Clinical Study Of Two-dimensional Speckle Tracking Imaging In Evaluating The Perioperative Changes Of Right Ventricular Systolic Function In Patients With Left Heart Valve Disease

Objective Two-dimensional speckle tracking imaging(2D-STI)was used to measure the right ventricle longitudinal strain(RVLS),and to explore the clinical application value of RVLS in assessing the perioperative changes of right ventricular systolic function in patients with left heart valve disease.Methods In the case group,80 patients with left heart valve disease diagnosed by transthoracic echocardiography and cardiac surgery were selected,and all patients had mild(or no)pulmonary hypertension(PH);the control group selected 40 healthy volunteers with matching gender and age.Both the case group and the control group underwent transthoracic echocardiography to check the conventional cardiac parameters which including: Left atrium diameter(LAD),left ventricular end diastolic diameter(LVEDD),right ventricular basal diameter(RVD),right atrium diameter(RAD),tricuspid annulus diameter(TVAD),right ventricle end diastole area(RVEDA),right ventricular end systolic area(RVESA),pulmonary artery diameter(PAD);Conventional right ventricular systolic function parameters include: tricuspid annular plane systolic excursion(TAPSE),right ventricle fractional area change(RVFAC),tissue Doppler imaging-derived tricuspid lateral annular peak systolic velocity(TDI-S′)and right ventricular index of myocardial performance(RIMP).The2D-STI was used to measure RVLS to obtain the right ventricular global longitudinal strain(RVGLS)and the right ventricular free wall longitudinal strain(RVFWLS).The differences in ultrasound parameters between the control group,preoperative case group,and postoperative case group were compared,and the correlation between RVFWLS,RGLLS and conventional right ventricular systolic function parameters was analyzed.The left heart valve surgery is divided into TVP group and NTVP group according to whether tricuspid valvuloplasty(TVP)is performed during the operation.Include ultrasound parameters and clinical related indicators that may affect TVP during left heart valve surgery,and perform multivariate logistic regression analysis on all the above parameters,to study the influencing factors of TVP at the same time of left heart valve surgery in mild(or no)PH.Results 1.Compared with the control group,the right ventricular systolic function parameters TAPSE,RVFAC,S′,absolute value of RVGLS and RVFWLS decreased,RIMP increased in the preoperative case group(P<0.01),and the left ventricular systolic function parameter LVEF decreased(P<0.01);Compared with the preoperative case group,the right ventricular systolic function was significantly reduced in the postoperative case group(P<0.01),and the left ventricular systolic function was slightly reduced(P<0.01).Compared with the control group,LAD,LVEDD,PAD,RVD,RAD,TVAD,PASP increased in the case group(P<0.01).Compared with the preoperative case group,LAD,LVEDD,PAD,and PASP in the postoperative case group were significantly reduced(P<0.01),but RVD,RAD,and TVAD did not change significantly(P>0.05).2.Patients with mild(or no)PH left heart valvular disease had a strong correlation between RGLLS,RVFWLS and TAPSE(r=-0.70,-0.76,P<0.01),and a weak correlation with RIMP(r=0.40,0.41,P<0.01),showed a weak correlation with RFFAC(r=-0.41,-0.42,P<0.01),and had no significant correlation with TDI-S′(r=-0.10,-0.17,P>0.05).3.The area under the ROC curve showed that RVGLS and RVFWLS have moderate predictive value in predicting the decrease of right ventricular systolic function in patients with left heart valve disease(P<0.01),RVFWLS(AUC 0.899,95%[CI]: 0.830-0.967,P<0.001)can better reflect right ventricular systolic function than RVGLS(AUC 0.855,95%[CI]:0.768-0.942,P<0.001),RVFWLS uses-16.75% as the cutoff value,and the sensitivity of TAPSE<17mm is 84.62% and the specificity is 83.33%.4.The results of multivariate logistic regression analysis showed that only RVGLS(P=0.007,OR=9.490)and RVFWLS(P=0.017,OR=0.110)were the main influencing factors of TVP during the same period of left heart valve surgery.Conclusions RVLS can quantitatively reflect the perioperative changes of right ventricular myocardial deformation characteristics in patients with left heart valvular disease,combined with conventional right ventricular systolic function parameters,to provide an effective reference for clinicians to choose ultrasound parameters for evaluating right ventricular systolic function.The patients with left heart valvular disease in mild(or no)PH,the tricuspid annulus diameter is still within the normal reference range,only RVGLS and RVFWLS can be used as related factors for tricuspid valvuloplasty during left heart valve surgery and provide a new reference basis for the selection of operation timing and operation methods.