心肌梗死患者二尖瓣反流机制的超声心动图研究

Study of the mechanism of mitral regurgitation in patients with myocardial infarction by echocardiography

目的利用超声学方法探讨心肌梗死患者二尖瓣反流(mitral regurgitation,MR)的发生机制。方法选择2015年6月至2016年6月于海军总医院心内科住院治疗的84例心肌梗死患者(心梗组)和30例健康人(对照组)进行超声心动图检查,半定量判定二尖瓣反流程度,测量左室重构参数,左室舒张末容积(end diastolic volume,EDV)、左室收缩末容积(cend systolic volume,ESV)、瓣环-乳头肌间距(annular-papillary distance,APD)、射血分数(ejection fraction,EF),计算左室球形指数(sphericity indice,SI);测量二尖瓣几何形变参数,舒张期二尖瓣环面积(mitral annular area,MAA)、二尖瓣环收缩功能(mitral annular contraction,MAC)、对合高度(coaptation depth,CD)、对合点下面积(tenting area,TA)、前叶活动角度(AM angle)和左房容积指数(left atria volume index,LAVI)。结果心梗组MAA、TA、EDV、ESV、SI、APD、CD和LAVI高于对照组,MAC、AM angle和EF低于对照组(P <0. 05)。不同反流程度患者超声参数对比,随MR程度加重,MAA、TA、CD、EDV、ESV、SI、APD、LAVI逐渐增大,MAC、AM angle、EF逐渐减低。多因素回归分析发现,MR程度与TA、CD、MAA和LAVI相关。结论左室重构会引起MR,该影响是通过改变二尖瓣几何构型来实现的。

Objective To explore the mechanism of mitral regurgitation （MR） in patients with myocardial infarction by echocardiography. Methods Echocardiography was performed in 84 patients with myocardiol infarction and 30 normal subjects. MR was categorized using a senti quantitative method. Indices of left ventrical remodeling, left ventrical end-diastolic volume （EDV）, end systolic volume （ ESV）, annular-papillary distance （ APD）, ejection fraction （ EF）, as well as left ventrical sphericity index （ SI ） were detected in the study. Indices of geometric mitral valve deformation, including diastolic mitrial annular area （ MAA ）, matrial annular contraction （MAC）, coaptation depth （CD）, tenting area （TA）, anterior mitrial angle （AM angle） and left atrial volume index （LAVI） were also measured. Results Compared to those of the control group, the values of MAA, TA, EDV, ESV, SI, APD, CD and LAVI were all higher, while the values of MAC, AM angle and EF were lower than those of the control group （P 〈 0.05 ）. Echocardiography data in patients with different regurgitation worsened with the seriousness of MR. The values of MAA, TA, CD, EDV, ESV, SI, APD and LAVI were increased, while the values of MAC, AM angle and EF were decreased gradually. Logistic regression analysis of multi-variables revealed that level of MR was associated with those of TA, CD, MAA and LAVI, but was not associated with the indices of left ventrical remodeling. Conclusion Left ventrical remodeling could induce MR, the impact of which was achieved through the alteration of mitral geometry.