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目的:探讨组织运动二尖瓣环位移技术(TMAD)评价心力衰竭(心衰)患者左心室整体收缩功能的应用前景。方法:选取心衰患者18例为病例组,健康志愿者16例为对照组。应用TMAD技术测定心尖四腔观(后间隔、侧壁)、心尖两腔观(下壁、前壁)和心尖左心室长轴观(后壁、前间隔)二尖瓣环6个位点运动参数:收缩期最大位移(Ds)、心电图R波顶点至位移曲线到达最大位移的时间(Ts-%)、6个位点达峰时间的标准差(Ts-SD)。应用脉冲多普勒组织速度成像(PW-DTI)测量上述6个位点收缩期S波时间速度积分(VTIs)。应用双平面Simpson法测量左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)和射血分数(LVEF)。比较两组二尖瓣环运动参数的特点,并分析其与LVEF的相关性。结果:①病例组二尖瓣环位移曲线形态不规则,各位点Ds较对照组明显减低(P<0.01);6个位点Ts-%、Ts-SD与对照组相比,差异有统计学意义(P<0.01)。②病例组Ds均值与LVEF呈显著正相关性,而与LVEDV、LVESV无显著相关性;③病例组二尖瓣环6个位点TMAD测得的Ds均值与PW-DTI测得的VTIs均值呈显著正相关。结论:①心衰患者二尖瓣环位移曲线形态不规则,位移幅度明显降低,达峰时间延迟且不同步;②心衰患者二尖瓣环位移参数与左心室整体心功能参数呈正相关,TMAD为准确评价心衰时左心室整体收缩功能提供了一种直观、便捷的新方法。
Objective: To investigate the application of tissue motion mitral annulus displacement (TMAD) in evaluating left ventricular global systolic function in patients with heart failure (CHF). Methods: Twenty-eight patients with heart failure were selected as case group and 16 healthy volunteers as control group. TMAD technique was used to measure the mitral annular motion at the apical four-chamber view (posterior septum, lateral wall), apical two-chamber view (inferior wall, anterior wall) and the apical view of the left ventricular (posterior wall, anterior septum) Parameters: Maximal systolic displacement (Ds), time (Ts -%) from peak to displacement of electrocardiogram R wave to maximum displacement and standard deviation (Ts-SD) of peak time of 6 loci. Pulmonary Doppler tissue velocity imaging (PW-DTI) was used to measure the S-wave time-velocity integrals (VTIs) of the above six sites. Left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were measured by biplane Simpson method. The characteristics of mitral annulus motion parameters were compared between the two groups and their correlation with LVEF was analyzed. Results: ① The shape of mitral annulus displacement curve was irregular in all cases, and the Ds of each point was significantly lower than that of the control group (P <0.01). The differences of Ts -% and Ts-SD at 6 sites were statistically significant Significance (P <0.01). (2) There was a significant positive correlation between Ds and LVEF in case group, but not with LVEDV and LVESV. (3) The average value of TMs measured by TMAD and the VTIs measured by PW-DTI in 6 cases of mitral annulus were Significantly positive correlation. Conclusion: ①The shape of mitral annulus displacement curve in patients with heart failure is irregular, the amplitude of displacement is significantly reduced, the peak time is delayed and asynchronous; ② The mitral annulus displacement parameters of heart failure patients are positively correlated with left ventricular global cardiac function parameters, TMAD In order to accurately evaluate the overall left ventricular systolic function of heart failure provides an intuitive and convenient new method.