经食管实时三维超声心动图观测二尖瓣构型改变对缺血性二尖瓣反流的影响

Role of coaptation imaging of mitral valve on ischemic mitral regurgitation by real-time three-dimensional transesophageal echocardiography

目的 采用经食管实时三维超声心动图（RT3D-TEE）观察缺血性二尖瓣反流（IMR）患者二尖瓣叶在收缩对合过程中的空间构型变化,探讨二尖瓣叶对合形态对IMR反流程度的影响.方法 分别对1 12例IMR患者和38例无二尖瓣反流的正常对照者行RT3D-TEE检查,其中IMR患者根据二尖瓣反流程度分为轻度反流组（n=46）、中度反流组（n=45）与重度反流组（n=21）.测量二尖瓣前叶对合线长度（LCA3dlf）、后叶对合线长度（LCP3dlf）、前小叶总面积（A3DTANT）、后小叶总面积（A3DTPOST）,比较四组间各项参数的差异,并进行Logistic回归多因素分析.结果 对照组前叶与后叶的对合线几乎为等长,而IMR患者随着反流程度的加重,LCA3dlf、LCP3dlf呈明显延长的趋势,LCA3dlf及LCP3dlf显著大于对照组（P＜0.05）;重度分流组不仅A3DTANT及A3DTPOST增大,而且瓣叶对合参数LCA3dlf及LCP3dlf显著大于轻中度IMR组（P＜0.05）.Logistic回归多因素分析显示LCP3dlf与IMR独立相关.ROC曲线分析显示曲线下面积为0.949,以LCP3dlf≥32 mm为截点,诊断IMR的敏感性为73.3％,特异性为94.7％.结论 IMR患者二尖瓣前后两叶的对合不良可能是造成IMR的主要原因之一,术前了解IMR患者二尖瓣叶的对合形态,有助于指导外科医师选择恰当的IMR手术方式及评估治疗效果.

Objective To explore the impact of morphological changes of mitral valve coaptation on ischemic mitral regurgitation （IMR）,and observe coaptation image of mitral valve in systole in patients with IMR by using real-time three-dimensional transesophageal echocardiography （RT3D-TEE）.Methods RT3D-TEE was performed on 112 patients with IMR and 38 patients without MR as the control.Patients with IMR were divided into group of mild IMR （n =46）,group of moderate IMR （n =45） and group of severe IMR （n =21）,according to the severity of mitral regurgitation.Mitral valve quantification （MVQ）software of Qlab 8.1 was used for image post-processing of RT3D-TEE.The coaptation parameters was measured,included length of anterior combination（LCA3dlf）,length of posterior combination（LCP3dlf）,area of anterior combination（A3DTANT） and area of posterior combination （A3DTPOST） at end-systole.Then,these coaptation parameters of mitral valve were compared statistically.Logistic regression assessing was applied for analyzing the results.Results Coaptation line of anterior and posterior leaflets was almost same in normal subjects.With increasing of mitral regurgitation,a tendency to prolong in LCA3dlf and LCP3dlf were observed in IMR （P 〈0.05）.Compared to that in mild and moderate IMR groups,besides A3DTANT and A3DTPOST,LCA3dlf and LCP3dlf were also increased significantly in severe IMR group （P 〈0.05）.LCP3dlf was an independent correlation factor of IMR by Logistic regression analysis.The sensitivity was 73.3% and the specificity was 94.7% when LCP3dlf≥32 mm was regarded as cut-off point,and the area under the ROC curve was 0.949 （0.900～0.999）.Conclusions Abnormal coaptation of anterior and posterior leaflets of mitral valve might be one of main cause of IMR.Involution structure of mitral valve before surgery is helpful for surgeon to select an optical surgical procedure and evaluate effects of treatment in patients with IMR.