摘要目的 采用超声心动图评价缺血性心肌病(ICM)患者与健康人群二尖瓣环与主动脉瓣环平面夹角(AMA)的变化及其与左室收缩功能的关系.方法 纳入31例ICM患者为ICM组,选取性别、年龄相匹配的健康人59例作为对照组,所有入选病例于胸骨旁左室长轴切面上,依次测量心电图R波顶点(R-AMA)、J点(J-AMA)、ST段中点(ST-AMA)、T波末(T-AMA)及P波末(P-AMA)对应的AMA,计算角度差⊿θ(AMAmax-AMAmin)及角度变化率(⊿θ/AMAmax);应用2D-STE技术获取左室整体纵向应变(GLS)及整体周向应变(GCS).采用Simpson双平面法测量左室射血分数(LVEF)、左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV).结果 对照组中J-AMA最大,而ICM组ST-AMA最大.ICM组中LVEDV、LVESV和各个时相的AMA均较对照组明显增大,而LVEF、GLS、GCS、⊿θ/AMAmax及⊿θ减小,差异均有统计学意义(P＜0.05).对照组内,T-AMA与LVEF有相关性(r=-0.349,P=0.007),⊿θ与GLS呈负相关(r=-0.372,P=0.004).ICM组中⊿θ/AMAmax及⊿θ与LVEF均有相关性(r=0.424,P=0.018;r=0.490,P=0.005).结论 ICM患者AMA明显增大,其⊿θ和⊿θ/AMAmax与LVEF密切相关,是心肌立体三维结构改变的一种表现.

abstractsObjective To evaluate the relationship between the change of the aortomitral angle (AMA) with left ventricular systolic function in patients with ischemic cardiomyopathy (ICM) by echocardiography.Methods Thirty-one patients were enrolled in the ICM group,and 59 healthy subjects were selected as the control group.On the parasternal left ventricular long axis plane,AMA were measured at the R wave apex (R-AMA),J-point(J-AMA),ST-segment midpoint(ST-AMA),T-final wave (T-AMA)and P-final wave (P-AMA).The angle difference(⊿ θ) =AMAmax-AMAmin,the angle changing rate =⊿ θ/AMAmax.The global left ventricular longitudinal strain (GLS) and global circumferential strain (GCS) were obtained by 2D-speckle tracking echocardiography.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were measured using Simpson biplane method.Results The J-AMA was the largest in the control group,while the ST-AMA was the largest in the ICM group.The levels of LVEDV,LVESV and AMA in ICM group were significantly higher than those in control group,while LVEF,GLS,GCS,⊿ θ/AMAmax and ⊿ θ were decreased (P ＜0.05).In the control group,there was a correlation between T-AMA and LVEF (r =-0.349,P =0.007),and ⊿ θ was negatively correlated with GLS (r =-0.372,P =0.004).In the ICM group,⊿1 θ/AMAmax and ⊿ θ were correlated with LVEF (r =0.424,P =0.018;r =0.490,P =0.005).Conclusions AMA in ICM patients is significantly increased.The angle difference and the rate of its change are closely related to the LVEF,which is a manifestation of three-dimensional structure change of the myocardial.