扩张型心肌病患者主动脉瓣环与二尖瓣环偶联机制及其与心功能的关系研究

Aortic and Mitral Annuli Coupling and Its Association with Cardiac Function in Patients with Dilated Cardiomyopathy

目的运用斑点追踪技术比较扩张型心肌病患者与正常人群主动脉瓣环和二尖瓣环位移(AE)及主动脉瓣二尖瓣环平面夹角(AMA)的大小及变化规律;评价二者间的偶联机制并探讨瓣环偶联运动与左室功能的相关性。方法纳入35例扩张型心肌病患者及35例性别年龄相匹配的健康人作为对照,采集经胸超声心动图图像。在胸骨旁长轴切面,使用Philips QLAB 9.0软件对瓣环各点AE及AMA进行二维定量。在心尖四腔心切面,使用Tomtec Arene1.0三维软件获取左室射血分数(LVEF)及整体纵向、环向及径向应变参数。结果与正常对照相比,扩张型心肌病患者各瓣环处AE明显减小,AMAmax及AMAmin增大,AMAmax-min减小,差异有统计学意义,其AE及AMA在心动周期内的变化规律与正常对照略有差异,即AMA在舒张期较早地达到最大值且变化幅度减小。各AE均与LVEF及各向应变正性相关,AMAmax及AMAmin与各AE、LVEF及各向应变负性相关,AMAmax-min与各AE、LVEF及各向应变正性相关(P均<0.05)。结论斑点追踪技术可用于快速方便地定量AE、AMA、LVEF及各向应变。扩张型心肌病患者主动脉瓣环和二尖瓣环的偶联运动存在异常,与左室收缩功能密切相关。瓣环位移及夹角可较方便、快速地判断心脏整体及局部收缩功能。

Objective To compare the mitral and aortic annuli excursion （AE） and aortomitral angle （AMA） variations between patients with and without dilated cardiomyopathy （ DCM ） using speckle tracking echoeardiography （STE）, and determine the role of annuli dynamics and coupling behaviors in the left ventricular function. Methods Thirty-five patients with DCM and thirty-five age and sex matched healthy adults underwent transthoracic echocardiographic examinations. In the parasternal long-axis view, the AE and AMA variations were measured using Philips QLAB 9.0 software. In the apical four chamber view, the left ventricular ejection fraction （LVEF）, longitudinal, circumferential, and radial strain were measured using Tomtec Arene 1.0 software. Results The DCM patients had significantly smaller AE and AMA max-min, bigger AMAmax and AMAmin, and varied cardiac cycle compared with the healthy adults. The AMA of DCM patients increased to its maximal value earlier in diastole with little variation. AE was positively correlated with LVEF and multidirectional strain. AMAmax and AMAmin were negatively correlated with AE, LVEF and multidirectional strain （P〈 0. 05）. Significant correlations were also found between AMAmax-min and AE, LVEF and multidireetional strain （P〈0.05）. Conclusion AE, AMA, LVEF and multidirectional strain can be quantified using STE, The coupling of mitral and aortic annuli in DCM patients is abnormal and correlated well with left ventricular systolic function. AE and AMA can be conveniently used for estimation of integral and regional cardiac function.