteers were selected as the normal control group for routine echocardiography and three-dimensional speckle tracking imaging.General clinical data(age,sex,height,weight and body surface area)were collected from all case groups and control groups,routine echocardiographic examination to obtain relevant 2D parameters.Three-dimensional speckle tracking imaging to obtain the volume parameters、global and regional strain parameters.Results:1.Comparison of general clinical data between the control group and the ASD group:There was no statistically significant difference in age,height,weight,and body surface area between the control group and the ASD group(P>0.05)2.Routine echocardiographic examination showed that compared with the control group,the LVEDD and LAESD were reduced and the MPAD was widened in ASD patients(P<0.05);Compared with before interventional closure,the LVEDD and LAESD increased,MPAD decreased after operation,and the difference between LVEDD and MPAD was statistically significant(P<0.05).3.3D-STI results show:3.1 3D-STI capacity parameters:Compared with the control group,the LVEDV、LVESV and LVEF of the ASD group were all reduced,among them,the EDV and ESV decreased more significantly(P<0.05);Compared with before interventional closure,the postoperative LVEDV、LVESV、and LVEF increased,among which EDV is more obvious,but the difference is not statistically significant(P>0.05).3.2 3D-STI strain parameters:①Radial peak strain:Compared with the control group,the strain of the basal segment of the anterior,the basal and middle segment of the anterior septum of ASD patients decreased(P<0.05);Compared with before interventional closure,the postoperative basal and middle segment of septum、posterior、inferior、lateral,middle segment of anterior septum strain and global strain decreased(P<0.05).②Circular peak strain:Compared with the control group,the strain of the basal segment of the anterior、anterior septum、inferior、lateral,the middle segment of anterior septum、septum and the apical segment of septum、inferior of ASD patients decreased(P<0.05);Compared with before interventional closure,the postoperative basal and middle segment of anterior、anterior septum,apical segment of inferior strain and global strain decreased(P<0.05).③Longitudinal peak strain:Compared with the control group,the strain of the basal segment of anterior、anterior septum、septum,the middle segment of lateral and apical segment of anterior、septum、inferior、lateral strain decreased(P<0.05);Compared with before interventional closure,the postoperative apical segment of anterior、inferior、lateral strain increased(P<0.05);The basal segment of posterior,the middle segment of anterior、anterior septum、septum、inferior、posterior、lateral strain and global strain decreased(P<0.05).④3D peak strain:Compared with the control group,the strain of the basal middle segment of anterior、anterior septum and apical segment of anterior train decreased(P<0.05);Compared with before interventional closure,the postoperative basal and middle segment of inferior、posterior、lateral,the middle segment of anterior septum,apical segment of inferior strain and global strain decreased(P<0.05).⑤Area peak strain:Compared with the control group,the strain of the basal segment of anterior、anterior septum,the middle segment of anterior、anterior septum、septum、lateral,apical segment of septum、inferior strain and global strain decreased(P<0.05);Compared with before interventional closure,the postoperative basal segment of anterior,the apical segment of anterior、inferior、lateral strain and global strain increased(P<0.05),the basal segment of lateral strain decreased(P<0.05).⑥Comparison of strain values between patients over 40 years old and patients under 40 years old,patients with defect 18mm or more and patients with defect 18mm or less after interventional closure:some regional and global strain of the four groups have lower than before operation,but patients over 40 years old compared with patients under 40 years of age and patients with defect of 18 mm or more compared with defects of 18 mm or less the decrease is more obvious(P<0.05).⑦The left ventricular some segment and global strain of ASD patients are positively correlated with LVEDV、LVESV and LVEF,Among them,the RS of the basal segment of the anterior,the CS of the middle segment of the anterior septum,the LS of the middle segment of the lateral,the 3DS of the basal segment of anterior septal,and the AS of the apical segment of septum correlation with LVEDV are highest,respectively 0.357、0.365、0.544、0.356、0.439;The RS of the basal segment of septum,the CS of the middle segment of the anterior septum,the LS of the middle segment of the lateral,the 3DS of the basal segment of anterior,and the AS of the apical segment of anterior correlation with LVESV are highest,respectively 0.483、0.536、0.604、0.420、0.602;the RS of the middle segment of inferior、GPCS、the LS of the basal segment of anterior septum,the 3DS of the middle segment of septum and GPAS correlation with LVEF are highest,respectively 0.606、0.580、0.408、0.531、0.537Conclusions:1.The right ventricular volume load increases of ASD,and the dilated right ventricle presses the septum to cause abnormal movement,which can cause the left ventricular systolic function to be reduced to varying degrees2.After ASD interventional occlusion,the abnormal shunt is relieved,the left ventricle undergoes adaptive change,and the shape and function are improved.However,the time course depends on the arrangement of ventricular myocardial fibers,the direction of myocardial deformation,the patient’s age,defect size and cardiac function,if the patient has abnormal left ventricular diastolic function,it may be heart failure can occur after occlusion.3.3D-STI is a new technique with real-time,non-invasive and simple.It can comprehensively and accurately evaluate the abnormality of the global and regional left ventricular systolic function in patients with atrial septal defect.