Assessment Of Clinical Outcome By Myocardial Strain In Patients With Valve Replacement:A Follow-up Study

Objective Myocardial strain derived from two-dimensional speckle tracking imaging(2D-STI)has been validated for cardiac function assessment.We sought to evaluate the changes of left ventricular(LV)myocardial strain of the global and regional longitudinal,radial and circumferential strain parameters in patients with valvular heart disease(VHD)before and after valve replacement for the evaluation of clinical outcomes.Methods Thirty-five patients with VHD and valve replacement and twenty normal person were enrolled.LS less than-20%defines abnormal segments and layers of myocardium.Two-dimensional echocardiographic images were recorded in apical four-chamber,long-axis,two-chamber views and three views of short axis at mitral valve,papillary muscle and apical levels of LV in all subjects.Echopac analysis software was used to obtained all the strain parameters.2D and strain variables of echocardiography were compared with control group.Patients were followed up at 1-week,1-month and 6-month postoperation.Results1.Compared with preoperative,left atrial end-systolic diameter(LAESD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF)at 6-month after operation were significantly improved(P<0.05),while postoperative LVEF was not improved at 1-week and 1-month after operation(P<0.05).Compared with the control group,LVEF was no statistically significant difference at 6-month after operation,while the other group of VHD were decreased(P<0.05).There was no statistically significant difference for the comparison of clinical data before and after valve replacement(P>0.05).2.The left ventricular global longitudinal strain parameters(GLSendo.GLS.GLSepi)of VHD group was significantly lower than that of the control group(P<0.05).Compared with control group,global longitudinal strain(GLS),global circumferential strain(GCS)and global radial strain(GRS)were decreased at 1-week and 1-month after operation(P<0.05,all),while GCS and GRS were significantly improved in preoperative and 6-month after operation(P<0.05).GCSendo,GCSepi in preoperative and 1-week and 1-month after operation were significantly lower than that of the control group,while GCSendo was decreased at 6-month after operation(P<0.05),and GCSepi was not improved(P>0.05).3.Compared with the preoperative,GLS,GCS,GRS,GLSendo,GCSendo and GCSepi were decreased at 1-week after operation,and which were improved at 6-month after operation(P<0.05,all).GLSendo at 1-month after operation was higher than at 1-week after operation,while GCSendo was lower than preoperative(P<0.05).Compared with the group of 1-month after operation,GCSendo was improved at 6-month after operation,and GLSendo,GLSepi,GCSepi were no statistically significant difference(P>0.05).4.Compared with preoperative,territorial longitudinal strain(TLS)of endocardial layers(TLSendo)was significant improved in 1-month after operation(P<0.01).There were no significant difference between preoperative and 1-week after operation by territorial radial strain(TRS),territorial longitudinal and circumferential strain(TLS,TCS)of epicardial layers(TLSepi,TCSepi),TLS and TCS(P>0.05,all).Territorial circumferential strain(TCS)of endocardial layer(TCSendo)was decreased which compared with preoperative.TLSendo,TLS,TLSepi were significantly improved in 6-month after operation while compared with preoperative(P<0.05,all).TCSendo,TCSepi,TCS and TRS was no significant difference(P>0.05).Compared with preoperative,TLSendo,TCSendo,TCSepi,TCS and TRS were significantly decreased at postoperative in 1-week(P<0.05,all).There was no significant difference between preoperative and 1-week after operation by TLS and TLSepi(P>0.05).Conclusions Sensitive detection of LV dysfunction,especially myocardial strain parameters are valuable for the clinical therapeutic effect in short-term in patients with valve replacement.Global longitudinal strain can evaluate the prognosis of cardiac function after valve replacement.TLSendo is a sensitive indicator of the outcomes of VHD patients and better than LVEF and other strain variables by 2D-STI.