组织运动二尖瓣环位移技术评价扩张型心肌病患者左心室收缩同步性

Evaluation of left ventricular systolic synchrony in patients with dilated cardiomyopathy by tissuemotion mitral annular displacement

目的探讨应用组织运动二尖瓣环位移技术(TMAD)评价扩张型心肌病(DCM)患者左心室收缩同步性的价值。方法选取2013年10月至2016年5月吉林大学中日联谊医院收治的DCM患者38例,作为扩张型心肌病组(DCM组),30名健康志愿者作为健康对照组,对DCM组与健康对照组行常规超声心动图检查,测量2组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),应用TMAD技术测量二尖瓣环6个位点(前间隔、后间隔、前壁、侧壁、后壁、下壁)的位移达峰时间(TP),计算出二尖瓣环位移达峰时间标准差(TP-SD)、二尖瓣环位移达峰时间最大差(TP-DIF),比较2组患者超声参数,并分析TP-SD、TP-DIF与LVEF的相关性。采用实时三维超声心动图(RT-3D)获取DCM组左心室16个节段的收缩末期容积达峰时间标准差(Tmsv16-SD),16节段收缩末期容积达峰时间最大差(Tmsv16-DIF)并分别与DCM组TP-SD、TP-DIF进行相关性分析。结果 DCM组LVEDV、LVESV测值显著高于健康对照组[(209.87±44.23)mm vs(93.12±12.29)mm,(158.45±41.32)mm vs(32.16±4.03)mm],差异有统计学意义(t=14.023、16.643,P均<0.01),DCM组LVEF测值与健康对照组相比明显减低,差异有统计学意义(t=26.112,P<0.01);DCM组6个位点的TP、TP-SD、TP-DIF测值均较健康对照组增加,差异有统计学意义(t=7.628、6.869、7.507、6.616、5.631、4.738、7.368、5.777、6.781,P均<0.01),TP-SD、TP-DIF与LVEF测值均呈负相关,差异有统计学意义(r=-0.645、-0.513,P均<0.05);TP-SD与Tmsv16-SD、TP-Dif与Tmsv16-Dif测值均呈正相关,差异有统计学意义(r=0.643,P<0.01;r=0.563,P<0.05)。结论本研究通过应用TMAD技术测量二尖瓣环位移达峰时间来评价左心室运动同步性,简便易行,无角度依赖性,有望成为评价左心室同步性的新方法。

Objective To investigate the value of tissue motion mitral annular displacement（TMAD） in assessment of left ventricular systolic synchrony in patients with dilated cardiomyopathy（DCM）.Methods Thirty-eight DCM patients and 30 healthy subjects were enrolled in this study.The left ventricular end diastolic volume（LVEDV）,left ventricular end systolic volume（LVESV）,and left ventricular ejection fraction（LVEF） in two groups were investigated using conventional echocardiographyexamination.The time of systolic mitral annular peak displacement（TP） in two groups were measured by the technique of TMAD at six sites（anteroseptal,posteroseptal,anterior,lateral,posterior and inferior）.The standard deviation of TP（TP-SD） and the maximal difference of TP（TP-DIF） were calculated.And the correlation between TP-SD and LVEF as well as TP-DIF and LVEF in the DCM group were analyzed.The standard deviation and maximal difference of the time to point with minimal systolic volume of 16 segments（Tmsv16-SD,Tmsv16-DIF） of the DCM group were measured by the technique of real-time three-dimensional echocardiography（RT-3D）.And the correlation between Tmsv-16SD and TP-SD as well as Tmsv16-DIF and TP-DIF were analyzed.Results Compared with the healthy subjects,LVESV and LVEDV increased（t=14.023,16.643,P〈0.01）and the LVEF decreased significantly（t=26.112,P〈0.01）in the DCM group.TP,TP-SD and TP-DIF in the DCM group obviously increased（t=7.628,6.869,7.507,6.616,5.631,4.738,7.368,5.777,6.781,P〈0.01）.TP-SD and TP-DIF were negatively correlated with LVEF（r=-0.645,-0.513,P〈0.05）,while TP-SD and Tmsv16-SD,TP-Dif and Tmsv16-Dif were positively correlated（r=0.643,P〈0.01;r=0.563,P〈0.05）.Conclusions In this study,the TMAD technique was used to measure the time of peak displacement of mitral annulus to evaluate the synchrony of left ventricle movement.It is expected to be a new method in evaluation of the synchrony of left ventricle,which is simple,feasible approach without angle dependence.