探讨M型超声心动图对存在节段性室壁运动异常的冠心病左室收缩功能的价值

摘要

目的 探讨传统M型超声心动图在检查存在节段性室壁运动异常(RWMA)的冠心病患者(CAD)左室收缩功能中的作用,为简化临床超声工作探寻依据.rn方法 收集住院冠心病患者,所有入选的冠心病患者均存在着明确的RMWA共56例,对所有入选者均采用M超、二维改良Simpson法(包括四腔面,二腔面,双平面)测量左室射血分数(LVEF),每搏输出量(SV),左室舒张末期容积(LVEDV),左室收缩末期容积(LVESV).根据超声心动图测量特点和常见的发生RMWA部位,将冠心病患者分为两组:M超扫描线通过RMWA组和不通过RMWA组,前壁RMWA和下后壁RMWA组；将2种测量方法测量指标进行统计学分析.rn结果 不同组之间左室收缩功能的比较结果(1)正常对照组与冠心病组比较左室EF值正常组高于冠心病组,而LVEDV,LVESV正常组低于冠心病组.(2)正常组M超与二维法比较 LVEF值均无统计学差异.(3)冠心病组M超与二维法比较 二维(双平面法)与M超测量2种方法测量的LVEF值有统计学差异,M超测量值均偏高,其均值比双平面法约高6％.(4)M超扫描线通过RMWA组和不通过RMWA组比较 通过组二维法与M超测量LVEF值均无统计学差异.非通过组二维法与M超测量LVEF值均有统计学差异,M超测量值较二维值高,其均值比四腔面法约高9％,比二腔面法约高14％,双平面法约高13％.(5)不同RWMA部位的2种测量方法比较前壁与下后壁组相比,两组LVEF无统计学差异.前壁组:二腔面和双平面法测量LVEF值与M超比较有统计学差异,M超测量值较二维值高,其均值比二腔面法约高6％,比双平面法约高5％.下后壁组:二腔和双平面LVEF与M超比较有统计学差异,M超测量均偏高.其均值比二腔面法约高8％,比双平面法约高6％.rn结论 大部分情况下,2种常用超声测量方法对于存在RWMA的冠心病患者的LVEF值的测量有差异,M超法稍高于二维改良Simpson法；但当通过RMWA时M超与二维法实际上差异不大,而且其他情况下也可根据情况用M超法粗略估计LVEF.%Objective To discuss when and how traditional M-mode echocardiography could be used to evaluate left ventricular systolic function in patients with coronary heart disease when regional wall motion abnormalities (RW-MA) exists, and try to simplify echo measurement procedure. Methods Coronary heart disease (CAD) hospitalized patients in Fu Wai Hospital and normal control group were selected, All patients with coronary heart disease, had clear RMWA and all people were measured by M-mode echocardiography and two-dimensional modified Simpson method (four-, two-chamber view and two-plane method) to measure left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV). According to the measurement characteristics and RMWA parts, coronary heart disease patients were divided into two groups: M-mode scan line pass (MLP) and no pass (MLNP) in RMWA area group, anterior and inferoposterior RMWA group; and the two measurement methods were statistically analyzed and compared. Results The results of comparison between each group as follows:①Compared with CAD group, LVEF value was higher, while LVEDV, LVESV were lower in normal control group. ②LVEF has no statistical difference between M-mode and modified Simpson method in normal control group ③LVEF has statistical difference between M-mode and modified Simpson method in CAD group.The LVEF value by M-mode was higher about 6% than that by two-plane Simpson method. ④LVEF has nostatistical difference between two methods in MLP group. While the LVEF value by M-mode were higher than that by (four-, two-chamber view and two-plane method) Simpson method about 9%, 14% and 13% respectively in MLNP group. ⑤LVEF has no statistical difference between anterior and inferoposterior RMWA groups. The LVEF value by M-mode were higher than that by (two-chamber view and two-plane method) Simpson method about 6% , 5% respectively in anterior RMWA group; and the LVEF value by M-mode were higher than that by (two-chamber view and two-plane method) Simpson method about 8%, 6% respectively in inferoposterior RMWA. Group. Conclusions Although it has difference between M-mode and modified Simpson method in most of the cases for CAD patients with RWMA, we still could estimate LVEF value by M-mode method. The LVEF value by M-mode was higher than that of modified Simpson method, but there were no difference in MLP group.