解剖M型及二维斑点追踪成像技术评价冠脉多支病变患者左室心肌功能

发布时间：2018-02-01 19:54

本文关键词： 解剖M型二维斑点追踪分层应变左室心肌功能冠脉多支病变　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:应用解剖M型及二维斑点追踪成像技术评价冠脉多支病变患者左室心肌功能的改变。方法:随机选取38例心脏结构正常及无明显节段性室壁运动异常的冠脉多支病变患者纳入MVD组和40例正常人作为对照组,应用常规二维超声心动图(2DE)采集常规心脏测量切面和左室心尖四腔、两腔和三腔的二维动态图像。应用常规二维超声心动图(2DE)、二维斑点追踪技术(2D-STI)、解剖M型(AMM)对两组左心室相关参数进行测量:1.2DE常规参数测值包括:舒张末期左室内径(LVDd)及室间隔(IVSTd)、左室后壁厚度(IVSTd),收缩末期左房内径(LAESd)及二尖瓣口脉冲多普勒(PW)血流速度E峰、A峰,二尖瓣环左室侧壁组织多普勒(TDI)e峰、a峰,并计算E/A,E/e。利用Simpson法测得左室射血分数(LVEF)。2.2D-STI技术测量左室收缩功能参数包括:(1)应用二维斑点追踪自动功能成像(AFI)分析软件在机分析左室心尖位各切面,快速获取左室心肌各节段收缩期纵向应变值及整体纵向应变值(GLS)。(2)应用二维斑点追踪分层应变功能脱机分析左室心尖位各切面,获取各切面心内膜下、中层、心外膜下心肌纵向应变值及各切面全层心肌整体纵向应变值。各纵向应变值均以绝对值进行分析。3.2D-STI技术及AMM测量左室舒张功能参数包括:(1)应用二维斑点追踪应变分析软件脱机分析左室心尖位各切面,测量左室心肌各节段舒张早期(SrE)及舒张晚期纵向应变率值(SrA),并计算各节段SrE/SrA。(2)分别在胸骨旁左室长轴切面、左室短轴乳头肌水平切面解剖M型运动曲线上测量室间隔、左室后壁、前壁及下壁的室壁运动幅度、收缩期达峰时间、舒张期松弛时间及收缩期达峰时间与舒张期松弛时间比值。结果:1.冠状动脉造影结果:MVD组冠状动脉造影显示侧支血管丰富的病例数目明显增多。2.2DE常规参数比较结果:与对照组比较,MVD组LVDd、IVSTd、LVPWTd、LAESd、E峰、E/A、a峰、LVEF差异均无统计学意义(P0.05),e峰减低、A峰及E/e升高,差异均有统计学意义(P0.05)。3.2D-STI测量左室收缩功能参数比较结果:(1)与对照组比较,MVD组患者整体GLS降低无统计学意义(P0.05),但是MVD组患者基底段、中间段水平的后间隔及左室下壁纵向应变减低,差异有统计学意义(P0.05)。(2)与对照组比较,MVD组左室心尖位各切面心内膜下心肌纵向应变均减低,差异均有统计学意义(P0.05),但左室心尖位各切面中层心肌、心外膜下心肌纵向应变及各切面全层心肌整体纵向应变减低均无显著差异(P0.05)。4.2D-STI及AMM测量左室舒张功能参数比较结果:(1)与对照组比较,MVD组患者部分节段SrE/SrA比值减低,差异均有统计学意义(P0.05)。(2)两组间左室前壁、下壁、后壁、室间隔运动幅度及收缩期达峰时间差异均无统计学意义(P0.05)。与对照组比较,MVD组患者舒张期松弛时间延长,收缩期达峰时间与舒张期松弛时间比值减低,差异均有统计学意义(P0.05)。结论:1.二维斑点追踪分层应变技术可以评价冠脉多支病变患者左室心肌纵向分层应变,为判断冠脉多支病变患者早期左室收缩功能损害提供一种新的评价方法。2.AMM联合2D-STI可以对冠脉多支病变患者左室局部舒张功能进行有效评价,有助于简便、无创地筛选出无症状冠脉多支病变患者。
[Abstract]:Objective: the application of anatomical M mode and two dimensional speckle tracking imaging assessment of coronary multivessel disease in patients with left ventricular function changes. Methods: randomly selected 38 patients with normal heart structure and no obvious coronary segmental wall motion abnormalities in patients with multivessel disease in MVD group and 40 cases of normal people as control group, using conventional two dimensional echocardiography (2DE) acquisition routine measurement of the heart section and the left ventricular apical four chamber, two chamber and three chamber of the two-dimensional dynamic images. The application of conventional two-dimensional echocardiography (2DE), two dimensional speckle tracking imaging (2D-STI), M (AMM) anatomical measurement of related parameters of the two groups of left ventricle: 1.2DE the conventional parameters measured include: left ventricular end diastolic diameter (LVDd) and interventricular septum (IVSTd), left ventricular posterior wall thickness (IVSTd), left atrial end systolic diameter (LAESd) and mitral pulse Doppler (PW) blood flow velocity of E peak, A peak of mitral annulus left ventricular lateral wall tissue Doppler (TDI) e peak, a peak, E/e. and E/A were calculated and measured left ventricular ejection fraction (LVEF) by Simpson method including the parameter measurement of left ventricular systolic function in.2.2D-STI (1): automated function imaging using two-dimensional speckle tracking (AFI) analysis software in machine analysis of left ventricular apical sections, fast get the left ventricular segmental systolic longitudinal strain and global longitudinal strain (GLS). (2) layered strain analysis of left ventricular function offline apical sections by two-dimensional speckle tracking for each section of subendocardial, subepicardial middle, longitudinal strain value and each section of full thickness myocardial global longitudinal strain the longitudinal strain values. Values are in absolute value of.3.2D-STI and AMM to measure the left ventricular diastolic function parameters include: (1) software offline analysis of left ventricular apical sections analysis using two-dimensional speckle tracking strain measurement of left ventricular myocardial segments early diastolic (SrE ) and late diastolic longitudinal strain rate (SrA), and calculate each segment of SrE/SrA. (2) respectively in the parasternal long axis view, left ventricular papillary muscle level in short axis view anatomy M motion curve measurement of interventricular septum, left ventricular posterior wall, anterior wall and inferior wall motion. Shrink during peak time, relaxation time and time to peak systolic and diastolic relaxation time ratio. Results: 1. the results of coronary angiography: group MVD coronary angiography showed that the number of cases of collateral vessels rich significantly increased.2.2DE conventional parameter comparison results: compared with control group, MVD group, LVDd, IVSTd, LVPWTd, LAESd. The peak of E, E/A, a peak, LVEF showed no significant difference (P0.05), e peak A peak decreased and E/e increased, the differences were statistically significant (P0.05) compared the parameters measurement of left ventricular systolic function in.3.2D-STI results: (1) compared with the control group, GLS MVD group had no statistical significance Yi (P0.05), but MVD group of patients with basal segment, middle segment level after the interval and left ventricular wall under longitudinal strain decreased, the difference was statistically significant (P0.05). (2) compared with the control group, MVD group, left ventricular apical section of the subendocardial myocardial longitudinal strain were decreased, the differences were statistically meaning (P0.05), but the middle section of left ventricular apical epicardial myocardial longitudinal strain and myocardial each section of full thickness myocardial longitudinal strain decreased overall there was no significant difference (P0.05).4.2D-STI and AMM measurement of left ventricular diastolic function parameters comparison results: (1) compared with the control group, patients in group MVD segment the ratio of SrE/SrA decreased, the differences were statistically significant (P0.05). (2) between the two groups of left ventricular anterior wall, inferior wall, posterior wall, ventricular septal motion and systolic peak time showed no significant difference (P0.05). Compared with the control group, MVD group of patients with diastolic relaxation time, systolic The peak time and relaxation time ratio decreased, the differences were statistically significant (P0.05). Conclusion: 1. dimensional speckle tracking strain layered technology can evaluate the coronary multivessel disease of left ventricular myocardial longitudinal layered strain, for the judgment of multivessel coronary disease in patients with early left ventricular systolic dysfunction and provide a new evaluation method combined with.2.AMM 2D-STI of multivessel coronary disease in patients with left ventricular diastolic function for effective evaluation, contribute to the simple, noninvasive screening of asymptomatic patients with multivessel coronary disease.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45;R541.4

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