组织运动二尖瓣环位移技术定量评价心力衰竭患者左心室整体收缩功能

Study of quantitative assessment of left ventricular systolic function by tissue motion annular displacement in heart failure patients

目的:探讨组织运动二尖瓣环位移技术(TMAD)评价心力衰竭(心衰)患者左心室整体收缩功能的应用前景。方法:选取心衰患者18例为病例组,健康志愿者16例为对照组。应用TMAD技术测定心尖四腔观(后间隔、侧壁)、心尖两腔观(下壁、前壁)和心尖左心室长轴观(后壁、前间隔)二尖瓣环6个位点运动参数:收缩期最大位移(Ds)、心电图R波顶点至位移曲线到达最大位移的时间(Ts-%)、6个位点达峰时间的标准差(Ts-SD)。应用脉冲多普勒组织速度成像(PW-DTI)测量上述6个位点收缩期S波时间速度积分(VTIs)。应用双平面Simpson法测量左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)和射血分数(LVEF)。比较两组二尖瓣环运动参数的特点,并分析其与LVEF的相关性。结果:①病例组二尖瓣环位移曲线形态不规则,各位点Ds较对照组明显减低(P<0.01);6个位点Ts-%、Ts-SD与对照组相比,差异有统计学意义(P<0.01)。②病例组Ds均值与LVEF呈显著正相关性,而与LVEDV、LVESV无显著相关性;③病例组二尖瓣环6个位点TMAD测得的Ds均值与PW-DTI测得的VTIs均值呈显著正相关。结论:①心衰患者二尖瓣环位移曲线形态不规则,位移幅度明显降低,达峰时间延迟且不同步;②心衰患者二尖瓣环位移参数与左心室整体心功能参数呈正相关,TMAD为准确评价心衰时左心室整体收缩功能提供了一种直观、便捷的新方法。

Objective： To evaluate the ability of tissue motion annular displacement （TMAD） for assessment of global left ventricular systolic function in patients with heart failure （HF）. Method：The HF group and the control group were composed of 18 patients with HF and 16 healthy subjects respectively. Apical two-, three-and four- chamber views were used to observe the mitral annulus motion of six sites （posteroseptal, lateral, inferior, anteri- or, posterior and anteroseptal annulus）. TMAD parameters including maximal systolic displacement （Ds）, time intervals from R wave to maximal systolic displacement （Ts-~） and standard deviation of Ts of six sites （Ts-SD） were measured. Velocity-time integral of S wave and systolic peak velocity were determined by pulsed wave- Doppler tissue imaging （PW-DTI）. Left ventricular ejection fraction （LVEF）, left ventricular end systolic volume （LVESV） and end diastolic volume （LVEDV） were determined by two-dimensional echocardiography. The corre- lation between mitral annular motion parameters and LVEF were analyzed. Result：（1）TMAD depicts mitral annular displacement-time curve as a irregular shape in the HF group. Compared to the control group, Ds was decreased significantly （P〈0.01）. There were significant statistical differences between the HF group and the control group in Ts and Ts-SD （P〈0.01）. （2）There was a high correlation between the mean Ds of six sites and LVEF while it was poorly correlated to LVESV and LVEDV in the HF group. （3）A positive correlation was found between mitral annular displacement determined by TMAD and PW-DTI. Conclusion： （1）TMAD depicts mitral annular displace- ment-time curve as a irregular shape in patients witti HF. The mitral annular displ.acement decreases significantly. The motions of six annular sites are delayed and not coordinated. （2） The positive correlation between TMAD parameters and LVEF indicates its value as a novel descriptor of global left ventricular systolic function in heart failure.