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
任永凤 1陆静 1李娜娜 1王效军 1李琦1
作者信息
- 1. 安徽医科大学附属亳州医院超声医学科 安徽 亳州 236800
- 折叠
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.
Abstract
Objective To investigate the value of tissue tracking mitral annular displacement(TMAD)in evaluating left ven-tricular 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 se-lected 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 cham-ber 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 correlation be-tween them(r = 0.696,P<0.01).According to ROC curve analysis,TMAD Midpt had considerable value in predicting cardiac events and LNGLS.The areas under the curve were 0.897 and 0.901 respectively(P<0.01).Conclusion TMAD technology can simply and quickly evaluate the left ventricular function impairment in asymptomatic SAS patients with preserved left ven-tricular ejection fraction.It is of great value to evaluate the prognosis of these patients and is worthy of clinical application.
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Key words
Aortic stenosis/Mitral annular displacement/Left ventricular systolic function/Ultrasound引用本文复制引用
基金项目
安徽医科大学临床科研基金(2021xkj218)
出版年
2024
NETL
NSTL
维普
万方数据