经胸冠状动脉检测联合自动追踪二尖瓣环位移对冠心病诊断的研究

Study of Diagnosing Coronary Heart Disease by Transthoracic Coronary Detection and Automated Tracking of Mitral Annular Displacement

目的:探讨经胸冠状动脉检测联合自动追踪二尖瓣环位移在冠心病诊断方面的临床应用价值。方法:选取于2010-2013年本院就诊的冠心病患者60例为冠心病组,同时选取本院检查正常的健康志愿者20人为对照组,经胸二维超声检测冠心病组及对照组左右冠状动脉主干近端内径。取心尖四腔心及心尖两腔心切面,应用PHILIP IE33超声诊断仪二尖瓣环运动定量软件,观察冠心病组及对照组室间隔、侧壁、前壁及下壁运动异常时二尖瓣环位移的变化情况,参数包括收缩末期瓣环的峰值位移(MAD)、中点和心尖之间标准化距离上的最大峰值移位(MAD Mid)及其占左室长径百分比(MAD Mid%)。将冠心病组与对照组结果进行对比,并与超声心动图测得左室射血分数(LVEF)值、E/A值做相关性分析。结果:根据超声心动图有无室壁运动异常将冠心病患者分为冠心病Ⅰ组(有室壁运动异常)和冠心病Ⅱ组(无室壁运动异常)。冠心病Ⅰ组MAD、MAD Mid及MAD Mid%较对照组及冠心病Ⅱ组均明显减低,差异有统计学意义(P<0.001);冠心病Ⅱ组MAD、MAD Mid及MAD Mid%较对照组差异无统计学意义(P>0.05)。对照组中室间隔MAD较侧壁、前壁、下壁均明显减低,差异有统计学意义(P<0.001)。冠心病组与对照组经胸左右冠状动脉主干近端内径差异无统计学意义(P>0.05)。冠心病Ⅰ组各位移参数与左室EF值及E/A值显著相关(P<0.001),以MAD Mid%均值相关性最高。结论:自动追踪二尖瓣环位移方法简便、快捷、可靠、无创伤、易于临床常规应用和推广,自动追踪二尖瓣环位移可应用于冠心病室壁运动异常及左室整体收缩、舒张功能的评价。

Objective：To evaluate and automated tracking of mitral annular displacement in diagnosing coronary heart disease（CHD）.Method：60 cases of coronary heart disease were selected in our hospital from 2012 to 2013 as the CHD group and 20 cases with normal as the control group.They were all received transthoracic left and right coronary diameter measured.Their apical four-chamber view and two-chamber view images were recorded by PHILIP IE33,the interventricular septum,side wall,front wall and wall motion abnormalities in the change of displacement of mitral valve ring of coronary heart disease group and control group were observed.Parameters included MAD of interventricular septum （MADsep）,left ventricular lateral wall（MADlat）,MAD of anterior wall（MADant）,MAD of inferior wall（MADinf）, middle point of mitral annulus（MADmid）,and MADmid%was defined as MADmid divided by left ventricular diameter. The results of coronary heart disease group and control group were compared.The correlation between MAD indexes and LVEF and E/A was also explored. Result：According to the results by echocardiography,CHD group was divided into CHDⅠ（with wall motion abnormality）and CHDⅡ（not with wall motion abnormality）. MAD indexes were significantly smaller in CHDⅠthan in control group and CHDⅡ,the difference was statistically significant（P〈0.001）;MAD indexes were no statistical significance in CHDⅡand control group（P〉0.05）;the ventricular septal MAD side wall,front wall and lower wall were significantly reduced in control group,the difference was statistically significant（P〈0.001）. Coronary heart disease group and control group by transthoracic left and right coronary diameter there was no significant difference（P〉0.05）. Coronary heart disease（CHD）Ⅰgroup each movement parameters significantly correlated the left ventricular EF value and E/A value（P〈0.001）,especially average MADmid%.Conclusion：ATMAD has advantages of easiness,rapid,non-invasion and repeatability. It can be a rapid and stable index for assessment of CHD wall motion abnormality and left ventricular systolic/diastolic function in CHD patients.