摘要
目的探讨缺血性二尖瓣反流患者的乳头肌功能不全与二尖瓣立体结构改变的相关性。方法将2019年2—12月收治的冠心病伴二尖瓣反流70例作为观察组,将同期体检的健康者50例作为对照组。2组均行二维超声心动图、斑点追踪技术、经胸三维超声检查,获得左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、前后乳头肌分别到二尖瓣前瓣环之间的距离(APM-AMA、PPM-AMA)、乳头肌间距离(IPMD)、前后乳头肌纵向峰值应变(ALS、PLS)、达峰延迟时间(DT)、瓣环前后径(DAP)、瓣环前外侧至后内侧直径(ALPM)、非平面角度(NPA)、幕状区高度(Htent)、瓣环三维面积(A3D)、瓣环三维周长(AC)、幕状区容积(Vtent),并对2组参数进行比较。结果观察组LVESV、LVEDV、IPMD、DT、DAP、ALPM、NPA、Htent、Vtent、AC、A3D大于对照组,LVEF及ALS、PLS绝对值小于对照组(P<0.05);观察组IPMD、DT与Vtent呈正相关(r=0.62、0.25,P<0.05),与LVEF呈负相关(r=-0.26、-0.29,P<0.05);观察组ALS、PLS与Vtent呈负相关(r=-0.26、-0.49,P<0.05),与LVEF呈正相关(r=0.35、0.32,P<0.05)。DAP、ALPM、A3D、NPA、Htent、Vtent、AC的观察者间和观察者内重复性较好。结论冠心病可以使乳头肌功能减弱,二尖瓣瓣环扩张,三维马鞍形结构扁平,Htent、Vtent均增大;IPMD与Vtent具有强相关性。
Objective To study the correlation between papillary muscle dysfunction and changes of mitral valve configuration in ischemic mitral regurgitation(IMR)patients.Methods Seventy patients with coronary heart disease(CHD)combined with mitral regurgitation admitted from February 2019 to December 2019 were enrolled as the observation group,and 50 healthy physical examinees during the same period were selected as the control group.Both groups underwent two-dimensional echocardiography,speckle tracking imaging,and three-dimensional transthoracic echocardiography.The parameters including left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),length of anterior or posterior papillary muscle tips to contralateral anterior mitral annular(APM-AMA,PPM-AMA),inter distance papillary muscle(IPMD),longitudinal strain of anterior or posterior papillary muscle(ALS,PLS),delay time(DT),anterior-to-posterior diameter(DAP),the anterolateral to posteromedial diameter of the mitral annulus(ALPM),non-planar angle(NPA),tenting height(Htent),three-dimensional annular area(A3D),three-dimensional annular circumference(AC),and tenting volume(Vtent)were collected,and the parameters were compared between the two groups.Results LVESV,LVEDV,IPMD,DT,DAP,ALPM,NPA,Htent,Vtent,AC and A3D in the observation group were greater than those in the control group,while LVEF and the absolute values of ALS and PLS were less than those in the control group(P<0.05).In the observation group,IPMD and DT were positively correlated with Vtent(r=0.62 and 0.25,P<0.05)and negatively correlated with LVEF(r=-0.26 and-0.29,P<0.05).In the observation group,ALS and PLS were negatively correlated with Vtent(r=-0.26 and-0.49,P<0.05)and positively correlated with LVEF(r=0.35 and 0.32,P<0.05).DAP,ALPM,A3D,NPA,HTent,VTent and AC had good inter-observer and intra-observer repeatability.Conclusion CHD can weaken papillary muscle function,and lead to dilated mitral annulus,flattened three-dimensional saddle-shaped structure,and increased tenting height and tenting volume.The correlation between IPMD and Vtent was the strongest.
作者
张敏郁
刘昕
陈宇娇
ZHANG Min-yu;LIU Xin;CHEN Yu-jiao(Department of Ultrasound,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China;Department of Ultrasound,the First Central Hospital of Baoding,Baoding,Hebei 071000,China)
出处
《解放军医药杂志》
CAS
2020年第10期45-48,共4页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
全军医学科技青年培育计划孵化项目(18QNP004)
河北省研究生创新资助项目(CXZZSS2019139)。
关键词
二尖瓣闭锁不全
心肌缺血
斑点追踪技术
左心室舒张末期容积
乳头肌间距离
瓣环前后径
幕状区高度
Mitral valve insufficiency
Myocardial ischemia
Speckle tracking imaging
Left ventricular end-diastolic volume
Inter distance papillary muscle
Anterior-to-posterior diameter
Tenting height
作者简介
共同第一作者:刘昕。
