二尖瓣环位移与实时三维超声对照评价扩张型心肌病左心室收缩功能

Comparative evaluation of mitral annular displacement and real-time 3D echocardiography on left ventricular systolic function in patients with dilated cardiomyopathy

目的探讨组织运动二尖瓣环位移自动追踪技术(TMAD)评估扩张型心肌病(DCM)左心室收缩功能的临床应用价值。方法对DCM患者32例(LVEF≤35%组23例,LVEF>35%组9例)、健康体检者30名(对照组)均进行常规超声心动图检查和实时三维超声心动图(RT-3DE)检查,测得左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF);采用TMAD技术测量二尖瓣环位移(TMAD)参数,包括后间隔处瓣环插入点最大位移(TMAD sep)、左心室侧壁处瓣环插入点最大位移(TMAD lat)、后间隔-侧壁瓣环连线中点的最大位移(TMAD Midpt)及左心室长轴缩短率(TMAD Midpt%),分析比较各组各参数及TMAD参数与LVEF的相关性。结果 LVEF≤35%组LVEDV、LVESV均大于对照组(P均<0.01),LVEF低于对照组(P<0.01);LVEF>35%组LVEDV、LVESV均大于对照组(P均<0.01),LVEF低于对照组(P<0.01);LVEF≤35%组TMAD sep、TMAD lat、TMAD Midpt、TMAD Midpt%均低于LVEF>35%组和对照组(P均<0.01),LVEF>35%组TMAD sep、TMAD lat、TMAD Midpt、TMAD Midpt%均低于对照组(P均<0.01)。DCM患者TMADsep、TMAD lat、TMAD Midpt、TMAD Midpt%均与LVEF呈正相关(r=0.64、0.69、0.70、0.75,P均<0.05)。结论 TMAD技术所测的瓣环位移参数有可能成为评价DCM左心室收缩功能的一种新的、可靠性指标。

Objective To explore the clinical value of tissue motion mitral annular displacement automatic tracking technology （TMAD） in evaluating left ventricular systolic function in patients with dilated cardio myopathy （DCM）. Methods Thirty-two patients with DCM （23 cases in LVEF≤35 % group, 9 cases in LVEF〉35 % group） and thirty healthy subjects （control group） were enrolled and underwent routine echocardiography. The left ventricular end-diastolic volume （LVEDV）, end systolic volume （LVESV） and left ventricular ejection fraction （LVEF） were measured by real-time three dimensional echocardiography （RT-3DE）. TMAD parameters such as maximal displacement at interventricular septum （TMAD sep）, maximal displacement at left ventricular lateral wall （TMAD lat）, middle point of mitral annulus （TMAD Midpt） and left ventricular longitudinal shortening （TMAD Midpt%） were measured. Those parameters among the three groups were compared, and the correlation between parameters of TMAD and LVEF derived from RT-3DE were analyzed. Results LVEDV, LVESV of LVEF≤35% group were higher than those of control group （all P〈0.01）, LVEF was lower than that of control group （P〈0.01） ; LVEDV, LVESV of LVEF〉35% group were higher than those of control group （all P〈0.01）, LVEF was lower than that of control group （P〈0.01） TMAD parameters such as TMAD sep, TMAD lat, TMAD Midpt, TMAD Midpt% of LVEF≤35% group were significantly lower than those of LVEF〉35 % group and control group （all P〈0.01）, above mentioned TMAD parameters of LVEF〉35% group were significantly lower than those of control group （all P〈0.01）. The correlation between TMAD sep, TMAD lat, TMAD Midpt, TMAD Midpt% and LVEF measured by RT-3DE in DCM group was positive （r=0. 64, 0. 69, 0. 70, 0.75, all P〈0. 05）. Conclusion TMAD technique of measuring TMAD expects to be a new and reliable approach to evaluate left ventricular systolic function in patients with DCM.