风湿性二尖瓣狭窄心肌病理改变与心肌运动的关系

目的 :探讨风湿性二尖瓣狭窄 (Mitralstenosis ,MS)患者心肌病理改变与心肌运动的关系 .方法 :MS患者 2 2例术前行常规心脏超声及组织多普勒成像 (Dopplertissueimag ing,DTI)检查 ,于心尖四腔切面记录室间隔侧二尖瓣环长轴方向射血期频谱S波和舒张期频谱D波峰值及心电图R波至频谱S波起始点的时间T ,选取 3个波幅最大的心动周期 ,算出此 3个心动周期的平均值S3 、D3 和T3 ;二尖瓣置换术中切取左室乳头肌行病理检查 .结果 :微动脉Di/Do与D3 呈正相关 ,(r =0 .5 0 ,P <0 .0 5 ) ;心肌纤维化程度与T3 呈正相关 ,(r=0 .6 8,P <0 .0 5 ) ;而S3 与D3 呈正相关 ,(r =0 .4 3,P <0 .0 5 ) .结论 :术前DTI检查测量D3 及T3 ,可以反映心肌病理变化 ,有助于对MS患者手术适应证的掌握及对预后的判断

Relation of myocardial pathologic changes to myocardial motion in patients with rheumatic mitral stenosis

AIM: To evaluate the relation of myocardial pathologic changes to myocardial motion in patients with rheumatic mitral stenosis (RMS). METHODS: Twenty two patients with RMS underwent echocardiography examination, including pre operation Doppler tissue imaging (DIT) in which systolic myocardial spectrum wave S, diastolic myocardial spectrum wave D and the duration (T) from R wave on surface electric cardiograph to S wave were recorded on apical four chamber view. The three largest waves were measured and the mean value was recorded respectively as S3, D3 and T3. Specimens of papillary muscles were obtained at the time of mitral valve replacement for pathologic analysis. RESULTS: Arteriole Di/Do was positively correlated to D3, ( r =0.50, P < 0.05), interstitial fibrosis level was positively correlated to T3, ( r=0.68, P <0.05) and S3 was positively correlated to D3 ( r=0.43, P <0.05). CONCLUSION: The measurement of D3 and T3 by DTI before operation can reflect pathologic changes of myocardium, which is helpful for the time choice of operation and the prediction of prognosis.