瓣环组织运动位移评价扩张型心肌病左室纵向收缩功能

目的 探讨二尖瓣环、主动脉瓣环组织运动位移评价扩张型心肌病患者左室纵向收缩功能的临床应用价值.方法 选取2013年07月至2014年12月在四川省人民医院心内科入院治疗的扩张型心肌病患者共38例,正常对照组46例,均实施常规经胸超声心动图检查,采集并储存左室心尖四腔、三腔、二腔心切面3个完整心动周期实时灰阶超声图像.采用Q-Lab图像工作站测量二尖瓣环后室间隔、侧壁及二者瓣环连线中点最大位移,二尖瓣环前室间隔、后壁及二者瓣环连线中点最大位移,二尖瓣环前壁、下壁及二者瓣环连线中点最大位移,主动脉瓣环无冠瓣、右冠瓣及二者瓣环连线中点最大位移,应用双平面Simpson's法计算左室射血分数(left ventricular ejection fraction,LVEF),分析扩张型心肌病患者和正常对照组二尖瓣环、主动脉瓣环位移变化,及其与左室LVEF值之间的关系.结果 1)扩张型心肌病组较正常对照组二尖瓣环后室间隔、侧壁及二者瓣环连线中点最大位移,二尖瓣环前室间隔、后壁及二者瓣环连线中点最大位移,二尖瓣环前壁、下壁及二者瓣环连线中点最大位移,主动脉瓣环无冠瓣、右冠瓣及二者瓣环连线中点最大位移及左室LVEF值均明显降低,差异有统计学意义(P<0.01).2)正常对照组中,二尖瓣环所有位点位移、主动脉瓣环右冠瓣位移及右冠瓣和无冠瓣连线中点位移与左室LVEF值呈明显正相关(P<0.01);主动脉瓣环无冠瓣位移与左室LVEF值呈正相关(P<0.05).扩张型心肌病组中,大多数二尖瓣环位移和主动脉瓣环位移与左室LVEF值呈正相关(P<0.05),仅二尖瓣环后壁、前室间隔、主动脉瓣无冠瓣位移与左室LVEF值无相关性(P>0.05).结论 二尖瓣环、主动脉瓣环组织运动位移能够快速、客观反映扩张型心肌病患者左室心肌纵向收缩功能,可成为超声评价左室纵向收缩功能的一种新方法.

Evaluation of Left Ventricular Longitudinal Systolic Function by Mitral and Aortic Annular Displacements in Patients with Dilated Cardiomyopathy

Objective To investigate the clinical application value of mitral annular displacement (MAD)and aortic annular displacement (AAD)in the evaluation of left ventricular longitudinal systolic function in patients with dilated cardiomyopathy (DCM).Methods A total of 38 DCM patients treated in Sichuan Provincial People's Hospital from July of 2013 to December of 2014 were selected and divided into the DCM group,and the other 46 age-matched healthy subjects were selected and divided into the control group.The routine echocardiography was performed to collect the real-time grayscale ultrasound images of three continuous cardiac cycles from the left ventricular apical four-chamber,three-chamber and two-chamber views.The image workstation Q-lab 9.1 was used to measure the maximum displacements respectively at the mitral posterior interventricular septum,lateral wall and midpoint of the line from the posterior interventricular septum to the lateral wall,the mitral anterior and inferior walls and the midpoint of the line from the anterior wall to the inferior wall,and the aortic noncoronary cusp,right coronary cusp,and midpoint of the line from the noncoronary cusp to the right coronary cusp.The two-plane Simpson's method was adopted to calculate the left ventricular ejection fraction (LVEF).The changes of MAD and AAD were analyzed and compared between the DCM patients and the healthy subjects,and the correlations were explored among the parameters of MAD,AAD and LVEF.Results Firstly,Compared with those in the control group,the levels of MAD,AAD and LVEF in the DCM group decreased significantly (P<0.01).Secondly,the levels of left ventricular LVEF in the control group were positively correlated with the levels of MAD (P<0.01) and those of AAD at the right coronary cusp and midpoint of the line from the noncoronary cusp to the right coronary cusp (P<0.01),and at the aortic noncoronary cusp (P<0.05),while those in the DCM group were positively correlated with all the levels of MAD and AAD (P<0.05)except those of MAD at the posterior wall and anterior interventricular septum (P>0.05)and those of AAD at the noncoronary cusp (P>0.05).Conclusion MAD and AAD can indicate the left ventricular systolic function of DCM patients quickly and objectively,so it can be a new method to evaluate the left ventricular systolic function.