组织运动瓣环位移评价缩窄性心包炎和限制性心肌病患者左心室收缩功能及其在鉴别诊断中的价值

Tissue Motion of Annular Displacement in the Evaluation of Left Ventricular Function and Differentiation between Constrictive Pericarditis and Restrictive Cardiomyopathy

目的利用组织运动瓣环位移(TMAD)评价缩窄性心包炎(CP)和限制性心肌病(RCM)患者左心室收缩功能及其在两者鉴别诊断中的应用价值。方法选取34例CP患者(CP组)和32例RCM患者(RCM组)作为病例组,同时选取35例正常健康人作为对照组,于心尖四腔心切面测量间隔和侧壁的二尖瓣瓣环位移(Dsep和Dlat)、平均位移(Dmid)及平均位移率(TMADmidpt%)。结果 CP组较对照组Dlat、Dmid和TMADmidpt%减低,Dsep正常,提示左心室收缩功能减低是由心包运动受限所致。RCM组各指标较CP组及对照组减低更明显,其原因可能与左心室心肌僵硬度增加有关。左心室射血分数与Dsep的相关性最佳(r=0.69,P <0.001)。当Dsep的截点值为8.45 mm时,可以有效地鉴别CP和RCM,敏感度为95.6%,特异度为92.4%。结论 CP及RCM患者左心室收缩功能均出现减低,但两者原因不同,左心室收缩功能减低程度不同。而TMAD可以为CP和RCM患者左心室收缩功能及两者鉴别诊断提供一种快速、可靠的方法。

Objective To evaluate left ventricular( LV) function in patients with constrictive pericarditis( CP) and in those with restric- tive cardiomyopathy( RCM) using the tissue motion of annular displacement( TMAD) and to analyze the clinical value of TMAD in the differential diagnosis between these two conditions. Methods In this study, 34 patients with CP and 32 patients with RCM were analyz- ed, and 35 healthy subjects were selected as the control group. The septal( Dsep) and lateral( Dlat) mitral annular longitudinal displace- ment, displacement in the midpoint( Dmid), and normalized midpoint displacement of the mitral ring( TMADmidpt%) were calculated in the apical four-chamber view. Results The Dlat, Dmid, and TMADmidpt% of the CP group were decreased compared with those of the control group, which indicated that the reduction was caused by pericardial restriction. The TMAD of the RCM group showed greater reduction than that of the CP and control groups, which may be due to increased myocardial stiffness. The correlation between Dsep and left ventricular ejection fraction was 0.69( P < 0.001 ). A cutoff value of 8.45 mm for Dsep could effectively differentiate CP from RCM with a sensitivity of 95.6% and a specificity of 92.4%. Conclusion Left ventricular function was decreased in patients with CP and in those with RCM, although the mechanism was different. TMAD can be used to precisely evaluate left ventricular myocardial function in patients with CP and RCM. TMAD is a readily obtained parameter that provides unique data for the differentiation between CP and RCM.