TMAD技术在无症状重度主动脉瓣狭窄患者预后评估中的价值  

The value of TMAD in the prognosis of patients with asymptomatic severe aortic stenosis

作　　者：任永凤[1] 陆静[1] 李娜娜 王效军 李琦 REN Yongfeng;LU Jing;LI Nana;WANG Xiaojun;LI Qi(Department of Ultrasonic Medicine,Bozhou Hospital Affiliated to Anhui Medical University,Bozhou 236800,China)

机构地区：[1]安徽医科大学附属亳州医院超声医学科,安徽亳州236800

出　　处：《医学影像学杂志》2024年第4期12-15,共4页Journal of Medical Imaging

基　　金：安徽医科大学临床科研基金项目(编号:2021xkj218)。

摘　　要：目的 探讨组织追踪二尖瓣环位移(tissue-tracking mitral annular displacement,TMAD)技术对保留射血分数(LVEF)无症状重度主动脉瓣狭窄(severe aortic stenosis,SAS)患者预后评估中的预测价值。方法 选取60例保留LVEF≥50%无症状SAS患者,依据随访有无发生主要心血管不良事件(MACE)分成A、B两组。采集患者连续4个心动周期心尖四腔、三腔及两腔切面动态图像,双平面辛普森法测量左心室LVEF。利用二维斑点追踪超声心动图技术获取左心室整体纵向应变(left ventricular globe Longitudinal straing,LVGLS),四腔心获取间隔与侧壁瓣环连线中点的纵向平均位移(TMAD),设备并可自动获取TMAD占舒张末期左心室长径的百分比(TMAD Midpt),检查后进行24个月的随访。比较两组上述各参数的差异,并分析TMAD Midpt预测SAS患者发生心脏相关事件的价值。结果 60例患者中A组21例,占35.0%,B组39例,占65.0%。A组TMAD Midpt及LVGLS显著低于B组,差异有统计学意义(P<0.01),两组间LVEF差异无统计学意义(P>0.05);A组患者心肌质量指数(myocardial mass index,MI)与B型脑钠肽(BNP)高于B组,差异有统计学意义(P<0.01),其他临床资料及超声心动图参数比较差异无统计学意义(P>0.05)。60例患者TMAD Midpt随着LVGLS的降低而降低,两者呈显著正相关(r=0.696,P<0.01)。ROC曲线分析,TMAD Midpt预测心脏事件与LVGLS具有相当的价值,曲线下面积分别为0.897、0.901(P<0.01)。结论 TMAD技术可以简便、快速地评估左心室射血分数保留的无症状SAS患者左心室功能损害,评估该类患者预后具有重要价值,值得临床推广应用。Objective To investigate the value of tissue tracking mitral annular displacement(TMAD)in evaluating left ventricular longitudinal motor function and prognosis in patients with preserved ejection fraction asymptomatic severe aortic stenosis(SAS).Methods Sixty asymptomatic SAS patients with preserved ejection fraction(LVEF≥50%)were selected and divided into two groups,i.e.,group A and B,based on the follow-up results and the occurrence of cardiovascular related time.All selected patients were asymptomatic patients with preserved ejection fraction(LVEF≥50%)at the initial examination,and were followed up for 24 months.The dynamic images of apical four chamber,three chamber and two chamber sections were collected for 4 consecutive cardiac cycles,and the left ventricular ejection fraction(LVEF)was measured by biplane Simpson method.The left ventricular global longitudinal strain(LVGLS)was obtained by two-dimensional speckle tracking echocardiography,and the longitudinal mean displacement of the midpoint between the septum and the lateral valve ring was obtained by four chamber heart(TMAD).The equipment can automatically obtain the percentage of TMAD in the end diastolic left ventricular length diameter(TMAD Midpt).The differences of the above parameters between group A and group B were compared,and the value of TMAD Midpt in predicting cardiac related events in SAS patients was analyzed.Results Among the 60 patients,there were 21 cases in group A,accounting for 35.0%,and 39 cases in group B,accounting for 65.0%.TMAD Midpt and lvgls in group A were significantly lower than those in group B(P<0.01),and there was no significant difference in LVEF between the two groups(P>0.05).The myocardial mass index(MI)and B-type brain natriuretic peptide(BNP)in group A were significantly higher than those in group B(P<0.01),but there was no significant difference in other clinical data and echocardiographic parameters(P>0.05).TMAD Midpt decreased with the decrease of LVGLS in 60 patients,and there was a significant positive corre

关 键 词：主动脉瓣狭窄 二尖瓣环位移 左心室收缩功能 超声检查 

分 类 号：R542.5[医药卫生—心血管疾病] R445.1[医药卫生—内科学]