上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (3): 313-.doi: 10.3969/j.issn.1674-8115.2011.03.015

• 论著（临床研究） • 上一篇    下一篇

二尖瓣环位移对肥厚性重构患者左室收缩功能的评估作用

吴卫华, 黄 艳, 陆 静, 马 兰, 魏松霞, 谢晓奕, 刘奇志, 王 雷, 杨 玲   

  1. 上海交通大学附属胸科医院超声科, 上海 200030
  • 出版日期:2011-03-28 发布日期:2011-03-29
  • 作者简介:吴卫华（1961—）, 女, 主任医师, 学士；电子信箱: liu987@vip.sina.com。

Evaluation of left ventricular systolic dysfunction by mitral annular displacement in patients with cardiac hypertrophy and remodeling

WU Wei-hua, HUANG Yan, LU Jing, MA Lan, WEI Song-xia, XIE Xiao-yi, LIU Qi-zhi, WANG Lei, YANG Ling   

  1. Department of Echocardiography, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2011-03-28 Published:2011-03-29

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摘要：

目的 应用超声二维斑点追踪显像技术测定二尖瓣环位移（MAD），探讨其在评估肥厚性重构所致的早期左室收缩功能减退方面的临床应用价值。方法 选择86例左室射血分数（LVEF）正常（>50%）的各类心肌肥厚（左室壁厚度≥12 mm）患者作为研究对象。采用Philips Sonos iE33超声仪进行检查，先通过M型超声计算出相对室壁厚度（RWT），然后取心尖四腔观分别采集二维和实时三维全容积（RT3D）图像。应用QLAB 6.2在机量化分析软件分别获取MAD相关参数（包括二尖瓣环中点位移和左室长轴缩短率）和经RT3D图像测得左室射血分数（RT3DLVEF）；计算三维心肌重构指标，包括左室舒末容积指数（LVEDVI）和左室质量指数（LVMI）。将心肌肥厚患者中RWT＜0.45且LVMI在正常范围内的患者归入肥厚正常几何构型组（HNG组），其余归入肥厚重构组（HR组）；以46名年龄相匹配的健康志愿者作为正常对照组。结果 HNG组、HR组和正常对照组的RT3D-LVEF均在正常范围内，两两比较差异均无统计学意义（P＞0.05）。HR组的MAD各值和LVEDVI均显著低于HNG组和正常对照组，差异均有统计学意义（P＜0.01或P＜0.05）；HNG组与正常对照组MAD相关参数值和LVEDVI比较差异均无统计学意义（P＞0.05）。Bland-Altman分析显示MAD各值的可重复性较高。结论 在心肌肥厚性重构患者中，与LVEF比较，MAD能更早地反映患者的左室收缩功能减退情况。

关键词: 左室肥厚, 重构, 二尖瓣环收缩期位移, 左室收缩功能

Abstract:

Objective To investigate the value of mitral annular displacement (MAD) by two-dimensional speckle tracking in evaluating left ventricular systolic dysfunction in patients with cardiac hypertrophy and remodeling. Methods Eighty-six patients with cardiac hypertrophy (left ventricular wall thickness ≥12 mm) and normal left ventricular ejection fraction (LVEF) (>50%) were selected. Philips Sonos iE33 ultrasound device was used for examinations. Relative wall thickness (RWT) was calculated by M mode ultrasound, and two-dimensional and real-time three-dimensional (RT3D) images were obtained at the apical four-chamber view. The related parameters of MAD (mitral annular middle displacement and left ventricular longitudinal fractional shortening) and LVEF measured by RT3D images (RT3D-LVEF) were obtained using on-line QLAB 6.2 software. Three dimensional myocardial remodeling parameters were calculated, including left ventricular end-diastolic volume index (LVEDVI) and left ventricular mass index (LVMI). Patients with cardiac hypertrophy, RWT＜0.45 and normal LVMI were classified into hypertrophic normal geometric group (HNG group), and the rest of patients were studied as hypertrophic remodeling group (HR group). Another 46 age-matched healthy volunteers were served as normal control group. Results RT3D-LVEF of HNG group, HR group and normal control group were normal, and there was no significant difference among groups (P＞0.05). MAD and LVEDVI in HR group were significantly lower than those in HNG group and normal control group (P＜0.01 or P＜0.05), while there was no significant difference in MAD and LVEDVI between HNG group and normal control group (P>0.05). Bland-Altman analysis indicated that MAD had a better repeatability. Conclusion MAD can evaluate left ventricular dysfunction earlier than LVEF in patients with cardiac hypertrophic and remodeling.

Key words: left ventricular hypertrophy, remodeling, mitral annular displacement, left ventricular systolic function