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目的应用三维斑点追踪技术和多普勒超声指标综合评价二尖瓣关闭不全时左心室收缩功能。方法随机入组30例器质性二尖瓣关闭不全患者[男16例,平均(50.72±11.52)岁]和30例性别、年龄匹配的正常对照[男18例,平均(46.86±8.67)岁],分别作为病例组及对照组。所有研究对象行常规超声心动图检查,并应用脉冲多普勒(PW)采集肺动脉、主动脉及二尖瓣口血流频谱(Philip IE33,s5-1);于心尖四腔心观采集全容积三维图像(Philip IE33,X3-1)。测量肺动脉(PA)、主动脉(AO)及二尖瓣口(MV)PW速度时间积分(VTI);左心室等容收缩及等容舒张时间。应用TOM-TEC分析软件4D-LV功能测量左心室17节段三维应变(S),计算基底段(b)、中间段(m)及心尖段(a)三维应变峰值及达峰时间(Sb,Tb,Sm,Tm,Sa,Ta)。上述所有指标均用体表面积(BSA)或心动周期进行校正。结果病例组左心室收缩期三维应变峰值增大(P<0.05),左心室等容收缩期延长(P<0.05),三维应变达峰时间延迟(P<0.05)。结论左心室收缩期三维应变峰值受二尖瓣特殊容量负荷变化影响,无法客观评价其左心室收缩功能;而收缩期左心室三维应变达峰时间和左心室等容收缩时间不受容量变化干扰,有望用于二尖瓣关闭不全患者的随访。
Objective To evaluate the systolic function of left ventricle with mitral regurgitation by three-dimensional speckle tracking and Doppler ultrasound. Methods Thirty patients with organic mitral regurgitation [16 males (mean, 50.72 ± 11.52) years] and 30 age-matched normal controls [18 males (mean, 46.86 ± 8.67) years ], Respectively, as case group and control group. All subjects underwent routine echocardiography, and pulmonary artery, aortic and mitral valve blood flow spectra were collected by pulsed Doppler (Philip IE33, s5-1) Three-dimensional image (Philip IE33, X3-1). Pulmonary artery (PA), aorta (AO) and mitral valve (PW) velocity time integral (VTI) were measured; left ventricular isovolumic contraction and isovolumic relaxation time were measured. The 3D strain (S) of 17 segments of the left ventricle was measured by TOM-TEC analysis software 4D-LV function, and the 3D strain peak and peak time of basal segment (b), middle segment (m) and apical segment Tb, Sm, Tm, Sa, Ta). All of the above parameters were corrected for body surface area (BSA) or cardiac cycle. Results The left ventricular systolic peak strain increased (P <0.05), the left ventricular isovolumic systolic phase prolonged (P <0.05) and the three-dimensional strain peak time delayed (P <0.05). Conclusions The peak value of 3D strain in left ventricular systole is influenced by the change of special volume load of mitral valve, and the left ventricular systolic function can not be objectively evaluated. However, the peak systolic left ventricular three-dimensional strain and left ventricular systolic time are not disturbed by the change of volume, Is expected to be used in patients with mitral regurgitation follow-up.