组织追踪技术测量二尖瓣环位移评价慢性心力衰竭患者左心室收缩功能及其影响因素

Assessment on left ventricular systolic function with tissue tracking derived mitral annular displacement and the impact factors in patients with chronic heart failure

目的探讨组织追踪技术(TT)测量收缩期二尖瓣环位移(MADs)在评价慢性心力衰竭患者左心室收缩功能中的作用及其影响因素。方法选取慢性心力衰竭患者46例(心衰组)及健康志愿者20名(对照组)。以二维超声测量左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV),采用双平面Simpson法测量左心室射血分数(LVEF)。在心尖四腔及两腔切面,应用TT技术测量左心室侧壁、室间隔、前壁及下壁4个位置的MADs,并计算其平均值,与M型超声测量的MADs进行一致性及相关性分析。用多重线性回归分析心衰组的年龄、LVEDD、体表面积对LVEF与MADs均值的相关性的影响。结果与对照组比较,心衰组的LVEDD、LVEDV、LVESV明显增高(P均<0.01),LVEF显著降低(P均<0.01)。心衰组4个位置的MADs均低于对照组(P均<0.01),TT与M型超声测量的MADs平均值高度相关且一致性良好(r=0.97,P<0.01)。MADs平均值与LVEF的关系受LVEDD的影响(r2=0.69,P<0.01)。结论TT测量MADs结合LVEDD可以准确、简洁、快速地评价慢性心力衰竭患者的左心室收缩功能。

Objective To observe the value of systolic mitral annular displacement（MADs） based on tissue tracking in patients with chronic heart failure（CHF）,and to investigate the relation between MADs and left ventricular ejection fraction（LVEF）.Methods Forty-six patients with CHF（CHF group） and 20 normal subjects（control group） were enrolled.Left ventricular end-diastolic diameter（LVEDD）,left ventricular end-diastolic volume（LVEDV） and left ventricular end-systolic volume（LVESV） were measured with two-dimensional echocardiography,while left ventricular ejection fraction（LVEF） was calculated with biplane Simpson＇s method.MADs was obtained from apical 4-chamber view and 2-chamber view using M-mode imaging and tissue tracking（TT）.Correlation and agreement between M-mode imaging and TT derived MADs were analyzed.The impact of age,LVEDD and body surface area on the relation between LVEF and MADs was analyzed using multiple linear regression in CHF group.Results Compared with control group,LVEDD,LVEDV,LVESV increased significantly（all P0.01）,and LVEF decreased significantly（P0.01） in CHF group.Mean MADs of four sites decreased significantly（all P0.01） in CHF group.Correlation and agreement between M-mode imaging and TT derived MADs were well（r=0.97,P0.01）.The relation between LVEF and MADs was influenced by LVEDD significantly（r2=0.69,P0.01）.Conclusion TT derived MADs in combination with LVEDD can be used to evaluate left ventricular systolic function in patients with HF briefly and accurately.