组织运动二尖瓣环位移技术定量评价重度心力衰竭患者左心室整体收缩功能的研究

Quantitative evaluation of left ventricular global systolic function in patients with severe heart failure by motion tracking of mitral annular displacement

目的 分析组织运动二尖瓣环位移技术（TMAD）测量重度心力衰竭（心衰）患者二尖瓣环收缩期最大位移（Ds）与左心室射血分数（LVEF）的相关性.探讨Ds评价重度心衰患者左室整体收缩功能和应用价值.方法 选择208例患者为观察对象,心衰组102例,其中重度心衰57例;心功能正常者106例为对照组.应用双平面Simpson法测量LVEF.应用TMAD技术测定心尖四腔观（侧壁、后间隔）、心尖两腔观（前壁、下壁）、二尖瓣环4个位点的收缩期Ds（Ds侧、Ds间、Ds前、Ds下、Ds平均）、二尖瓣环4个位平均位移（Dsmid1）、二尖瓣环连线中点处位移（Dsmid2）及二尖瓣环连线中点平均位移（Dsmid平均）,并分析Ds各参数与LVEF之间的关系.结果 ①Ds侧、Ds间、Ds前、Ds下、Ds平均、Dsmid1、Dsmid2和Dsmid平均之间比较未见统计学差异.②二尖瓣环各位移Ds与LVEF呈显著正相关,以Ds平均、Dsmid1、Dsmid2、Dsmid平均与LVEF相关性最好.以Dsmid平均评价LVEF＜30％的截断点值为5.65,敏感度为94％,特异度为98.2％;以Dsmid1评价LVEF＜30％的截断点值为5.45,敏感度为94.7％,特异度为94.7％.结论 应用TMAD测量二尖瓣环位移Ds与LVEF存在良好的相关性,当LVEF＜30％时,Dsmid平均＜5.65 mm,Dsmidl ＜5.45 mm.

[Abstract] Objective To analyze the correlation between the systolic maximum displacement （Ds） and left ventricular ejection fraction（LVEF） in patients with severe heart failure（CHF） by motion tracking of mitral an- nular displacement （TMAD）. To investigate the application value of Ds in evaluating left ventricular systolic func- tion in patients with severe heart failure. Methods 208 patients were selected, 102 cases with heart failure, of which 57 cases with severe heart failure, 106 cases with normal heart function as the control group. LVEF was measured by double plane Simpson＇s rule. The systolic Ds was measured at 4 sites： lateral wall （Dslat） and poste- rior septum（Dssep） in apical four chamber view, and anterior wall（Dsant） and inferior wall（Dsinf） in apical two chamber view by TMAD, and the systolic displacement of mitral annulus midpoint in two chamber views（ Dsmidl, Dsmid2）, the mean value of Ds from the 4 sites, and the two Dsmid were also calculated （Dsmea, Dsmidmea）. The correlation of these displacement parameters with LVEF was analyzed. Results （1）There was no significant difference among Dslat,Dsscp,Dsam Dstnf,Ds,Domidl Dsmid2,and Dsmid. （2）There was positive correlation between Ds and LVEF. Dsmea, Dsmidl, Dsmid2, Dsmidmea were significantly positive,with LVEF. The cut-off value of the Dsmidmea for LVEF〈30% was 5.65 mm, with a sensitivity of 94%, and a specificity of 98.2%,the cut-off value of the Dsmidl for LVEF〈30% was 5.45 ram, with a sensitivity of 94.7%, and a specificity was 94.7%. Conclusion The application of TMAD in the measurement of mitral annular displacement of Ds and LVEF has a good correlation. When LVEF is 〈30%, the Dsmid〈5.65 mm, Dsmidl〈5.45 mm.