扩张型心肌病患者二尖瓣乳头肌移位的超声研究

Study of the anatomical location features of mitral papillary muscle in patients with dilated cardiomyopathy using echocardiography

目的 研究扩张型心肌病（DCM）患者二尖瓣乳头肌移位的解剖特点,结合电生理及解剖学,解释心脏再同步化治疗术后疗效不一的可能机制.方法 47例DCM患者,根据心电图表现分为完全性左束支阻滞组（CLBBB组）和非完全性左束支阻滞组（NCLBBB组）,以左室腔中心为原点,测量二尖瓣前、后乳头肌相对左室前壁在心动周期内的角度变化（AngⅠ、AngⅡ）,并分别测量乳头肌相对距离的变化（A-PD）,将其测值与正常对照组相比较.结果 与对照组相比,DCM患者Ang Ⅰ、AngⅡ均明显增大,差异有统计学意义（P＜0.05）;与对照组及CLBBB组相比,NCLBBB组A-PD测值增大,差异有统计学意义（P＜0.05）;与NCLBBB组相比,CLBBB组AngⅠ、AngⅡ增大,差异有统计学意义（P＜0.05）.结论 DCM患者均合并二尖瓣乳头肌移位,但CLBBB患者这一趋势更为明显.

Objective To test the anatomical location of papillary muscle in patients with dilated cardiomyopathy（DCM） using echocardiography and to explain the possible mechanism of the curative effect after cardiac resynchronization therapy.Methods Fourty-seven patients with DCM were divided into the complete left bundle branch block （CLBBB） group and non complete left bundle branch block （NCLBBB） group,according to the characteristics of electrocardiogram.The center of left ventricle（LV） was manually determined by measuring a random 2 radiuses from that point to the free wall.Ang Ⅰ was defined as the angle between the anterior papillary muscle and the anterior LV free wall; Ang Ⅱ,the angle between the posterior papillary muscle and the anterior LV free wall.The distence between the papillary muscles （A-PD） were measured meanwhile.All the value was compared with that in the sex-and age-matched control subjects.Results Compared with the control group,Ang Ⅰ and Ang Ⅱ in the DCM group were significantly increased.Compared with the control group and CLBBB group,A-PD value of the NCLBBB group was increased.Compared with NCLBBB group,Ang Ⅰ and Ang Ⅱ of the CLBBB group were significantly increased,the difference was statistically significant respectively （P 〈0.05）.Conclusions Posterior shift of papillary muscle was common in DCM,and the phenomenon is more obvious in patients with CLBBB.