组织二尖瓣环位移评价冠状动脉慢性完全闭塞患者的左心室收缩功能

Assessment of left ventricular longitudinal systolic function in patients with chronic total occlusion using tissue-tracking mitral annular displacement

目的:采用二维斑点追踪成像(Two-dimension speckle-tracking echocardiography,2D-STE)技术检测组织二尖瓣环位移(Tissue-tracking mitral annular displacement,TMAD),评价左心室射血分数(Left ventricular ejection fraction,LVEF)保留且室壁运动正常的冠状动脉慢性完全闭塞(Chronic total occlusion,CTO)患者的左心室收缩功能,探讨其临床应用价值。方法:前瞻性分析2019年5月—2020年11月LVEF保留且室壁运动正常的CTO患者37例作为CTO组,健康受试者40例作为对照组,同时按照图像质量将受试者分为图像质量优、中、差组。采用2D-STE技术测量TMAD参数,包括室间隔位点位移(TMAD1)、侧壁位点位移(TMAD2)、瓣环连线中点处位移(TMAD Midpt)及TMAD Midpt与舒张末期左心室纵向长度的比值(TMAD Midpt%)。两组进行比较。结果:与对照组比较,CTO组的TMAD参数均显著降低(t/χ^(2)=-6.27、-5.88、-7.06、-8.93,P<0.001)。受试者工作特征(ROC)曲线分析显示TMAD Midpt%诊断LVEF保留和室壁运动正常的CTO患者的曲线下面积(AUC)为0.95,显著大于其他TMAD参数(P=0.03、0.002、0.01)。以TMAD Midpt%小于12.7%诊断CTO的敏感度为87.1%,特异度为95.0%。此外,各图像质量分组间TMAD参数比较无明显差异(P>0.05),且各组间TMAD Midpt%诊断CTO的AUC比较无显著差异(P>0.05)。TMAD Midpt%的观察者内和观察者间的组内相关系数均大于0.75,具有良好的重复性。结论:LVEF保留且室壁运动正常的CTO患者左心室收缩功能减低。TMAD Midpt%不受图像质量影响,重复性好,可以评价LVEF保留且室壁运动正常的CTO患者的左心室收缩功能,具有良好的临床应用价值。

Objective:To assess left ventricular systolic function in coronary artery chronic total occlusion(CTO)patients with preserved left ventricular ejection fraction(LVEF)and normal wall motion using tissue-tracking mitral annular displacement(TMAD)by two-dimension speckle-tracking echocardiography(2D-STE).Methods:From May 2019 to November 2020,37 CTO patients with preserved LVEF and normal wall motion were prospectively enrolled as the CTO group,and 40 healthy subjects without CTO were selected as the control group.According to the image quality,all subjects were divided into“good”,“medium”and“poor”.TMAD at interventricular septum(TMAD1),lateral wall(TMAD2),midpoint(TMAD Midpt)and the per-centage of TMAD Midpt to left ventricular longitudinal length at end-diastolic(TMAD Midpt%)were measured by 2D-STE.Results:TMAD parameters were significantly lower in the CTO group in comparison with the control group(t/χ^(2)=-6.27,-5.88,-7.06,-8.93,P<0.001).Receiver operating characteristic(ROC)curve analysis revealed the area under curve(AUC)of TMAD Midpt%was 0.95 in predicting the presence of CTO with preserved LVEF and normal wall motion,significantly better than the other TMAD parameters(P=0.03,0.002,0.01).The optimal cut-off TMAD Midpt%value for prediction of CTO was 12.7%(sensitivity:87.1%,specificity:95.0%).In addition,there were no significant differences in AUCs of TMAD parameters across the groups of image quality(P>0.05).The intra-and inter-observer correlation coefficients of TMAD parameters were>0.75,showing good intra-and inter-observer reproducibility.Conclusion:CTO patients with preserved LVEF and normal wall mo-tion have impaired left ventricular systolic function.TMAD Midpt%may be a reliable and reproducible approach to evaluate left ventricular systolic function in CTO patients with preserved LVEF and normal wall motion,which can provide potential clinical application value.