改进的解剖M型超声评价二尖瓣环运动速度的初步探讨

Improved anatomic M-mode measurement of mitral annulus velocity

目的 探讨改进的解剖M型(AMM)超声与组织多普勒成像(TDI)对二尖瓣环峰值运动速度测量结果的差异性.方法 随机选取31例正常人及30例心力衰竭患者,先采用TDI的定量组织速度成像模式(QTVI)行心尖四腔心切面扫查,测量二尖瓣环间隔及侧壁的收缩期、舒张早期及舒张晚期的峰值速度,然后将上述二维图像输入经改进的、具有检测局部心肌运动速度的AMM进行后处理,检测二尖瓣环峰值运动速度,比较两种技术在测量相同部位及相同时相峰值速度的差异及相关性.结果 改进的AMM多数测值略高于TDI测值,但非常接近.一致性检验结果显示,在正常组二尖瓣环间隔和侧壁收缩期及舒张早期两种技术测值差异有统计学意义(P＜0.05),其他部位及时相的测值差异无统计学意义(P＞0.05).在心力衰竭组二尖瓣环侧壁两种方法数据差异有统计学意义(P＜0.05),在后间隔各时期两种技术测值差异无统计学意义(P＞0.05).但相关性分析显示TDI及AMM检测结果的相关性良好,在正常组两种技术测值相关系数0.58～0.87,心力衰竭组相关系数为0.69～0.92.结论 改进的AMM是一种有潜力和有待开发完善的用于评价心肌局部运动的新技术.

ObjectiveThis study was designed to compare improved anatomic M-mode (AMM) with tissue Doppler imaging (TDI) in measuring peak systolic and diastolic mitral annulus velocity and to determine whether the improved anatomic M-mode is feasible to measure regional myocardial velocity. MethodsEchocardiography with tissue Doppler imaging was performed in 61 subjects, of whom 31 were healthy volunteers (aged 40.0±9.6 years) and 30 were patients with systolic heart failure (aged 53.1±16.3 years, EF≤45%).Quantitative tissue Doppler imaging (QTVI) studies were obtained from 2 mitral annular sites, inferoseptal and lateral wall, from apical 4-chamber views. Then the left ventricular images were postprocessed by improved anatomic M-mode ,which was developed by Biomedical Engineering Institute of Fuzhou University in China. Comparing the peak systolic mitral annular velocity (Vs) early and late diastolic mitral annular velocity (Ve and Va) measured by anatomic M-mode and tissue Doppler imaging respectively. ResultsMost of the values derived from AMM were slightly higher than those of TDI. Peak systolic inferoseptal and lateral wall velocities and lateral wall peak early diastolic velocities by AMM were higher than those of TDI in the healthy group (P<0.05). Lateral mitral annulus velocities by AMM were higher than those of TDI in heart failure group (P<0.05). However, the velocities derived from AMM corellated well with TDI in the healthy group (r=0.58 to 0.87), and even better in heart failure group (r=0.69 to 0.92). ConclusionsImproved anatomic M-mode can be used to measure the velocities of a selected myocardial region. It has the potential for evaluating regional systolic and diastolic left ventricular function but needs further improvement.