摘要
目的 应用三维斑点追踪技术(3D-STE)测量缺血性二尖瓣反流(IMR)患者左室应变及扭转参数,探讨其评估IMR患者左室收缩功能的临床应用价值.方法 选取125例冠心病患者,根据有无IMR及其程度分为单纯冠心病组50例、轻度IMR组35例及中重度IMR组40例,另选同期50例健康体检者为对照组.应用三维超声心动图获取各组左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)及二尖瓣反流容积(Rvol),3D-STE获取左室应变及扭转参数,包括左室整体纵向应变(GLS)、整体环向应变(GCS)、整体径向应变(GRS)、整体扭转角度峰值(Twist)、扭矩(Torsion)、心尖段扭转角度(Apical)、基底段扭转角度(Basel)、左室收缩不同步指数(SDI),比较各组上述参数的差异.应用Pearson相关分析法分析各超声心动图参数与Rvol的相关性.结果 与对照组比较,单纯冠心病组、轻度IMR组、中重度IMR组LVEDV、LVESV、SDI均增大,LVEF、GLS、GCS、GRS、Twist、Torsion、Apical、Basel均减小,差异均有统计学意义(均P<0.05).与单纯冠心病组比较,轻度IMR组、中重度IMR组LVEDV、SDI均增大,LVEF、GLS、Twist、Torsion、Apical、Basel均减小,差异均有统计学意义(均P<0.05).与轻度IMR组比较,中重度IMR组LVEDV、Rvol、SDI均增大,LVEF、GLS、Twist、Torsion、Apical、Basel均减小,差异均有统计学意义(均P<0.05).相关性分析显示,LVEDV与Rvol呈正相关(r=0.607,P<0.01),GLS、Twist、Apical、Torsion、Basel与Rvol均呈负相关(r=-0.547、-0.617、-0.495、-0.483、-0.269,均P<0.05).结论 3D-STE可准确测量IMR患者左室应变及扭转参数,在评估左室收缩功能方面具有较好的应用价值.
Abstract
Objective To measure the left ventricular strain and torsion parameters in patients with ischemic mitral regurgitation(IMR)by three-dimensional speckle tracking echocardiography(3D-STE),and to explore the clinical application value of 3D-STE in assessing left ventricular systolic function in patients with IMR.Methods Totally 125 patients with coronary heart disease were selected,according to the presence and severity of IMR,they were divided into simple coronary artery disease group(n=50),mild IMR group(n=35)and moderate to severe IMR group(n=40).Additionally,50 healthy volunteers were enrolled as the control group.The left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF)and mitral regurgitant volume(Rvol)were obtained by three-dimensional echocardiography.The left ventricular global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),peak twist angle(Twist),torsion(Torsion),apical rotation(Apical),basal rotation(Basel)and the left ventricular systolic dyssynchrony index(SDI)were obtained by 3D-STE.The differences of the above parameters among each group were compared.Pearson correlation analysis method was used to analyze the correlation between various echocardiographic parameters and Rvol.Results Compared with the control group,LVEDV,LVESV and SDI were increased in the simple coronary artery disease group,mild IMR group and moderate to severe IMR group,while the LVEF,GLS,GCS,GRS,Twist,Torsion,Apical and Basel were decreased,and the differences were statistically significant(all P<0.05).Compared with the simple coronary artery disease group,LVEDV and SDI were increased in mild IMR group and moderate to severe IMR group,while the LVEF,GLS,Twist,Torsion,Apical and Basel were decreased,and the differences were statistically significant(all P<0.05).Compared with the mild IMR group,the LVEDV,Rvol and SDI were increased in the moderate to severe IMR group,while LVEF,GLS,Twist,Torsion,Apical and Basel were decreased,and the differences were statistically significant(all P<0.05).Correlation analysis showed that the LVEDV was positively correlated with Rvol(r=0.607,P<0.001),and GLS,Twist,Apical,Torsion were negatively correlated with Rvol(r=-0.547,-0.617,-0.495,-0.483,-0.269,all P<0.05).Conclusion 3D-STE can accurately measure left ventricular strain and torsion parameters in patients with IMR,which has good clinical application value in assessing left ventricular systolic function.
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