二维斑点追踪技术定量评价房颤患者左室心肌分层应变

发布时间：2018-06-09 22:55

本文选题：房颤 + 心衰　；参考：《郑州大学》2017年硕士论文

【摘要】：目的心房颤动是临床上最常见的心律失常之一,影响患者生存质量,可使患者的卒中和心衰发生率明显增加,是我国最主要的致残和致死疾病之一[1]。房颤发作时心房失去有效的收缩射血功能,加之快速而不规则的心室率,使左室收缩功能和顺应性受损[2],从而进一步影响左室局部及整体功能。关于左室心肌局部和整体功能的定量评价,已经受到影像诊断的广泛关注,而目前却较少对左室心肌功能的分层分析进行深入研究。本文以房颤患者为研究对象,利用2D-STI评价房颤患者左室心肌分层应变,初步探讨房颤患者左室分层应变变化规律。方法48例房颤无心衰组,32例房颤合并心衰组,40例正常对照组。常规测量,采集动态图像后,应用Echo PAC113软件分析二维动态图像,获得左室18个节段心内膜、中层心肌和心外膜各层的收缩期峰值纵向应变及心内膜、中层心肌和心外膜整体收缩期峰值纵向应变。常规超声测量指标:Simpson法测量左室射血分数(LVEF),左房内径(LAD)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)以及舒张早期二尖瓣口血流速度(E)和室间隔处二尖瓣环运动速度(e')的比值E/e'。节段分层应变指标:十八节段心内膜收缩期峰值纵向应变(PLSEndo)、中层心肌收缩期峰值纵向应变(PLSMid)、心外膜收缩期峰值纵向应变(PLSEpi)。整体分层应变指标:心内膜整体收缩期峰值纵向应变(GPLSEndo)、中层心肌整体收缩期峰值纵向应变(GPLSMid)、心外膜整体收缩期峰值纵向应变(GPLSEpi)及全层心肌整体收缩期峰值纵向应变(GPLS)。结果1、常规超声心动图测量参数比较:与对照组相比,房颤无心衰组左室舒张末内径、左室收缩末内径、左室射血分数均无统计学差异,但左房内径、舒张早期二尖瓣口血流速度(E)和室间隔处二尖瓣环运动速度(e')的比值E/e'有差异(P0.05)。房颤合并心衰组与对照组相比左房内径、左室舒张末内径、左室收缩末内径、左室射血分数以及舒张早期二尖瓣口血流速度(E)和室间隔处二尖瓣环运动速度(e')的比值E/e'均有显著统计学差异(P0.01)。2、节段分层应变的比较:与对照组比较,房颤无心衰组及房颤合并心衰组基底段、中间段、心尖段心内膜收缩期峰值纵向应变(PLSEndo)、中层心肌收缩期峰值纵向应变(PLSMid)、心外膜收缩期峰值纵向应变(PLSEpi)均减低,差异均有统计学意义(P0.05)。房颤合并心衰组与房颤无心衰组相比,基底段、中间段、心尖段心内膜收缩期峰值纵向应变(PLSEndo)、中层心肌收缩期峰值纵向应变(PLSMid)、心外膜收缩期峰值纵向应变(PLSEpi)均减低,差异均有统计学意义(P0.05)。3、整体分层应变的比较:与对照组比较,房颤无心衰组及房颤合并心衰组的心内膜、中层心肌、心外膜整体收缩期峰值纵向应变(GPLSendo、GPLSMid、GPLSepi)及左室整体全层收缩期峰值纵向应变(GPLS)明显减低,差异有统计学意义(P0.05)。房颤合并心衰组与房颤无心衰组相比,心内膜、中层心肌、心外膜整体收缩期峰值纵向应变(GPLSendo、GPLSMid、GPLSepi)及左室整体的全层收缩期峰值纵向应变(GPLS)明显减低,差异有统计学意义(P0.05)。对照组所有入选者左室自内层到外层心肌的GPLS均依次减低。4.ROC曲线分析左室全层整体纵向应变对房颤患者左室心肌的检测左室全层整体纵向应变检测房颤患者左室心肌的曲线下面积为84.9%,当截断点为-21.38%时,灵敏度77.7%,特异度72.5%。结论分层应变技术可定量分层评价房颤患者左室心肌的整体及局部功能,具有一定的临床应用价值。
[Abstract]:Objective atrial fibrillation is one of the most common arrhythmia in clinic. It affects the quality of life of the patients. It can increase the incidence of stroke and heart failure in patients. It is one of the most important deformity and fatal diseases in China, one of the most fatal diseases in China, [1]. atrial fibrillation, the atrial loss of effective systolic ejection function, coupled with the rapid and irregular ventricular rate, make the left ventricular contraction. Function and compliance damage [2], which further affects the local and overall function of the left ventricle. The quantitative assessment of the local and overall function of the left ventricular myocardium has received extensive attention from the imaging diagnosis. At present, there is less in-depth study of the stratified analysis of left ventricular myocardial function. This article uses 2D-STI to evaluate the patients with atrial fibrillation. Stratified strain of left ventricular myocardium in patients with atrial fibrillation was preliminarily investigated. Methods 48 cases of atrial fibrillation, 32 cases of atrial fibrillation, heart failure, 40 cases of normal control. After routine measurement, dynamic images were collected, and two dimensional dynamic images were analyzed with Echo PAC113 software to obtain 18 segments of the left ventricular endocardium and middle layer. Peak systolic peak longitudinal strain and endocardium, middle myocardial and epicardial systolic peak longitudinal strain. Conventional ultrasonic measurement index: Simpson method to measure left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and early diastolic mitral valve flow The ratio of velocity (E) and mitral annulus velocity (E') at ventricular septum E/e'. segment stratified strain index: Eighteen segment endocardial systolic peak longitudinal strain (PLSEndo), middle myocardial systolic peak longitudinal strain (PLSMid), epicardial systolic peak longitudinal strain (PLSEpi). Overall stratified strain index: the peak systolic peak value of endocardium Longitudinal strain (GPLSEndo), median myocardial total systolic peak longitudinal strain (GPLSMid), epicardial systolic peak longitudinal strain (GPLSEpi) and total systolic peak longitudinal strain (GPLS). Results 1, conventional echocardiographic measurements were compared: compared with the control group, the left ventricular end diastolic diameter, left ventricle, and left ventricle were compared with the control group. There was no statistical difference between the end systolic diameter and the left ventricular ejection fraction, but the left atrial diameter, the early diastolic flow velocity of mitral valve mouth (E) and the ratio of the mitral annulus velocity (E') in the interventricular septum were different (P0.05). The left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter and left ventricular ejection fraction were compared with the control group (P0.05) in the early diastolic diameter of the left atrium (E). The ratio of mitral valve flow velocity (E) and mitral annulus velocity (E') at the ventricular septum in the early diastolic phase and the ratio E/e' of the mitral annulus velocity (E') in the interventricular septum had significant statistical difference (P0.01).2, compared with the control group, and compared with the control group, the basal segment of atrial fibrillation and atrial fibrillation combined with heart failure group, the middle segment, and the peak longitudinal strain of the endocardium systolic phase of the apical segment (PLSEnd) O), the peak systolic peak longitudinal strain (PLSMid), the peak systolic peak longitudinal strain (PLSEpi) of the epicardium all decreased, and the difference was statistically significant (P0.05). The atrial fibrillation combined with the heart failure group was compared with the heart failure group of the atrial fibrillation, the basal segment, the middle segment, the peak longitudinal strain of the endocardium systolic peak in the apical segment (PLSEndo), and the peak systolic peak length of the middle myocardium. Strain (PLSMid), epicardial peak systolic peak longitudinal strain (PLSEpi) decreased, and the difference was statistically significant (P0.05).3, the overall stratified strain comparison: compared with the control group, the endocardium, the middle myocardium, the epicardial systolic peak longitudinal strain (GPLSendo, GPLSMid, GPLSepi) and the left ventricle were compared with the control group. The overall total systolic peak longitudinal strain (GPLS) was significantly reduced, and the difference was statistically significant (P0.05). The endocardium, the middle myocardium, the peak systolic peak longitudinal strain (GPLSendo, GPLSMid, GPLSepi) and the total systolic peak longitudinal strain (GPLS) in the left ventricular whole of the heart failure group and the atrial fibrillation group were significantly lower than those of the heart failure group of atrial fibrillation. The difference was statistically significant (P0.05). The GPLS in all the left ventricular from the left ventricular to the outer layer of the left ventricular myocardium in all the controls was reduced by.4.ROC curve. The left ventricular myocardium in the left ventricular myocardium in patients with atrial fibrillation was detected by the overall longitudinal strain of the left ventricle. The area of the left ventricular myocardium in the left ventricular myocardium of the patients with atrial fibrillation was 84.9%, and the truncated point was -21.. At 38%, the sensitivity of 77.7%, specificity 72.5%. conclusion stratified strain technique can be used to quantitatively evaluate the overall and local function of left ventricular myocardium in patients with atrial fibrillation, which has certain clinical value.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45;R541.75

【参考文献】