斑点追踪技术定量评价尿毒症心肌病左室肥厚及形变对心功能的影响

发布时间：2018-01-04 19:13

本文关键词：斑点追踪技术定量评价尿毒症心肌病左室肥厚及形变对心功能的影响　出处：《中南大学学报(医学版)》2017年04期 　论文类型：期刊论文

【摘要】：目的:应用二维斑点追踪技术(two dimensional speckle tracking imaging,2D-STI)检测尿毒症心肌病(uremic cardiomyopathy,UCM)患者心肌生物力学参数,评价左室肥厚及左室形变对心功能的影响。方法:随机将67例UCM患者分为临床心功能正常组(A亚组,32例)及心功能异常组(B亚组,35例),另选30例作为正常对照组。比较受检者临床心功能分级积分NYHA-P、左室射血分数(left ventricular ejection fraction,LVEF)、左室重量指数(left ventricular mass index,LVMI)、左室球形指数(left ventricular spherical index,LVSI)以及心肌生物力学参数即左室平均径向应变(mean radial strain,MRS)、平均径向应变率(mean radial strain rate,MRSR)、平均纵向应变(mean longitudinal strain,MLS)、组织运动瓣环位移(tissue motion annular displacement,TMAD)、左室心肌收缩期扭转角度(systolic twist angle,STA)。结果:UCM组LVMI增大,而STA,MLS,MRS,MRSR,TMAD,LVSI减低(P0.05)。UCM组中B亚组与A亚组比较:LVMI差异无统计学意义(P0.05),MLS,MRS,MRSR,STA,TMAD,LVSI减低(P0.05)。正常对照组和UCM组MLS绝对值与LVEF均呈正相关;UCM患者MLS绝对值与LVSI呈正相关,与LVMI呈负相关。以MLS 14.10%为截断点判定患者NYHA-P4分灵敏度为90.5%,特异度为71%,Yuedden指数最高0.585。UCM患者心肌收缩期STA较对照组减低(P0.05)。结论:用2D-STI技术检测心肌生物力学参数来评价UCM患者左室局部功能具有独特的优越性,左室肥厚与心室形变无直接相关,临床心功能分级与左室肥厚及心室形变相关,与局部心功能参数相关性更明显,局部心肌力学参数改变存在于心功能分级尚好及心室重构程度较轻的患者,局部心肌力学参数下降预示心功能向异常化发展。
[Abstract]:Objective: to apply two dimensional speckle tracking imaging. 2D-STI was used to detect the biomechanical parameters of uremic cardiomyopathy (UCM) patients with uremic cardiomyopathy. Methods: 67 patients with UCM were randomly divided into subgroup A (n = 32) and subgroup B (n = 35). Another 30 cases were selected as normal control group. The clinical cardiac function score NYHA-P was compared. Left ventricular ejection fractionation (LVEF). Left ventricular mass index (LVMI). Left ventricular spherical index. Left ventricular mean radial strain (LVSI) and myocardial biomechanical parameters (mean radial straining MRS). The mean radial strain rate was mean radial strain rate.Meanwhile the mean longitudinal strain was mean longitudinal strain. MLS, tissue motion annular displacement (TMAD). Results the systolic twist of left ventricular torsion was increased in the group of LVMI, and the LVMI was increased in the group of left ventricular contractile torsion. There was no significant difference between subgroup B and subgroup A (P 0.05) and MLS MRS MRSR in group B (P 0.05). The absolute value of MLS in normal control group and UCM group was positively correlated with LVEF. The absolute value of MLS in UCM patients was positively correlated with LVSI and negatively correlated with LVMI. The sensitivity of NYHA-P4 score was 90.5% with MLS 14.10% as cut-off point. The specificity was 71%. The peak Yuedden index of 0.585.UCM patients with myocardial systolic STA was lower than that of the control group (P 0.05). Conclusion: measuring myocardial biomechanical parameters by 2 D-STI technique has unique advantages in evaluating left ventricular regional function in patients with UCM. There was no direct correlation between left ventricular hypertrophy and ventricular deformation. The clinical cardiac function grade was correlated with left ventricular hypertrophy and ventricular deformation, especially with regional cardiac function parameters. The changes of local myocardial mechanical parameters were found in patients with good cardiac function grade and mild degree of ventricular remodeling. The decrease of local myocardial mechanical parameters indicated the development of cardiac function towards abnormality.
【作者单位】：中山大学附属汕头医院超声科;
【基金】：广东省医学科研基金(A2010584)~~
【分类号】：R445.1;R542.2;R692.5
【正文快照】： Effect of left ventricular hypertrophy and deformation oncardiac function in patients with uremia cardiomyopathy byusing quantitative speckle tracking technologyZHENG Yi,YANG Xiaohong,ZHOU Qiping,HUANG Yaoyao,ZHANG Fan,WANG Liangyu(Department of Ultrasou

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