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目的:利用定量组织速度成像(QTVI)技术探讨心力衰竭(CHF)患儿左室非同步运动与二尖瓣反流的关系。方法:正常小儿40例,CHF患儿30例。(1)左心室非同步性指标检测获取标准心尖四腔和两腔观,QTVI状态下,获得左心室4个壁基底段、中间段和心尖段共12个位点的QTVI曲线,测量各位点QRS波起点至心肌收缩期峰值速度和舒张早期峰值速度的时限(Ts和Te)。计算左心室12个心肌节段Ts和Te的最大差值(Max-△Ts和Max-△Te)。(2)二尖瓣反流测量:于左室长轴切面,测量二尖瓣反流面积与左房面积比值MRA/LAA。结果:CHF组Max-△Ts和Max-△Te明显大于健康对照组;21例CHF患儿存在不同程度的二尖瓣反流;MRA/LAA与Max-△Te呈正相关(r=0.32,P<0.05),与Max-△Ts不相关(P>0.05)。结论:CHF患儿存在的二尖瓣反流现象与左室非同步运动有关,其中舒张非同步运动对二尖瓣反流起主要作用。
Objective: To explore the relationship between left ventricular nonsynchrony and mitral regurgitation in children with heart failure (CHF) by quantitative tissue velocity imaging (QTVI). Methods: 40 normal children and 30 children with CHF. (1) Detection of left ventricular nonsynchrony index Obtaining standard apex quadruple chamber and two chambers view, QTVI state, obtaining QTVI curve of 12 sites of basal segment, middle segment and apical segment of 4 walls of left ventricle, measuring each site QRS wave onset to peak systolic and diastolic peak velocities (Ts and Te). The maximum difference (Max- △ Ts and Max- △ Te) between the two myocardial segments Ts and Te in the left ventricle was calculated. (2) Mitral regurgitation measurement: In the long axis of the left ventricle, MRA / LAA was measured for mitral regurgitation and left atrial area. Results: Max- △ Ts and Max- △ Te in CHF group were significantly higher than those in healthy control group. There were different degrees of mitral regurgitation in 21 CHF children. MRA / LAA was positively correlated with Max- △ Te (r = 0.32, P <0.05), not related to Max- △ Ts (P> 0.05). Conclusions: The presence of mitral regurgitation in children with CHF is associated with left ventricular asynchrony, and diastolic asynchrony plays a major role in mitral regurgitation.