组织多普勒评价风心病二尖瓣狭窄患者经皮球囊扩张术前后心房内及心房间电机械延迟  

Assessment of intratrial and interatrial electromechanical delay in patients with rheumatic mitral stenosis before and after percutaneous balloon mitral valvuloplasty by tiusse Doppler imaging

作　　者：邓燕[1] 郭盛兰[1] 张莉[1] 吴棘[1] 

机构地区：[1]广西医科大学第一附属医院超声科,530021

出　　处：《江苏医药》2012年第13期1529-1532,共4页Jiangsu Medical Journal

基　　金：广西自然科学基金(2010GXNSFA013138);广西医疗卫生自筹经费计划课题(Z2011363)

摘　　要：目的探讨组织多普勒成像(TDI)评价风湿性心脏病单纯性二尖瓣狭窄(MS)患者经皮球囊扩张术(PBMV)前后心房内和心房间电机械延迟的价值。方法采用TDI测量30例对照组和30例MS合并窦性心律患者(PBMV术前、后)P波起始点至心尖四腔观左室侧壁、室间隔侧二尖瓣环及右室侧壁三尖瓣环组织多普勒曲线上A波起始点的时限(P-LA、P-IAS、P-RA),计算左房内、右房内及左右心房间电机械延迟(T1、T2、T3),即P-LA与P-IAS、P-IAS与P-RA、P-LA与P-RA差值;分析MS患者这些指标变化值与左房容积指数(LAVI)、左房内径指数(LADI)、二尖瓣口面积(MVA)、平均二尖瓣跨瓣压差(MMG)变化值的相关性。结果 MS患者P-LA、P-IAS较对照组明显延长(P<0.05),PBMV术后明显缩短(P<0.05);T1、T2、T3较对照组明显增大(P<0.05),PBMV术后明显减少(P<0.05)。P-LA、P-IAS及T1、T3变化值与LAVI变化值呈显著相关(P<0.05),而与LADI、MVA、MMG变化值无明显相关关系(P>0.05)。结论 TDI可准确评价MS患者心房内和心房间电机械延迟;PBMV术后MS患者电机械活动的改善与左房容积缩小关系密切。Objective To study the value of tiusse Doppler imaging（TDI） in evaluating the intratrial and interatrial electromechanical delay in the patients with rheumatic mitral stenosis（MS） before and after percutaneous balloon mitral valvuloplasty （PBMV）. Methods The intraatrial and interatrial electromechanical delay was examined with TDI before and after PBMV in 30 MS patients with sinus rhythm（group MS）. The results were compared to those of 30 healthy volunteers（group C）. The interval of time from the initiation of the P wave on the surface electrocardiogram（ECG） to the onset of TDI-derived A wave at the level of left ventricular lateral mitral annulus, septal mitral annulus, and right ventricular tricuspid annulus （P-IAS, P-LA, P-RA） was measured. Intraatrial electromechanical delay was defined as the differences between P-LA and P-IAS （T1）, P-IAS and P-RA（T2）. Interatrial electromechanical delay was defined as the difference between P-LA and P-RA （T3）. The correlations between the changes of indices measured by TDI and the changes of left volume index （LAVI）, left atrial diameter index （LADI）, mitral valve area （MVA）, mean mitral gradient（MMG） were analyzed. Results P-LA and P-IAS were significantly longer in group MS than those in group C（P〈0. 05）, and T1, T2 and T3 were higher in group MS than those in group C （P〈0. 05）. The indices in group MS were decreased after PBMV（P〈0. 05）. There was a significant correlation between the changes of P-LA,PqAS and T1 ,T3 with the changes of LAVI（P〈0. 05） ,but not with the changes of LADI, MVA and MMG（P〈0. 05）. Conclusion Intratrial and interaatrial electromechanical delay in the patients with MS can be assessed by TDI. The improvement of atrial electromechanical conduction is closely related to the decrease of left atrial volume after PBMV.

关 键 词：组织多普勒成像 二尖瓣狭窄 电机械耦联 

分 类 号：R541[医药卫生—心血管疾病]