风湿性心脏病二尖瓣狭窄患者左室纵轴功能的超声评价

Evaluation of left ventricular long-axis function in the patients with rheumatic mitral stenosis by echocardiography

目的:检测风湿性心脏病二尖瓣狭窄(MS)患者左心室纵轴功能。方法:选取不同程度单纯MS患者48例(轻、中、重度MS各16例,合并心房纤维性颤动(AF)25例)和正常人32例,分别应用组织多普勒(DTI)超声及M型超声测量二尖瓣环后间隔、侧壁、前壁、下壁4个位点的收缩峰值速度(vMA)、左室射血分数(LVEF)和房室平面位移值(DAVP)。结果:MS患者二尖瓣环4个位点的vMA和DAVP值均明显低于对照组(P<0.001),2组间LVEF差异无统计学意义(P>0.05);MS不同狭窄程度患者间vMA和DAVP值均存在差异(P<0.05),且随着狭窄程度的增加,vMA和DAVP明显下降;合并AF与未合并AF的MS轻、中、重度患者的vMA和DAVP值差异均无统计学意义(P>0.05)。结论:MS患者尽管LVEF值正常,但已存在左室纵轴收缩功能的下降。AF不是影响MS患者左室纵轴功能的主要因素。

Aim： To measure left ventricular long axis function in the patients with rheumatic mitral stenosis（MS）. Methods：Fourty eight patients with MS and 32 controls were evaluated by ECG. Peak systolic velocity was measured by Doppler tissue imaging（DTI） at four sites of mitral annulus （ posterior septum, lateral, anterior and inferior wall） , meanwhile, the displacement was measured by M-mode at the same four sites of atrioventricular plane. Results：Peak systolic velocity of mitral annular （vMA） and atrioventrieular plane displacement（ DAVe ） were significantly lower in the patients with MS than those of controls （P 〈 0. 001 ）. There were no significant differences in LVEF between the patients with MS and the controls （ P 〉 0.05 ）. MVA and DAVe were different in the mild, moderate and sevre MS（P 〈 0.05 ）. There were no significant differences in VMA and DAVe between the MS patients with atrial fibrillation and those without（P 〉 0.05）. Conclusion： Although left ventricular ejection fraction is normal, long-axis systolic function is reduced in patients with MS.