无创心肌做功技术评估单纯主动脉瓣反流患者TAVR术后左心室心肌功能OA

Objective:To investigate the value of noninvasive myocardial work(MW)in assessing the improvement of left ventricular myocardial function after transcatheter aortic valve replacement(TAVR)in patients with pure aortic regurgitation(AR).Methods:Thirty-five patients with moderate to severe or more aortic regurgitation(AR)who underwent transcatheter aortic valve replacement(TAVR)in the cardiology department of our hospital from August 2023 to August 2024 were selected.Transthoracic echocardiography was performed before the operation and immediately after the operation,as well as at 1 month,3 months,and 6 months postoperatively.The ultrasound parameters were processed offline,and the changing trends of each parameter and the predictive efficacy of each parameter for left ventricular reverse remodeling(LVRR)after the operation were analyzed.Results:In patients with pure aortic regurgitation(AR),the left ventricular ejection fraction(LVEF),left ventricular global longitudinal strain(LVGLS),global work index(GWI),global constructive work(GCW),and global work efficiency(GWE)at various follow-up time points before and after transcatheter aortic valve replacement(TAVR)showed a trend of first decreasing and then increasing.In contrast,the global wasted work(GWW)exhibited a trend of first increasing and then decreasing,while the left ventricular end-diastolic dimension(LVDD)continued to decrease.Compared with preoperative status,left ventricular function in patients with pure AR significantly improved at 6 months post-TAVR.The area under the curve(AUC)of preoperative LVEF,LVGLS,GWI,and GCW for predicting left ventricular reverse remodeling(LVRR)after TAVR in patients with isolated AR were 0.783,0.835,0.868,and 0.857,respectively,all of which were statistically significant(P<0.05).However,the AUC of preoperative GWW and GWE for predicting LVRR after TAVR in patients with pure AR were 0.569 and 0.637,respectively,with no statistical significance(P>0.05).When the GWI cutoff value was 1 367.5 mmHg%,the AUC was 0.868(95%CI:0.708-1.000,P=0.001),with a sensitivity of 93%and a specificity of 85%.Conclusion:The efficacy of postoperative TAVR in patients with pure AR is significant,noninvasive MW can effectively assess the improvement of LV myocardial function,and the preoperative GWI may be a potential predictor of postoperative LVRR in patients with pure AR undergoing TAVR.