双脉冲波多普勒评价正常成年人二尖瓣环不同位点组织运动特征

摘要

目的 应用双脉冲波多普勒(DPW)技术同步评价二尖瓣环不同位点组织运动差异,探讨不同位点组织运动参数在左心室功能评价中的价值.方法 DPW技术获取112例健康成年人二尖瓣环侧壁、后间隔、下壁和前壁以及后壁5个位点组织运动速度频谱.测量峰值及起始时间和达峰时间；计算E/A、Em/Am、E/Em和左室射血分数(LVEF)、左室短轴缩短率(LVFS).结果 ①Sm、Em、Am及Em/Am游离壁瓣环均大于间隔瓣环(P＜0.05),E/Em间隔瓣环大于游离壁瓣环；Sm峰后壁瓣环最先开始加速,加速时间最短(P＜0.01)；Em峰各位点间时间参数差异无统计学意义；Am峰起始、达峰时间游离壁较间隔延迟,加速时间间隔长于游离壁(P＜0.05).②相关分析表明,仅后壁瓣环位点Sm峰值速度与LVEF、LVFS具有相关性(r=0.243,r=0.227,P＜0.01)；前壁、后壁瓣环Em/Am与E/A相关性最高(均为r=0.545,P＜0.01).结论 正常成年人不同二尖瓣环位点间组织运动峰值速度和时序存在差异；在不同位点评价左室功能的结果也不同.%Objective To define the mechanical features of mitral annulus at various sites,and to investigate the specific mechanics characterization at different mitral annulus sites in evaluation consequences of left ventricular function by dual pulse-wave Doppler (DPW) technology.Methods The DPW spectrums were obtained at lateral and aboral interval,anterior and inferior and posterior mitral annular from 112 normal adults.The peak systolic velocity (Sm),peak early diastolic velocity (Em),peak late diastolic velocity (Am),the beginning time of the peak and the time to peak were measured,and E/A,Em/Am,E/Em,left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were computed.Results 1)Sm,Em,Am and Em/Am measured in the free wall annulus were significantly greater than measured in the interval annulus of mitral annular sites.However,E/Em was opposited (P ＜ 0.05).Sm of the posterior wall mitral annulus accelerated frist and experienced shortest duration in all the mitral annular sites (P ＜ 0.01).There were no significant differences of Em time parameters among different mitral annulus sites.Am of the beginning time and peak time in the free wall annulus were significantly longer than that in the interval annulus of anterior mitral annular sites.However,the acceleration time was opposited(P ＜0.05).2) Sm was correlated with LVEF and LVFS (r =0.243 and r =0.227,P ＜0.01) only at the posterior mitral annular site,Em/Am of anterior and posterior wall mitral annulus had the highest correlations with mitral orifice flow E/A(r =0.545 and 0.545 respectively,P ＜ 0.01).Conclusions There are significant differences among the mechanics patterns at different mitral annulus sites in normal adults.The mechanics characterization at different mitral annulus sites have different conclusions of left ventricular function.