Clinical Research Of Speckle Stracking Imaging In Assessment Of Papillary Muscle Function In Ischemic Mitral Regurgitation Patients

Coronary heart disease also called ischemic heart disease,because of coronary endometrial damaging leads to plaque formation,lumen stenosis and even occlusion,reduce or block myocardial blood supply,cause angina,myocardial infarction,arrhythmia,heart failure and sudden death series.On the basis of environmental and genetic factors,multiple risk factors can lead to the occurrence and development of coronary heart disease.The risk factors of coronary heart disease mainly include:male,smoking,type 2 diabetes,hyperlipidemia,hypertension etc.Type 2 diabetes is related to the severity of coronary artery stenosis.The development of coronary heart disease will be associated with cardiac function,glomerular filtration rate and they also associate with the severity of coronary artery disease.In recent years,with the changes of people’s living habits,diet structure and living environment,the incidence of physical strength reduction,high fat diet and weight increase,coronary heart disease presents a clear upward trend.It has become one of the serious harmful cardiovascular disease,affect the quality of life.Therefore,early effective personalized intervention is particularly important.Ischemic mitral regurgitation is one of the most common complications of coronary heart disease.Because of coronary lesions,one or more changes in the mitral device(including left ventricular,valve leaflet,annulus,valve structureand left atrium)lead to mitral regurgitation.It is very important to evaluate the function of mitral valve device and the degree of regurgitation.At present,the assessment of the degree of mitral regurgitation:(1)enhanced CT: the lesions of the mitral device can clearly show the structure of the mitral valve and the hemodynamic parameters measured by volume measurement,but the post-processing process is complex,radiation damage to the human body,and is not suitable for long-term follow-up.(2)magnetic resonance imaging(MRI):It doesn’t depend on the hypothesis of geometric shape,and is repeatable,but expensive,costs too much time,and is not suitable for patients with fast rhythm.(3)left ventricular angiography:we can understand the structure and function of mitral valve and if the mitral valve is regurgitation or not and the degree,but may cause some complications,therefore have not been used routinely.(4)real-time three plane echocardiography:real-time display of three-dimensional shape of regurgitation and calculate the volume of regurgitation,but the acoustic window condition and cooperation of patients have high requirements and is still in the initial stage.(5)Doppler echocardiography:low cost,no radiation,simple operation,and can be dynamically observed and repeatedly use,low condition of patients,and can can bedside testing,so application more widely.It is the first method to evaluate mitral regurgitation.ObjectiveTo evaluate papillary muscle function in ischemic mitral regurgitation patients by two-dimensional speckles tracking imaging(2D-STI)and three-dimensional ultraphonic,and to investigate the influence factors of ischemic mitral regurgitation primarily,providing the basis of clinical predictive for ischemic mitral regurgitation.Methods76 patients with ischemic mitral regurgitation were brought into case group.Control group involved in 66 healthy volunteers,Two groups were examined by transthoracic echocardiography and two-dimensional speckles tracking imaging.Routine parameters and fractional shortening(FS),length between the posterior or anterior papillary muscle tip sand the contralateral anterior mitral annular(APM-AMA,PPM-AMA),mitral leaflet closure(MLC),inter distance papillary muscle(IPMD),AngI(defined as the angle between the anterior papillary muscle and the anterior LV free wall),AngII(the angle between the posterior papillary muscle and the anterior LV free wall),anterior,posterior papillary muscle longitudinal strain(ALS,PLS),delay time(DT),left ventricular end-diastolic diameter,(LVEDd),left ventricular end-diastole volume(LVEDV),left ventricular ejection fraction(LVEF)were acquired respectively and compared.ResultsCompared with control group,LVEDd,LVEDV,LVEF,AFS,PFS,IPMD,MLC,ALS,PLS and DT in case group were significantly different(P<0.05).ALS,PLS,AFS,PFS and had positive correlation with LVEF(P<0.05),and negative correlation with LVEDV(P<0.05).MLC,IPMD,DT had negative correlation with LVEF(P<0.05).ALS,PLS,MLC,AFS,PFS,IPMD were significantly correlated with Gensini score(r=-0.65,-0.78,0.54,-0.51,-0.57,0.49,P<0.05).Its correlates in logistic analysis included IPMD,MLC,PLS,DT,with OR 1.26,1.32,1.37,1.52(P<0.05).Conclusions2D-STI could assess the PM dysfunction caused by myocardial infarction more accurately.An increase IPMD and MLC,a decrease PLS,desynchronization of PMs are risk factors of IMR.The result is contributed to clinical predictive for ischemic mitral regurgitation.