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应用组织运动二尖瓣环位移自动追踪技术评价经皮冠状动脉介入治疗后左心室整体收缩功能改变
引用本文:段凤霞,何文,杜丽娟,隗冬梅. 应用组织运动二尖瓣环位移自动追踪技术评价经皮冠状动脉介入治疗后左心室整体收缩功能改变[J]. 中华医学超声杂志(电子版), 2015, 12(8): 635-640. DOI: 10.3877/cma.j.issn.1672-6448.2015.08.010
作者姓名:段凤霞  何文  杜丽娟  隗冬梅
作者单位:1. 100050,首都医科大学附属北京天坛医院
摘    要:
目的探讨采用组织运动二尖瓣环位移自动追踪技术(TMAD)评价冠状动脉粥样硬化性心脏病(CAD)患者经皮冠状动脉介入术(PCI)后6个月左心室整体收缩功能改变的价值。 方法选择2012年11月至2013年12月首都医科大学附属北京天坛医院心内科住院CAD患者22例,全部经冠状动脉造影证实前降支狭窄程度≥70%、成功行PCI术、并成功追踪6个月。其中男性16例,女性6例,年龄39~67岁,平均年龄(52.8±5.5)岁;健康对照组35例,其中男性25例,女性10例,年龄33~59岁,平均年龄(50.2±9.1)岁。在心尖四腔心和两腔心切面应用双平面Simpson′s法测量左心室射血分数(LVEF)。于标准的心尖四腔心、三腔心、两腔心切面,选择连续3~5个心动周期存储动态图像(CAD患者于术前及术后6个月存储图像),用Qlab 7.0软件进行脱机分析。测量二尖瓣环6个位点收缩期最大位移(Ds),瓣环连线中点最大位移(D-mid),左心室长轴缩短率(FSL),计算6个位点Ds均值,3个切面D-mid均值、FSL均值。比较对照组与CAD组术前、后上述指标是否存在差异,分析二尖瓣环位移指标与LVEF的相关性。 结果与健康对照组比较,CAD组术前常规超声测量指标左心房前后径(LAd)、左心室舒张末内径(LVd)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)增加[(3.43±0.17)cm vs(3.66±0.21)cm,(4.60±0.23)cm vs(4.89±0.43)cm,(82.51±6.22)ml vs(88.47±9.71)ml,(25.81±3.81)ml vs(38.90±7.24)ml];与健康对照组比较,左心室射血分数(LVEF)降低[(64.75±3.43)% vs (56.41±7.17)%] ,差异均有统计学意义(t=-3.24、-2.67、-2.60、-6.50、5.53,P均<0.05)。PCI术后6个月,LAd、LVd、LVEDV、LVESV降低[(3.57±0.18)cm、(4.76±0.31) cm、(86.86±8.69)ml、(37.08±8.31)ml],LVEF升高(58.85±6.19) %,与术前比较差异均有统计学意义(t=2.33、2.79、2.48、3.18、-2.12,P均<0.05)。健康对照组、CAD组术前、CAD组术后二尖瓣环6个位点Ds均值分别为(13.09±1.34) mm、(10.78±1.59) mm、(13.57±1.19)mm;3个切面D-mid均值分别为(13.75±1.59)mm、(11.36±2.63)mm、(14.23±1.48)mm;FSL均值分别为(17.32±2.41)%、(13.56±2.52)%、(16.29±1.77)% 。与对照组相比,CAD组术前二尖瓣环6个位点Ds均值、3个切面D-mid均值、FSL均值均减低,差异均有统计学意义(t值分别为4.19、4.47、4.72,P均<0.05) 。与CAD组术前比较,PCI术后6个月二尖瓣环6个位点Ds均值、3个切面D-mid均值、FSL均值均增加,差异均有统计学意义(t值分别为-7.55、-7.48、-6.82,P均<0.05) 。CAD组术后二尖瓣环6个位点Ds均值与对照组相比差异无统计学意义(t值分别为-1.47、-1.10、-1.44,P>0.05) 。CAD组PCI术后Ds均值、D-mid均值及FSL均值与LVEF均呈正相关(r值分别为0.72、0.71,0.83,P<0.001)。 结论CAD患者PCI术后左心室整体收缩功能较术前明显改善;TMAD技术可用于评估CAD患者PCI术后左心室整体功能。

关 键 词:冠状动脉疾病  超声心动描记术  二尖瓣  心室功能,左  
收稿时间:2014-10-09

The evaluation of left ventricular global systolic function after percutaneous coronary intervention operation by tissue automated motion tracking of mitral annular displacement
Fengxia Duan,Wen He,Lijuan Du,Dongmei Wei. The evaluation of left ventricular global systolic function after percutaneous coronary intervention operation by tissue automated motion tracking of mitral annular displacement[J]. Chinese Journal of Medical Ultrasound, 2015, 12(8): 635-640. DOI: 10.3877/cma.j.issn.1672-6448.2015.08.010
Authors:Fengxia Duan  Wen He  Lijuan Du  Dongmei Wei
Affiliation:1. Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University. Beijing, 100050, China
Abstract:
ObjectiveTo discuss the value of the left ventricular global systolic function in patients with coronary atherosclerotic disease before and after percutaneous coronary intervention (PCI) operation by tissue automated motion tracking of mitral annular displacement (TMAD) . MethodsTwenty-two patients (16 males and 6 females, age 39-67 years old) with coronary atherosclerotic heart disease in the department of cardiology of our hospital who were successfully undergone PCI and successfully tracked for 6 months (coronary artery stenosis≥70%, which were confirmed by coronary angiography) , and 35 normal controls (25 males and 10 females, age 33-59 years old) were enrolled in this study. After routine echocardiography, left ventricular ejection fraction (LVEF) was measured by biplane Simpson's method. Apical four-chamber, three-chamber and two-chamber two-dimensional dynamic images were stored (the images of patients with coronary atherosclerotic disease were stored before operation and at 6 months after operation) , which lasted three to five consecutive cardiac cycles. The parameters were obtained using offline Qlab 7.0 software: maximal systolic displacement (Ds) of every annulus, systolic displacement of the middle point (D-mid) , longitudinal fractional shortening (FSL) , then the mean of Ds, D-mid and FSL were calculated respectively. The parameters of TMAD between normal controls and the CAD group were compared. Correlation analysis of parameters of TMAD and LVEF were made. ResultsCompared with normal controls, LAd, LVd, LVEDV and LVESV in CAD group increased [(3.43±0.17) cm vs (3.66±0.21) cm, (4.60±0.23) cm vs (4.89±0.43) cm, (82.51±6.22) ml vs (88.47±9.71) ml, (25.81±3.81) ml vs (38.90±7.24) ml], while LVEF [(64.75±3.43) % vs (56.41±7.17) %] decreased ( t=-3.24, -2.67, -2.60, -6.50 and 5.53, P<0.05) . At 6 months after operation, LAd, LVd, LVEDV and LVESV [(3.57±0.18) cm, (4.76±0.31) cm, (86.86±8.69) ml, (37.08±8.31) ml] decreased, while LVEF (58.85±6.19) % increased (t=2.33, 2.79, 2.48, 3.18 and -2.12, P<0.05 for all) . The mean of Ds for normal controls, CAD group before and after operation were (13.09±1.34) mm, (10.78±1.59) mm, and (13.57±1.19) mm; the mean of D-mid for normal controls, CAD group before and after operation were (13.75±1.59) mm, (11.36±2.63) mm and (14.23±1.48) mm. The mean of FSL for normal controls, CAD group before and after operation were (17.32±2.41) %, (13.56±2.52) % and (16.29±1.77) %. The mean of Ds, D-mid, and FSL signifycantly decreased in CAD group compared with those of normal controls (t=4.19, 4.47 and 4.72, P<0.05 for all) . The mean of Ds, D-mid and FSL signifycantly increased in CAD group after operation compared with those before operation (t=-7.55, -7.48 and -6.82, P<0.05 for all) . There were no significant difference between CAD group after operation and normal controls for the mean of Ds, D-mid and FSL (t=-1.47, -1.10 and -1.44, P>0.05) . There was correlation between the mean of Ds, D-mid, FSL and LVEF (r=0.72, 0.71 and 0.83, P<0.001) in CAD group after operation. ConclusionsThe left ventricular global systolic function was obviously improved in CAD patients after PCI operation. TMAD technology could be used for assessment of left ventricular global systolic function in CAD patients after PCI operation.
Keywords:Coronary atherosclerotic heart disease  Echocardiography  Mitral valve  Ventricular function   left  
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