实时三维超声评价缺血性二尖瓣返流心肌梗死患者左室局部收缩功能研究

Evaluation of left ventricular regional systolic function in patients with ischemic mitral regurgitation by real-time three-dimensional echocardiography

目的探讨实时三维超声评价缺血性二尖瓣返流的心肌梗死患者左室局部收缩功能的价值。方法选取自2017年11月至2018年7月于沈阳军区总医院心血管内科就诊的67例心肌梗死合并二尖瓣返流患者为研究对象,根据心肌梗死程度将38例陈旧性下壁心肌梗死伴二尖瓣返流患者分为A组,29例急性下壁心肌梗死伴二尖瓣返流患者分为B组,同时选取45例同期健康体检者为C组。二维超声测量二尖瓣返流的流颈宽度及二尖瓣返流面积与左房面积之比,应用实时三维超声测量左室各节段射血分数,比较各组间相关参数。结果 A组患者二尖瓣返流面积与左房面积之比为(24. 90%±2. 34%),显著高于B组的(18. 20%±6. 68%),A组患者的流颈宽度为(4. 60±1. 04) mm,显著高于B组的(3. 00±2. 25) mm,差异均有统计学意义(P <0. 05)。A组各节段射血分数较B、C两组均减小,其中,前侧壁基底段、中间段,下侧壁基底段、中间段、心尖段,下壁基底段、中间段、心尖段及后间隔中间段明显减小,差异有统计学意义(P <0. 05)。B组患者的下壁基底段、中间段及后间隔基底段、中间段较C组减小,差异有统计学意义(P <0. 05)。结论实时三维超声技术可无创评价左室局部收缩功能,准确评估缺血性二尖瓣返流情况,为临床治疗及患者预后提供有效信息。

Objective To investigate the relationship between ischemic mitral regurgitation and the regional systolic function of left ventricular wall in patients with myocardial infarction(MI)by real-time three-dimensional echocardiography(RT-3DE).Methods A retrospective study was performed on 67 cases of MI patients with mitral regurgitation who were admitted from November 2017 to July 2018.According to the degree of MI,patients were divided into two subgroups:inferior old MI with mitral regurgitation group(Group A,n=38)and inferior acute MI with mitral regurgitation group(Group B,n=29).At the same time,45 healthy volunteers were selected as the control group(Group C).Left ventricular segmental ejection fraction(sEF)was measured by RT-3DE.The width of vena contracta(VC),left atrial area(LAA),mitral regurgitation area(RegA)and the ratio of mitral regurgitation area to left atrial area(RegA/LAA)were measured by two-dimensional echocardiography.Compare the differences of the relative parameters among each group.Results The ratio of the area of mitral regurgitation to left atrial area was(24.90%±2.34%)in Group A,which was significantly higher than(18.20%±6.68%)in Group B.The width of the neck was(4.6±1.04)mm in Group A,which was significantly higher than(3.0±2.25)mm in Group B(P<0.05).The EF of each segment in Group A was reduced compared with that in Group B and C,and the difference was statistically significant(P<0.05).The lower wall basal segment and middle segment of anterior lateral wall,the basal segment,middle segment and apical segment of the lower lateral wall,the basal segment,middle segment,apical segment and the middle segment of posterior interval were significantly reduced,and the difference was statistically significant(P<0.05).The lower wall basal segment,middle segment,posterior interval basal segment and middle segment of patients in Group B were reduced compared with those in Group C,and the difference was statistically significant(P<0.05).Conclusion Real-time three-dimensional ultrasonography can noninvasively evaluate left ventricular local systolic function,accurately assess ischemic mitral regurgitation,and provide effective information for clinical treatment and prognosis.