联合三维应变及多普勒参数评价射血分数正常的二尖瓣反流患者左心室收缩功能异常  

Assessment of left ventricular function in mitral regurgitation patients using three-dimensional strain and doppler parameters

作　　者：陈海燕[1] 潘翠珍[1] 王毓琳[2] 潘荪[2] 王春生[2] 舒先红[1] 

机构地区：[1]复旦大学附属中山医院上海市心血管研究所心超室,上海200032 [2]复旦大学附属中山医院上海市心血管研究所心外科,上海200032

出　　处：《中华临床医师杂志（电子版）》2012年第4期43-46,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：复旦大学附属中山医院2010中山青年基金(367)

摘　　要：目的应用三维斑点追踪技术和多普勒超声指标综合评价二尖瓣关闭不全时左心室收缩功能。方法随机入组30例器质性二尖瓣关闭不全患者[男16例,平均(50.72±11.52)岁]和30例性别、年龄匹配的正常对照[男18例,平均(46.86±8.67)岁],分别作为病例组及对照组。所有研究对象行常规超声心动图检查,并应用脉冲多普勒(PW)采集肺动脉、主动脉及二尖瓣口血流频谱(Philip IE33,s5-1);于心尖四腔心观采集全容积三维图像(Philip IE33,X3-1)。测量肺动脉(PA)、主动脉(AO)及二尖瓣口(MV)PW速度时间积分(VTI);左心室等容收缩及等容舒张时间。应用TOM-TEC分析软件4D-LV功能测量左心室17节段三维应变(S),计算基底段(b)、中间段(m)及心尖段(a)三维应变峰值及达峰时间(Sb,Tb,Sm,Tm,Sa,Ta)。上述所有指标均用体表面积(BSA)或心动周期进行校正。结果病例组左心室收缩期三维应变峰值增大(P<0.05),左心室等容收缩期延长(P<0.05),三维应变达峰时间延迟(P<0.05)。结论左心室收缩期三维应变峰值受二尖瓣特殊容量负荷变化影响,无法客观评价其左心室收缩功能;而收缩期左心室三维应变达峰时间和左心室等容收缩时间不受容量变化干扰,有望用于二尖瓣关闭不全患者的随访。Objective To interpret the specific dynamic status of mitral regurgitation through the combination of 3D strain and Doppler imaging.Methods Thirty consecutive non-ischemic mitral regurgitation patients[16 male patients,average（50.72±11.52）years old]and 30 healthy volunteers[18 male patients,average（46.86±8.67）years old]were randomly enrolled as Patient Group and Control Group,respectively.All the subjects received routine,Doppler and 3D echocardiography（Philip IE33,s5-1,X3-1）.Velocity time integrity（VTI）at pulmonary artery,aorta and mitral valve,iso-systolic and iso-diastolic time of left ventricle were measured.3D data were analyzed off-line by TOM-TEC 4D LV analysis station to get Systolic Peak Strain（S）of basal（Sb）,middle（Sm）and apical segments（Sa）and their time to peak（Tb,Tm and Ta）.All the parameters were indexed by body surface area（BSA）or cardiac cycle.Results Systolic peak of 3D strain increased in Patient Group（P0.05）while Time to Peak 3D strain was delayed（P0.05）and iso-systolic time was prolonged（P0.05）.Conclusions Peak 3D strain can be influenced by mitral regurgitation and thus is not able to evaluate its left ventricluar function accurately.However,Time to Peak 3D strain and Iso-volumic period are less volume-dependent and may be helpful in follow-up of mitral regurgitation patients.

关 键 词：超声心动描记术 三维 超声心动描记术 多普勒 二尖瓣闭锁不全 心室功能 

分 类 号：R542.51[医药卫生—心血管疾病] R445.1[医药卫生—内科学]