二尖瓣环位移斑点组织追踪成像在重症瓣膜病诊疗中的应用  

Tissue Mitral Annular Displacement Tracking Imaging in Diagnosis and Treatment of Valvular Disease

作　　者：纪淑姣[1] 李玉珍[1] 冯艳芬[1] 张莹莹[1] JI Shujiao;LI Yuzhen;FENG Yanfen;ZHANG Yingying(Department of Ultrasound,Henan Province Chest Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省胸科医院超声科,河南郑州450003

出　　处：《中国医学影像学杂志》2018年第8期590-594,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨二尖瓣环位移斑点组织追踪成像(TMAD)在重症瓣膜病合并心功能不全患者诊疗中的应用价值。资料与方法回顾性分析2014年3月-2016年10月河南省胸科医院收治的重症瓣膜病合并心功能衰竭[左心室射血分数(LVEF)<50%]患者48例,按照小剂量多巴酚丁胺负荷超声试验峰值剂量时每搏量增加是否>20%分为两组,A组有心肌收缩储备30例,B组无心肌收缩储备18例,均行外科瓣膜置换术,应用TMAD技术、心肌做功指数(Tei指数)及超声常规参数评价两组患者的手术治疗效果。结果 A组术后1、6个月的TMAD参数、LVEF与术前比较均明显升高,Tei指数减低(P均<0.05),B组术后1、6个月的TMAD参数、LVEF与术前比较均明显减低,Tei指数增高(P均<0.05);A组术后6个月LVEF、TMAD参数与术后1个月比较明显升高,Tei指数明显减低(P<0.05),B组TMAD参数术后6个月较术后1个月时明显减小(P<0.05),而LVEF、Tei指数变化差异无统计学意义(P>0.05)。A组、B组的二尖瓣环后间隔最大位移、二尖瓣环侧壁最大位移与LVEF的相关性良好(r=0.783、0.732,0.762、0.742,P均<0.05)。结论 TMAD参数可作为小剂量多巴酚丁胺负荷超声试验预测重症瓣膜病合并左心功能衰竭患者有无心肌收缩储备功能的另一个参考指标,且TMAD技术在瓣膜病的疗效评价及预后判断中具有重要价值。Purpose To investigate the value of mitral annulus displacement tissue tracking imaging(TMAD)speckle tracking imaging in diagnosis and treatment of the patients with severe valvular disease combined cardiac insufficiency.Materials and Methods Fortyeight patients with severe valvular disease combined cardiac insufficiency[with left ventricular ejection fraction(LVEF)<50%]in Henan Chest Hospital from March 2014 to October 2016 were retrospectively analyzed.They were assigned into two groups based on the presence(group A,n=30)or absence(group B,n=18)of contractile reserve(CR)by low-dose dobutamine stress echocardiography(LDSE).All the patients underwent surgical valvular replacement.TMAD parameters,Tei index and conventional ultrasonic parameters were used to evaluate the efficacy in the two groups.Results Compared with pre-operation,TMAD parameters and LVEF were improved,Tei index were decreased in group A after operation(P<0.05);while the parameters in group B showed opposite trends(P<0.05).Compared with 1 month after operation,TMAD parameters and LVEF were improved,Tei index were decreased in group A at 6th month after operation(P<0.05);while TMAD parameters were reduced(P<0.05),LVEF and Tei index were not significantly changed in group B at 6th month after operation(P>0.05).The maximal displacement at interventricular septum(TMADsep)and maximal displacement at left ventricular lateral wall(TMADlat)were well correlated with LVEF in both group A and group B(r=0.783,0.732,0.762 and 0.742,respectively,P<0.05).Conclusion TMAD parameters can be used as another indicator of LDSE to predict myocardial contractile reserve in patients with severe valvular disease combined cardiac insufficiency.In addition,TMAD is of great value in the evaluation of the efficacy and prognosis for patients with valvular disease.

关 键 词：心脏瓣膜疾病 心力衰竭 超声心动描记术 斑点追踪成像 心肌收缩 

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