组织运动二尖瓣环位移评价急性前壁心肌梗死患者左室整体收缩功能的临床价值

Clinical value of tissue motion mitral annular displacement in review of global left ventricular systolic function in patients with acute anterior myocardial infarction

目的探讨组织运动二尖瓣环位移（TMAD)评价急性前壁心肌梗死患者的左室整体收缩功能的临床价值。方法选择宜宾市第一人民医院胸心外科于2012年1月~2015年8月收治的79例急性前壁心肌梗死患者（观察组）及同期进行体检的60例健康对照者（对照组）为研究对象。采用PhilipsIe33型超声诊断仪及配套探头常规二维超声行超声心动图检查，应用PhilipsQlab9.0分析软件中的TMAD插件，比较急性前壁心肌梗死患者与健康对照者常规二维超声结果左室射血分数（LVEF)、左室收缩末期内径（LVESD)及二尖瓣环收缩期速度（s)，TMAD参数（二尖瓣环6个位点位移、二尖瓣环位移相关指标）。结果急性前壁心肌梗死患者LVEF、LVESD、室间隔侧s、左室侧壁s分别为（48.0±2.65)%、(42.5±2.89)mm、（4.78±1.23)cm/s、（5.37±1.32)cm/s，对照组分别为（61.7±4.98)%。、（48.3±3.04)mm、（8.60±1.45)cm/s、（10.9±1.68)cm/s;与对照组比较，急性前壁心肌梗死患者LVEF显著减小，LVESD及室间隔侧、左室侧壁二尖瓣环收缩期速度显著减小，差异具有统计学意义（P<0.05);与对照组比较，急性前壁心肌梗死患者二尖瓣环前后壁、前后间隔、下壁、左室侧壁6个位点的收缩期最大位移值均降低，差异具有统计学意义（P<0.05);与对照组比较，急性前壁心肌梗死患者心尖四腔、两腔、左室长轴收缩期二尖瓣环连线中点的最大位移值及其占左室长轴的百分比均降低，差异具有统计学意义（P<0.05)。结论对急性前壁心肌梗死患者，TMAD技术能够通过测量二尖瓣环不同位点位移参数值，准确、客观的评价其左心室收缩功能，具有简便、不依赖图像质量等优点。

Objective To discuss the clinical value of tissue motion mitral annular displacem ent(TMAD)in review of global left ventricular systolic function in patients with acute anterior myocardial infarction(AAMI).Methods AAMI patients(n=79,observation group)and healthy controls(n=60,control group)were chosen from theDepartment of Ultrasonography of First People’s Hospital of Yibin City from Jan.2012to Aug.2015.All groupswere given echocardiography examination of routine two-dimensional ultrasound by using Philips Ie33type ultrasonicdiagnostic apparatus and matched probe.The results of routine two-dimensional ultrasound[left ventricular ejectionfraction(LVEF),left ventricular end-systolic diam eter(LVESd)],systolic mitral annular velocity(s)]and TMADparameters(6locus displacement and displacement related indexes of mitral annulus)were compared between2groupsby using TMAD plug-in in Philips Qlab9.0analysis software.Results LVEF was(48.0±2.65)%,LVESd was(42.5±2.89)mm,s of ventricular septum was(4.78±1.23)cm/s and s of left ventricular side wall was(5.37±1.32)cm/sin observation group,and LVEF was(61.7±4.98)%,LVESd was(48.3±3.04)mm,s of ventricular septum was(8.60±1.45)cm/s and s of left ventricular side wall was(10.9±1.68)cm/s in control group.LVEF decrease significantly,and LVESd,s of ventricular septum and s of left ventricular side wall decreased significantly in observation groupcompared with control group(P<0.05).The maximum systolic displacement values of mitral annulus at6loci(anteriorand posterior walls,anterior and posterior septa,inferior wall and left ventricular side wall)decreased in observationgroup compared with control group(P<0.05).The maximum displacement value and its percentage in left ventricularlong-axis in apical four chambers,two cardiac chambers and left ventricular long-axis systolic mitral annulus midpointdecreased in observation group compared with control group(P<0.05).Conclusion TMAD can review exactly andobjectively the left ventricular systolic function,through measuring parameters of mitral annular displacement at6loci,with the advantages of easy and independent of imagine quality in patients with AMI.