| Objective:This study was aimed to use 3D-STI to quantitatively analyze the cardiac function of patients with AS and AI, and also the evolution of cardiac function before and after AVR, and then screened out the parameter of STI and its reference threshold with the highest predictive value of cardiac insufficiency after AVR. This study would provide an effective measuring method to guide the clinical work, evaluate the cardiac function of patients, predict surgical risk and prognosis, and also provide a forceful evidence for the clinical application of 3D-STI.Methods:65 patients underwent AVR for AVD in cardiac surgery of Zhongshan Hospital affiliated to Fudan University from May 2013 to December 2013 were selected and divided into AS group (n=26) and AI group (n=39) according to different diseases.41 healthy people without cardiovascular diseases were selected into the control group. hs-cTnT and NT-proBNP of patients were tested before and 7 days after operation. All the objects of study were detected by conventional echocardiography and 3D-STI. The control group was detected once and the patient group was detected before operation,7 days after operation and 1 month after operation. LVEDV, LVESV, LVEF, IVST, PWT, peak pressure gradient and mean pressure gradient were detected by conventional echocardiography and global longitudinal strain, global radial strain, global circumferential strain, global three-dimensional strain, twist and torsion were detected by 3D-STI. Both preoperative parameters of conventional echocardiography and STI were compared with control group. The changes of parameters before operation,7 days after operation and 1 month after operation were also compared. The correlation between strains of STI and hs-cTnT, NT-proBNP was analyzed. With the occurrence of main cardiovascular adverse events served as the criterion of postoperative cardiac insufficiency, Logistic analysis of regression was used to analyze the predictive value of preoperative factors to postoperative adverse events.Results:65 patients in the patient group were included in the statistics, with an average age of 54.4±12.7 years, in which 26 patients with AS and 39 patients with AI.41 healthy people in the control group were included in the statistics, with an average age of 55.1±7.8 years.36 severe and 3 moderate AI patients were in AI group.26 patients in AS group were all severe AS.30 patients underwent AVR and 9 underwent minimally invasive AVR in AI group.25 patients underwent AVR and 1 underwent minimally invasive AVR in AS group. No patient died during perioperative period in AS or AI group. There were 10 with ventricular fibrillation when heart re-beat,1 with cardiac insufficiency,5 with prolonged hospital stay,2 with readmission in AS group. There were 12 with ventricular fibrillation when heart re-beat, 3 with difficulty in stopping CPB,5 with cardiac insufficiency,2 with new onset atrial fibrillation,1 with pulmonary infection,1 with difficulty in stopping ventilator,8 with prolonged hospital stay,2 with readmission in AI group. Preoperative peak pressure gradient in AS group was 114.4±30.9mmHg, and mean pressure gradient was 62.2±16.1mmHg, but LVEF (66.9±6.9%) had no evident decrease (P>0.05) compared with the control group (67.8±4.5%). Preoperative LVEF (57.7±10.7%) in AI group obviously decreased (P< 0.01) compared with the control group (67.8±4.5%). Preoperative 3DS, GCS, GLS and GRS in both AS group and AI group had an obvious decrease (AS group:3DS-27.0±6.6% vs-31.9±5.1%, GLS:-15.1±4.4% vs-19.0±3.1%, GRS:30.9±7.7% vs 37.9±5.8%, GCS:-21.9±5.9% vs-26.4±5.3%; AI group:3DS-22.1±5.7% vs-31.9±5.1%, GLS-13.5±3.9% vs-19.0±3.1%, GRS 26.3±7.4% vs 37.±5.8%, GCS-18.2±5.5% vs-26.4±5.3%; P0.01 or 0.001) in compared with the control group. Preoperative LVEF in AS patients was 66.9±6.9%, and became 65.6±5.9% at 7 days after operation and 69.7±4.2% at 1 month after operation. Preoperative LVEF in AI patients was 57.7±10.7%, and became 53.6±11.1% at 7 days after operation and 62.0±10.9% at 1 month after operation. STI parameters in AS group before operation,7 days after operation,1 month after operation were:3DS-27.0±6.6% vs-20.0±7.7% vs-29.7±7.6%, GLS-15.1±4.4% vs-12.1±5.3% vs-18.0±5.3%, GRS 30.9±7.7% vs 22.7±9.5% vs 33.3±28.8%, GCS-21.9±5.9% vs-15.0±6.4% vs-24.1±7.3%. STI parameters in AI group before operation,7 days after operation,1 month after operation were:3DS-22.1±5.7% vs-17.5±7.2% vs-24.6±7.4%,1GLS-13.5±3.9% vs-11.3±5.5% vs-17.7±6.7%, GRS 26.3±7.4% vs 21.0±9.7% vs 30.7±9.5%, GCS-18.2±5.5% vs-13.5±6.8% vs-21.8±8.0%. LVEF and STI parameters in both AS and AI groups decreased at 7 days after operation and obviously increased at 1 month after operation (P<0.05). NT-proBNP, LVEDD, LVESD, LVEF,3DS, GCS, GRS and GLS had predictive value to adverse events of patients with AI after AVR, in which GRS had the highest predictive value. The AUC of ROC curve was 0.821 and the sensitivity and specificity in predicting postoperative adverse events were 83.33% and 81.48% for GRS<25.05%. Peak pressure gradient, mean pressure gradient,3DS, GCS, GRS and GLS had predictive value to adverse events of patients with AS after AVR, in which GLS had the highest predictive value. The AUC of ROC curve was 0.825 and the sensitivity and specificity in predicting postoperative adverse events were 80.00% and 93.75% for|GLS|< 13.45%.Conclusions:(1)3D-STI can sensitively detect and assess the cardiac function of AS and AI patients and the change of cardiac function before and after AVR, which is easy to handle and with high accuracy. (2) The ability of parameters of STI to detect and judge impaired cardiac function is obviously superior to LVEF. Parameters of STI can detect cardiac insufficiency with normal LVEF. (3) 3DS, GCS, GRS and GLS of 3D-STI can predict postoperative adverse events of patients with AVD and have high predictive value. (4) GRS<25.05% has the highest predictive value to postoperative adverse events of patients with AI and |GLS|< 13.45% has the highest predictive value to postoperative adverse events of patients with AS. |
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