Application Study Of Ultrasonic Angle In Mitral Insufficiency

Objective:To measure the angle of the dislocation of mitral valve coaptation(DMC)and functional mitral regurgitation(FMR),investigate the changes of mitral valve morphology、opening and closing activity of patients with DMC or FMR,and the feasibility of mitral valve angle in evaluating DMC and FMR.Methods:All selected patient condition:The left ventricular ejection fraction(LVEF),50%-70%。Exclude mitral valve prolapse、rheumatic heart disease、mitral valve vegetations or calcification,at least mild aortic regurgitation and aortic stenosis,congenital heart disease、dilated cardiomyopathy etc.The DMC groups:39 patients were diagnosed of DMC by the two dimensional echocardiography,according to the guide of American echocardiography,they were divoded into 2 groups: mild mitral regurgitation group 20 cases;Moderate to severe mitral regurgitation group 19 cases.The FMR groups:38 patients were diagnosed of age-sex matched FMR by the Two dimensional echocardiography,mild mitral regurgitation group 30cases;Moderate to severe mitral regurgitation group 8 cases.The control group: 50 cases of age-sex matched normal control group,with normal mitral valve and no mitral regurgitation.Ask the patient lying on the left side,in the long axis view of left ventricle,apply the conventional two-dimensional echocardiography measure left ventricular end-diastolic diameter(LVDd),left atrial diameter(LAd),the angle between anterior mitral valve and aortic posterior wall(A1)and the angle of anterior mitral valve and posterior mitral valve(A2);in multiple chamber view measure the regurgitant jet area(RJA)and vena contracta width(VCW),the ratio of regurgitant jet area and left atrial area,used for grading the the severity of regurgitation,left ventricular ejection fraction(LVEF)was calculates by bi-plane Simpson’s rule.And then analyse therelationships between LVDd、LAd、the angle and the severity of regurgitation of mitral valve using Pearson correlation analysis method,and receiver operating characteristic curve(ROC)analysis confirmed cutoffs for the diagnosis of DMC and FMR.Results:1.A1:Compared with normal control group,the FMR groups showed no significant difference(P>0.05),the DMC groups were smaller than the control group and FMR groups(P<0.05),there was no significant difference between mild DMC groups and moderate to severe DMC groups or mild FMR groups and moderate to severe FMR groups(P>0.05).2.A2:Compared with normal control group,the FMR groups and the DMC groups were larger,the difference was statistically significant(P<0.05),the DMC groups were larger than FMR groups(P<0.05);there was no significant difference between mild and moderate to severe DMC groups(P>0.05),the moderate to severe FMR groups was larger than the mild FMR groups(P<0.05).3.Pearson correlation analysis showed:In the DMC group,LAd、LVDd and the severity of mitral regurgitation had no correlation with A1 and A2(P>0.05).In the FMR group,LAd(r=0.734)、LVDd(r=0.576)、A2(r=0.428)were positively correlated with the severity of mitral regurgitation(P<0.05),but A1 had no correlation with the severity of mitral regurgitation(P>0.05),A2(r=0.362)was positively correlated with LAd(P=0.054),but had no correlation with LVDd(P>0.05).4.ROC curve analysis:When the A1 was 148.6°,the sensitivity of DMC was97%,the specificity was 98%;A2 was 109.1°,the sensitivity of assessing mild FMR was 70.4%,the specificity was 68%,A2 was 119.3°,the sensitivity of moderate to severe FMR evaluation was 75%,the specificity was 90%.Conclusion:1.The method of measuring the angle of mitral valve is feasible.For the patients with dislocation of mitral valve coaptation,except according to the two dimensional echocardiography showed the poor coaptation of anterior and posterior mitral valves and eccentric regurgitation,we can use the A1 for diagnosed.At the end of systole,when the A1 is not more than 148.6° for the node,the sensitivity of diagnosis ofDMC were 97%,and the specificity was 98%.2.At the end of systole,the A2 angle is not less than 119.3°(the sensitivity was75%,the specificity was90%)can become a reference index for evaluating the moderate to severe FMR.