摘要
目的观察组织运动二尖瓣环位移(TMAD)技术评估心脏淀粉样变性患者左心室功能的价值。方法回顾性纳入经病理学确诊的34例心脏淀粉样变性成年患者为观察组,以同期32名健康体检者为对照组,收集受试者基本资料,采集左心室功能常规超声参数及TMAD参数数据,进行组间比较,并分析TMAD参数与左心室射血分数(LVEF)或二尖瓣环收缩期位移(MAPSE)的相关性。结果与对照组相比,观察组体表面积(BSA)、收缩压、N末端B型利尿钠肽前体(NT-proBNP)、肌酐及尿素水平均较高(P均<0.05)。观察组主动脉内径(AO)、左心房内径(LA)、室间隔厚度(IVS)、左心室后壁舒张末期厚度(LVPWD)、肺动脉内径(PA)及二尖瓣舒张早期峰值流速(E峰)值较大,而左心室舒张末期内径(LVEDD)、LVEF、短轴缩短率(FS)、二尖瓣环舒张早期间隔运动速度峰值E′(IVS E′)及侧壁运动速度峰值E′(LW E′)和MAPSE值均较小(P均<0.05),其中观察组LVEF为(58.18±7.09%)。观察组TMAD参数心尖四腔心(A4C)切面二尖瓣环室间隔位点位移(A4C MV1)、侧壁位点位移(A4C MV2)、二尖瓣环连线中点平均位移率(A4C Midpt)及其平均位移率(A4C Midpt%),以及心尖两腔心(A2C)切面A2C MV1、A2C MV2、A2C Midpt及A2C Midpt%数值均低于对照组(P均<0.05)。观察组中,A4C Midpt%与LVEF呈中度正相关(r=0.488,P<0.05),A2C Midpt与MAPSE呈高度正相关(r=0.712,P<0.05),A4C MV2、A4C Midpt、A4C Midpt%、A2C MV1、A2C MV2、A2C Midpt%均与MAPSE呈中度正相关(r=0.420~0.691,P均<0.05)。结论相比LVEF,TMAD或可更敏感地反映心脏淀粉样变性患者左心室收缩功能的变化。
Objective To observe the value of tissue motion mitral annular displacement(TMAD)technique to assess left ventricular function in patients with cardiac amyloidosis.Methods A total of 34 adult patients with cardiac amyloidosis diagnosed by pathology were retrospectively included as the observation group,and 32 healthy adults were collected as the control group for the same period.Basic data of the subjects were collected,and data of routine ultrasonic parameters of left ventricular function and TMAD parameters were obtained,and then compared between groups.The correlation of TMAD parameters with left ventricular ejection fraction(LVEF)or mitral annular plane systolic excursion(MAPSE)were assessed.Results Compared with the control group,the observation group had higher levels of body surface area(BSA),systolic blood pressure,N-terminal pro-B-type natriuretic peptide(NT-proBNP),creatinine and urea(all P<0.05).The observation group had increased values of ascending aorta(AO),left atrium(LA),interventricular septum(IVS),left ventricular posterior wall thickness in diastole(LVPWD),pulmonary artery(PA),and early diastolic peark velocity of mitral inflow(peak E),while smaller values of left ventricular end-diastolic dimension(LVEDD),LVEF,fractional shortening(FS),early diastolic tissue Doppler velocity E'septal(IVS E')and lateral(LW E')and MAPSE(all P<0.05),and the LVEF in observation group was(58.18±7.09)%.For TMAD patameters,the observation group had smaller values of the following parameters on apical four chamber(A4C)view as medial displacement of mitral valve annulus(A4C MV1),displacement of lateral mitral valve annulus(A4C MV2),displacement of the midpoint of the mitral valve annulus(A4C Midpt)and the corresponding percentage(A4C Midpt%),as well as smaller values of the following paramets on apical two chamber(A2C)view as A2C MV1,A2C MV2,A2C Midpt and A2C Midpt%(all P<0.05).In the observation group,A4C Midpt%showed a moderate positive correlation with LVEF(r=0.488,P<0.05),and A2C Midpt showed a high positive correlation with MAPSE(r=0.712,P<0.05),and A4C MV2,A4C Midpt,A4C Midpt%,A2C MV1,A2C MV2,A2C Midpt%all showed a moderate positive correlation with MAPSE(r=0.420 to 0.691,all P<0.05).Conclusion Compared with LVEF,the TMAD parameters might reflect the changes in left ventricular systolic function more sensitively in patients with cardiac amyloidosis.
作者
闫玉莲
付奇环
张敏
余姝琦
孔翼婷
曾华容
涂一凡
刘蓉
YAN Yulian;FU Qihuan;ZHANG Min;YU Shuqi;KONG Yiting;ZENG Huarong;TU Yifan;LIU Rong(Department of Ultrasound,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China)
出处
《中国医学影像技术》
CSCD
北大核心
2024年第10期1504-1508,共5页
Chinese Journal of Medical Imaging Technology
