基于斑点追踪技术测定二尖瓣环位移评估甲亢性心脏病左心室收缩功能改变的临床研究

Clinical study on the measurement of mitral valve annulus displacement based on speckle tracking technology to evaluate the changes of left ventricular systolic function in hyperthyroid heart disease

目的探讨基于斑点追踪技术测定二尖瓣环位移(MAD)评估甲亢性心脏病左心室收缩功能改变的应用价值。方法选取2018年10月—2021年10月秦皇岛市第一医院80例甲亢性心脏病患者作为观察组,另选取同期收治单纯甲亢患者作为对照组。比较两组临床资料、游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室收缩末期容积(LVESV)、左室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、心室短轴缩短率(FS)、室间隔-侧壁瓣环点连线中点的最大位移(TMAD Midpt)、左心室侧壁瓣环插入点最大位移(TMAD2)、TMAD Midpt占左心室长径的百分比即左心室长轴缩短率(TMAD Midpt%)、室间隔瓣环插入点最大位移(TMAD1),分析甲亢性心脏病发病影响因素,同时分析二维超声测量参数、MAD参数与FT3、FT4相关性及二维超声测量参数与MAD参数相关性。结果观察组FT3、FT4、LVESD、LVEDD、LVESV、LVEDV水平高于对照组,FS、LVEF、TMAD1、TMAD2、TMAD Midpt、TMAD Midpt%水平低于对照组(P<0.05);FT3、FT4、LVESD、LVEDD、LVESV、LVEDV、FS、LVEF、TMAD1、TMAD2、TMAD Midpt、TMAD Midpt%均与甲亢性心脏病独立相关(P<0.05);Pearson相关性模型分析可知,甲亢性心脏病患者LVESD、LVEDD、LVESV、LVEDV与FT3、FT4呈正相关关系,FS、LVEF、TMAD1、TMAD2、TMAD Midpt、TMAD Midpt%与FT3、FT4呈负相关关系(P<0.05);甲亢性心脏病患者LVESD、LVEDD、LVESV、LVEDV与TMAD1、TMAD2、TMAD Midpt、TMAD Midpt%呈负相关关系,FS、LVEF与TMAD1、TMAD2、TMAD Midpt、TMAD Midpt%呈正相关关系(P<0.05)。结论基于斑点追踪技术测定MAD与LVESD、LVEDD、LVESV、LVEDV、FS、LVEF相关性良好,是评估甲亢性心脏病左心室收缩功能改变的新技术,可为甲亢性心脏病诊断提供帮助。

Objective To explore the application value of measuring the mitral annulus displacement(MAD)based on speckle tracking technology in evaluating the changes in left ventricular systolic function of hyperthyroid heart disease.Methods 80 patients with hyperthyroid heart disease in our hospital from October 2018 to October 2021 were selected as the observation group,and patients with pure hyperthyroidism admitted during the same period were selected as the control group.Comparison of clinical data,free thyroid hormone(FT4),free triiodothyronine(FT3),left ventricular endsystolic internal diameter(LVESD),left ventricular end-diastolic internal diameter(LVEDD),left ventricular endsystolic volume(LVESV),left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),ventricular short-axis shortening rate(FS)between the two groups(TMAD Midpt),the maximum displacement of the midpoint of the septal-lateral annulus line(TMAD Midpt),the maximum displacement of the insertion point of the left ventricular lateral annulus(TMAD2),the percentage of the TMAD Midpt to the long diameter of the left ventricle,i.e.the left ventricular long-axis shortening rate(TMAD Midpt%),and the maximum displacement of the insertion point of the septal annulus(TMAD1),to analyse the factors influencing the development of hyperthyroid heart disease.The 2D ultrasound measurement parameters,the correlation between MAD parameters and FT3 and FT4 and the correlation between 2D ultrasound measurement parameters and MAD parameters were also analysed.Results The levels of FT3,FT4,LVESD,LVEDD,LVESV,and LVEDV in the observation group were higher than those in the control group,and the%levels of FS,LVEF,TMAD1,TMAD2,TMAD Midpt,and TMAD Midpt were lower than those in the control group.The difference was statistically significant(P<0.05);Logistic regression analysis shows that FT3,FT4,LVESD,LVEDD,LVESV,LVEDV,FS,LVEF,TMAD1,TMAD2,TMAD Midpt,TMAD Midpt%are independently related to hyperthyroid heart disease(P<0.05);Pearson is related Sexual model analysis shows that LVESD,LVEDD,LVESV,LVEDV and FT3,FT4 are positively correlated in patients with hyperthyroid heart disease,and FS,LVEF,TMAD1,TMAD2,TMAD Midpt,TMAD Midpt%are negatively correlated with FT3,FT4(P<0.05);LVESD,LVEDD,LVESV,LVEDV and TMAD1,TMAD2,TMAD Midpt,TMAD Midpt%are negatively correlated in patients with hyperthyroid heart disease,and FS,LVEF are positively correlated with TMAD1,TMAD2,TMAD Midpt,and TMAD Midpt%(P<0.05).Conclusion The determination of MAD based on the speckle tracking technique has a good correlation with LVESD,LVEDD,LVESV,LVEDV,FS,and LVEF.It is a new technique for evaluating the changes in left ventricular systolic function of hyperthyroid heart disease,and can provide help for the diagnosis of hyperthyroid heart disease.