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目的:探讨组织运动二尖瓣环位移自动追踪技术(TMAD)在评价急性心肌梗死(AMI)患者左心室整体收缩功能中的临床应用价值。方法:选取AMI患者29例为AMI组,年龄匹配的健康志愿者31例为对照组,采用Philips IE33彩色超声诊断仪,行常规超声心动图检查,应用双平面Simpson法测量左心室舒张末容积、左心室收缩末容积和左心室射血分数(LVEF)。存储心尖四腔、三腔和两腔连续3～5个心动周期二维动态图像,用Qlab 7.0软件进行脱机分析,测量二尖瓣环6个位点收缩期最大位移(Ds)、瓣环连线中点最大位移(D-mid)和左心室长轴缩短率(FSL),分别计算其均值,并与简化双平面Simpson测量的LVEF做相关分析。结果:①与对照组相比,AMI组二尖瓣环6个位点Ds、D-mid、FSL及其均值显著降低,均差异有统计学意义(均P<0.001);②2组Ds均值、D-mid均值及FSL均值与LVEF均具有相关性(AMI组r分别为0.787、0.776和0.779,P<0.001;对照组r分别为0.662、0.706和0.759,P<0.001);③重复性检验:AMI组Ds均值、D-mid均值及FSL均值观察者内变异系数分别为4.67%、4.60%和4.31%,观察者间变异系数分别为6.09%、5.60%和5.65%;对照组上述指标观察者内变异系数分别为5.28%、4.83%和4.93%,观察者间变异系数分别为5.57%、5.42%和4.91%。结论:TMAD技术可作为一种简单、准确及客观评价AMI患者左心室整体收缩功能的新方法。
Objective: To investigate the clinical value of tissue movement automatic mitral annulus tracking (TMAD) in evaluating left ventricular global systolic function in patients with acute myocardial infarction (AMI). Methods: Twenty-nine AMI patients were selected as AMI group and 31 age-matched healthy volunteers as control group. The Philips IE33 color ultrasound system was used to perform routine echocardiography. The left ventricular end-diastolic volume was measured by biplane Simpson method. Left ventricular end-systolic volume and left ventricular ejection fraction (LVEF). Three-dimensional dynamic images of three to five cardiac cycles of atrium, quad-chamber, and two-chamber continuous atrium were stored and analyzed by Qlab 7.0 software. The maximal systolic displacement (Ds) The midpoint maximal displacement (D-mid) and left ventricular long axis shortening (FSL) were calculated, and the mean values were calculated respectively. The correlations were also analyzed with simplified LVDF of biplane Simpson. Results: ①Compared with the control group, the mean Ds, D-mid and FSL of six sites of mitral annulus in AMI group were significantly decreased (all P <0.001) D-mid mean and FSL mean were correlated with LVEF (r = 0.787,0.776 and 0.779, P <0.001 for control group, r = 0.662, 0.706 and 0.759 for control group, P <0.001) In the AMI group, the coefficient of variation (Ds) was 4.67%, 4.60% and 4.31% in the Ds mean, D-mid mean and FSL mean respectively. The coefficient of variation among the observers were 6.09%, 5.60% and 5.65% The coefficient of variation was 5.28%, 4.83% and 4.93% respectively. The coefficient of variation among the observers were 5.57%, 5.42% and 4.91% respectively. Conclusion: TMAD can be used as a simple, accurate and objective evaluation of the left ventricular systolic function in patients with AMI new method.