应用组织二尖瓣环位移评价完全性左束支传导阻滞左心室收缩功能  

Assessment of left ventricular systolic function using tissue motion annular displacement of mitral valve in patients with left bundle branch block

作　　者：刘喜慧 李光源[1] 李珺[1] 王永槐[1] 孔凡鑫 杨军[1] 马春燕[1] LIU Xihui;LI Guangyuan;LI Jun;WANG Yonghuai;KONG Fanxin;YANG Jun;MA Chunyan(Department of Cardiovascular Ultrasound,First Hospital of China Medical University,Shenyang 110001,P.R.China)

机构地区：[1]中国医科大学附属第一医院心血管超声科,辽宁沈阳110001

出　　处：《医学影像学杂志》2020年第10期1789-1793,共5页Journal of Medical Imaging

基　　金：辽宁省自然科学基金联合基金项目(编号:20180530052);国家自然科学基金项目(编号:81871373)。

摘　　要：目的采用二维斑点追踪技术检测组织二尖瓣环位移(TMAD)评价完全性左束支传导阻滞(cLBBB)患者的左心室收缩功能。方法选取74例cLBBB患者作为病例组,同期收集年龄性别匹配的健康志愿者50例作为对照组,行超声心动图检测左心室收缩功能参数、TMAD各参数,比较两组各参数的差异。结果与对照组相比,cLBBB组除左心室射血分数(LVEF)减低外,左心室心腔参数均增大。依据LVEF是否低于53%,将cLBBB组分为保留组(pEF-cLBBB组)和减低组(dEF-cLBBB组),dEF-cLBBB组TMAD各参数均低于pEF-cLBBB组和对照组(P<0.001)。TMAD各参数均与LVEF呈正相关(r=0.65,r=0.65,r=0.68,r=0.73,P<0.001);TMADmid%预测LVEF减低的曲线下面积最大(0.916),当截断值为9.85%时,敏感度为90%,特异度为86%。结论cLBBB患者左心室收缩功能减低,即使LVEF保留的cLBBB患者左心室功能亦减低,TMAD参数中TMADmid%是预测LVEF减低的有效参数。TMAD参数可作为临床评价左心室收缩功能简便易行且准确灵敏的新参数。Objective To explore the value of tissue motion tracking of mitral annular displacement(TMAD)in the assessment of the mitral valve in evaluation of left ventricular systolic function in patients with complete left bundle branch block(cLBBB).Methods A total of 76 patients with cLBBB confirmed by electrocardiogram were enrolled in cLBBB group.And 50 age-matched healthy volunteers were collected as control group.All subjectives underwent echocardiography.The LVEF and parameters of TMAD were measured and recorded.The parameters of left ventricular systolic function and TMAD were detected by echocardiography,and the differences between the two groups were compared.Results Compared with the control group,the left ventricular ejection fraction(LVEF)was decreased in the cLBBB group,and other left ventricular parameters of chamber size were increased.According to whether the LVEF was lower than 53%,the cLBBB group was divided into pEF-cLBBB group(LVEF>53%)and dEF-cLBBB group(LVEF≤53%).The TMAD parameters of dEF-cLBBB group were lower than those of pEF-cLBBB group and control group(P<0.001).All parameters of TMAD were positively correlated with LVEF(r=0.65,r=0.65,r=0.68,r=0.73,P<0.001).TMADmid%predicted the maximum AUC of LVEF≤53%(0.916).When the cutoff value was 9.85%,the sensitivity was 90%and the specificity was 86%.Conclusion In cLBBB patients,left ventricular systolic function was decreased,even in cLBBB patients with preserved LVEF.Moreover,TMADmid%,one of the TMAD parameters,was an effective parameter to predict LVEF reduction.TMAD parameter can be used as a new parameter to evaluate left ventricular systolic function.

关 键 词：组织二尖瓣环位移 完全性左束支传导阻滞 左心室收缩功能 超声心动图 

分 类 号：R541[医药卫生—心血管疾病] R445.1[医药卫生—内科学]