二尖瓣环位移与实时三维超声心动图评价心力衰竭患者左心功能的对比研究  

Comparative Study of Mitral Annular Displacement and Real-time 3D Echocardiography in Evaluating Left Ventricular Function in Patients with Heart Failure

作　　者：颜社平[1] 王银荣[1] 闫瑞玲 庄磊[1] 王伟娟[1] 

机构地区：[1]解放军乌鲁木齐总医院超声科,乌鲁木齐市830000 [2]解放军兰州总医院超声科

出　　处：《中国超声医学杂志》2013年第12期1078-1082,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的应用斑点追踪技术测量二尖瓣环位移(MAD)评价心衰患者左心功能,并与实时三维超声心动图(RT-3DE)进行对比分析,探讨其临床应用价值。方法研究对象包括射血分数正常的心衰患者(HFNEF)25例和射血分数减低心衰患者(HFREF)29例,另选健康者对照29例。采用实时三维超声心动图(RT-3DE)分别测量左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)、左心室射血分数(LVEF);使用斑点追踪显像技术(STI)测量二尖瓣环位移(MAD)参数:左室室间隔处瓣环插入点最大位移(TMAD1),左室侧壁处瓣环插入点最大位移(TMAD2),室间隔-侧壁瓣环连线中点的最大位移(TMAD Midpt)及其占左心室长径的百分数(即左心室长轴缩短率,TMAD Midpt%)。结果对照组、HFNEF组、HFREF组3组间LVEDV、LVESV依次递增,LVEF依次递减,但HFNEF与对照组相比LVEDV、LVESV差异无统计学意义(P均>0.05),其余各组间比较均有显著差异(P均<0.05)。心衰各组的MAD各测值均显著低于对照组,且HFREF组减低HRNEF组更为显著(P均<0.01)。MAD各参数与实时三维超声心动图所测LVEF均呈显著正相关,r值分别为0.73(TMAD1),0.71(TMAD2),0.74(TMAD-Midpt),0.78(TMAD-Midpt%)(P均<0.01)。结论斑点追踪显像技术测量MAD有望为心衰患者提供一种简便、快捷、可靠的新方法,尤其对于卧床、肺气干扰、声窗较差的老年患者优势更大。Objective To explore the value of mitral annular displacement（MAD） based on speckle tracking imaging（STI） in evaluating left ventricular function in patients with heart failure（HF） compared with real-time three dimensional echocardiography.Methods 25 heart failure cases with normal ejection fraction（HFNEF） and 29 heart failure cases with reduced ejection fraction（HFREF） were included in this study,as well as 29 healthy subjects regarded as control group.The left ventricular end diastolic volume（LVEDV）,end systolic volume（LVESV）,Left ventricular ejection fraction （LVEF） were measured by real-time 3D echocardiography （RT-3DE）.MAD parameters such as maximal displacement at interventricular septum （TMAD1）,maximal displacement at left ventricular lateral wall （TMAD2）,maximal displacement at the midpoint of interventricular septum and left ventricular lateral wall （TMAD-Midpt）,and left ventricular longitudinal shortening（TMAD-Midpt%） were measured and compared,and correlation between MAD parameters and LVEF by RT-3DE were analyzed.Results LVEDV,LVESV showed a tendency to increase and LVEF to decrease among the control group,HFNEF group and HFREF group,but LVEDV and LVESV showed no significant difference between HFREF group and control group （P〉0.05）.The parameters of MAD were significantly lower in HF group than those in control group,and the parameters of HFREF group decreased significantly compared to HFNEF group（P〈0.05）.The parameters of MAD correlated positively with LVEF measured by RT-3DE [r=0.73（TMAD1）,0.71（TMAD2）,0.74（TMAD-Midpt）,0.78（TMAD-Midpt%）]（all P〈0.05）.Conclusions Based on speckle tracking imaging technique,MAD would provide an novel,rapid and relible approach to de termine left ventricular function,especially in the old HF patients with poor accoustic windows.

关 键 词：斑点追踪显像技术 二尖瓣环位移 实时三维超声心动图 心力衰竭 左心室功能 

分 类 号：R541.6[医药卫生—心血管疾病]