缺血性心肌病患者二尖瓣环和主动脉瓣环夹角运动变化与左心室收缩功能关系的超声研究

Ultrasonic research on the correlation between aortomitral angle and left ventricular systolic function in the patients with ischemic cardiomyopathy

目的采用超声心动图评价缺血性心肌病（ICM）患者与健康人群二尖瓣环与主动脉瓣环平面夹角（AMA）的变化及其与左室收缩功能的关系。方法纳入31例ICM患者为ICM组，选取性别、年龄相匹配的健康人59例作为对照组，所有入选病例于胸骨旁左室长轴切面上，依次测量心电图R波顶点（R—AMA）、J点（J-AMA）、ST段中点（ST—AMA）、T波末（T—AMA）及P波末（P—AMA）对应的AMA，计算角度差△θ（AMAmax—AMAmin）及角度变化率（△θ／AMAmax）；应用2D-STE技术获取左室整体纵向应变（GLS）及整体周向应变（GCS）。采用Simpson双平面法测量左室射血分数（LVEF）、左室舒张末期容积（LVEDV）和左室收缩末期容积（LVESV）。结果对照组中J—AMA最大，而ICM组ST—AMA最大。ICM组中LVEDV、LVESV和各个时相的AMA均较对照组明显增大，而LVEF、GLS、GCS、△θ／AMAmax及△θ减小，差异均有统计学意义（P〈0．05）。对照组内，T—AMA与LVEF有相关性（r=-0．349，P=0．007），△θ与GLS呈负相关（r=-0．372，P=0．004）。ICM组中△θ／AMAmax及△θ与LVEF均有相关性（r=0．424，P=0．018；r=0．490，P=0．005）。结论ICM患者AMA明显增大，其△θ和△θ／AMAmax与LVEF密切相关，是心肌立体三维结构改变的一种表现。

Objective To evaluate the relationship between the change of the aortomitral angle （AMA） with left ventricular systolic function in patients with ischemic cardiomyopathy （ICM） by echocardiography. Methods Thirty-one patients were enrolled in the ICM group, and 59 healthy subjects were selected as the control group. On the parasternal left ventricular long axis plane, AMA were measured at the R wave apex （R-AMA）, J-point（J-AMA）, ST-segment midpoint（ST-AMA）, T-final wave （T-AMA） and P-final wave （P-AMA）. The angle difference（ △θ） = AMAmax- AMAmin, the angle changing rate = △θ/AMAmax. The global left ventricular longitudinal strain （GLS） and global circumferential strain （GCS） were obtained by 2D-speckle tracking echocardiography. Left ventricular ejection fraction（LVEF）, left ventricular end-diastolic volume（LVEDV） and left ventricular end-systolic volume（LVESV） were measured using Simpson biplane method. Results The J-AMA was the largest in the control group, while the ST-AMA was the largest in the ICM group. The levels of LVEDV, LVESV and AMA in ICM group were significantly higher than those in control group, while LVEF, GLS, GCS, △θ/AMAmax and d 0 were decreased （P 〈0.05）. In the control group, there was a correlation between T-AMA and LVEF （r = - 0.349, P = 0.007）,and △θ was negatively correlated with GLS （ r = - 0.372, P = 0.004）. In the ICM group, △θ/AMAmax and △θ were correlated with LVEF （ r = 0.424, P = 0.018; r = 0.490, P = 0.005）. Conclusions AMA in ICM patients is significantly increased. The angle difference and the rate of its change are closely related to the LVEF, which is a manifestation of three-dimensional structure change of the myocardial.