组织二尖瓣环位移在评价冠状动脉慢血流患者左心室收缩功能中的应用价值

Application value of tissue mitral annular displacement in evaluating left ventricular systolic function in patients with coronary slow flow

目的:应用组织二尖瓣环位移(TMAD)检测冠状动脉慢血流(CSF)患者左心室收缩功能并探讨其可行性。方法:选取CSF患者64例(CSF组)及同期对照组患者50例(Con组)。采用超声心动图测量左心室射血分数(LVEF)、左心室整体纵向应变(LVGLS)以及TMAD各参数,比较两组间的差异;同时比较LVEF、LVGLS和TMAD参数的图像获取成功率、参数分析时间及参数测量重复性。结果:CSF组的LVGLS及TMAD各参数均低于Con组(P<0.05);TMAD各参数与受累冠脉支数、mTFC及LVGLS均呈负相关(P<0.05),二尖瓣环侧壁位点位移(TMAD2)、间隔与侧壁两点连线中点位移(TMADmid)、中点位移率(TMADmid%)与LVEF呈正相关(P<0.05);TMADmid%和M-E/A联合识别CSF的AUC最大(AUC:0.76;95%CI:0.67~0.83;P<0.001);TMAD参数的图像获取成功率高于LVEF和LVGLS(P<0.05),TMAD参数测量时间短于LVEF及LVGLS(P<0.001),TMAD参数ICC最高,具有较好的观察者内和观察者间的重复性。结论:CSF患者左心室收缩功能减低,TMAD参数尤其是TMADmid%可作为评估CSF左心室收缩功能的可靠指标,与LVEF和LVGLS相比,TMAD参数的获取更高效,重复性更好且不依赖图像质量。

Objective:The aim of this study was to use tissue mitral annular displacement(TMAD)to detect left ventricular systolic function in patients with coronary slow flow(CSF),and to explore its feasibility.Methods:Sixty-four patients with CSF(CSF group)and 50 patients with control group(Con group)were selected.Echocardiography was used to measure the parameters of left ventricular ejection fraction(LVEF),left ventricular global longitudinal strain(LVGLS)and TMAD parameters.The differences between the two groups were compared.The success rate of image acquisition,time of parameter analysis and repeatability of parameter measurement of LVEF,LVGLS and TMAD were compared.Results:LVGLS and TMAD parameters in CSF group were lower than those in Con group(P0.05).The parameters of TMAD were negatively correlated with the number of involved coronary vessels,mTFC and LVGLS(P0.05),TMAD2,TMADmid and TMADmid%were positively correlated with LVEF(P0.05).The combination of TMADmid%and M-E/A had the largest AUC for identifying CSF(AUC:0.76;95%CI:0.67~0.83;P0.001).The success rate of image acquisition of TMAD parameters was higher than that of LVEF and LVGLS(P0.05),and the measurement time of TMAD parameters was shorter than that of LVEF and LVGLS(P0.001).TMAD parameters had the highest ICC,and had excellent intra-observer and inter-observer repeatability.Conclusion:Left ventricular systolic function is decreased in patients with CSF.TMAD parameters,especially TMADmid%,can be used as a reliable indicator to evaluate left ventricular systolic function in CSF.Compared with LVEF and LVGLS,the acquisition of TMAD parameters is more efficient,with better repeatability and independent of image quality.