组织运动二尖瓣环位移自动追踪技术评估冠心病患者左房功能的临床价值

Clinical value of tissue automated motion tracking of mitral annular displacement in evaluating left atrial function in coronary heart disease patients

目的探讨组织运动二尖瓣环位移自动追踪(TMAD)技术在评估不同病变程度冠心病患者左房功能中的临床价值。方法选取我院疑诊为冠心病患者88例,根据Gensini评分将其分为对照组30例(Gensini评分0分)、轻度病变组30例(Gensini评分<25分)及中重度病变组28例(Gensini评分≥25分)。应用双平面Simpson法获取各组左房总射血分数(LATEF)、被动射血分数(LAPEF)和主动射血分数(LAAEF),TMAD技术获取左房充盈期位移(TMAD-D)、被动射血期位移(TMAD-P)和左房收缩期位移(TMAD-S),比较各组上述参数的差异;分析冠状动脉病变患者TMAD-D与LATEF、TMAD-P与LAPEF、TMAD-S与LAAEF、TMAD参数与Gensini评分的相关性。绘制受试者工作特征(ROC)曲线分析TMAD参数对中重度冠状动脉病变的诊断效能。结果与对照组比较,轻度病变组LATEF、LAPEF、TMAD-D、TMAD-P均减小,中重度病变组LATEF、LAPEF、LAAEF、TMAD-D、TMAD-P、TMAD-S均减小,差异均有统计学意义(均P<0.05);与轻度病变组比较,中重度病变组LATEF、LAPEF、LAAEF、TMAD-D、TMAD-P、TMAD-S均减小,差异均有统计学意义(均P<0.05)。相关性分析显示,冠状动脉病变患者TMAD-D与LATEF、TMAD-P与LAPEF、TMAD-S与LAAEF均呈正相关(r=0.856、0.847、0.774,均P<0.001),TMAD-D、TMAD-P、TMAD-S与Gensini评分均呈负相关(r=-0.765、-0.551、-0.531,均P<0.001)。ROC曲线分析显示,TMAD-D、TMAD-P、TMAD-S诊断中重度冠状动脉病变的曲线下面积分别为0.951、0.841、0.835。结论TMAD技术能准确评估不同病变程度冠心病患者左房功能,可为临床提供参考依据。

Objective To explore the clinical value of tissue automated motion tracking of mitral annular displacement(TMAD)in evaluating left atrial function in coronary heart disease patients with different levels of coronary artery lesions.Methods According to Gensini score,a total of 88 patients with suspected coronary heart disease in our hospital were divided into control group(Gensini score=0,30 cases),mild lesion group(Gensini score<25,30 cases)and moderate to severe lesion group(Gensini score≥25,28 cases).Left atrial total ejection fraction(LATEF),left atrial passive ejection fraction(LAPEF)and left atrial active ejection fraction(LAAEF)were obtained by biplane Simpson method.Left atrial filling period displacement(TMAD-D),left atrial passive ejection period displacement(TMAD-P)and left atrial systolic period displacement(TMAD-S)were obtained by TMAD.The differences of the above parameters among the three groups were compared.The correlation between TMAD-D and LATEF,TMAD-P and LAPEF,TMAD-S and LAAEF,TMAD parameters and Gensini score in patients with coronary artery disease were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of TMAD parameters in diagnosing moderate to severe coronary artery disease.Results Compared with the control group,LATEF,LAPEF,TMAD-D and TMAD-P in the mild lesion group were decreased(all P<0.05),and LATEF,LAPEF,LAAEF,TMAD-D,TMAD-P and TMAD-S in the moderate to severe lesion group were decreased(all P<0.05).Compared with the mild lesion group,LATEF,LAPEF,LAAEF,TMAD-D,TMAD-P and TMAD-S in the moderate to severe lesion group were decreased(all P<0.05).Correlation analysis showed that there were positive correlations between TMAD-D and LATEF,TMAD-P and LAPEF,TMAD-S and LAAEF in patients with coronary artery disease(r=0.856,0.847,0.774,all P<0.001).TMAD-D,TMAD-P and TMAD-S were negatively correlated with Gensini score(r=-0.765,-0.551,-0.531,all P<0.001).ROC curve analysis showed that the area under the curve of TMAD-D,TMAD-P and TMAD-S in the diagnosis of moderate to severe coronary artery disease were 0.951,0.841 and 0.835,respectively.Conclusion TMAD can accurately evaluate left atrial function in coronary heart disease patients with different levels of coronary artery lesions,and can provide a reference.