三维斑点追踪技术评价房颤患者左房功能改变的初步研究

发布时间：2018-04-18 13:43

本文选题：三维斑点追踪技术 + 房颤　；参考：《郑州大学》2014年硕士论文

【摘要】：目的应用三维斑点追踪技术（Three-dimension speckle tracking imaging,3D-STI）初步研究阵发性房颤患者、持续性房颤患者左房功能变化，探讨房颤（Atrialfibrillation, AF）对左房功能的影响，评价该技术在检测AF患者左房功能中的应用价值。方法选取二维图像清晰的37例阵发性房颤患者（AF1组）、43例持续性房颤患者（AF2组）及40例健康体检者（对照组），采集全容积左室心尖四腔和两腔切面图像并存储，运用3D-STI进行分析。测量并比较：①左房16节段收缩期纵向、径向、圆周和面积峰值应变（PLS、PRS、PCS、PAS），左室收缩期左房整体纵向、径向、圆周和面积应变（GLSs、GRSs、GCSs、GASs），以及左房收缩期整体纵向、径向、圆周和面积应变（GLSa、GRSa、GCSa、GASa）等收缩功能参数；②左房16节段纵向、径向、圆周和面积应变达峰时间（TLS、TRS、TCS、TAS），左房整体纵向、径向、圆周和面积应变达峰时间（GTLS、GTRS、GTCS、GTAS），以及左房纵向、径向、圆周和面积应变达峰时间标准差（TLS-SD、TRS-SD、TCS-SD、TAS-SD）等非同步参数。分析3D-STI参数与左房整体功能（LAEF）的相关性。绘制3D-STI收缩功能参数与非同步参数ROC曲线。采用心率对时间参数进行校正。结果 1.随着AF程度的加重，左房心肌局部收缩功能下降，AF1组、AF2组大部分节段PLS、PRS、PCS、PAS低于对照组，差异有统计学意义（P0.05）。 2. AF患者左房储存功能及助力泵功能受损，AF1组、AF2组GLSs、GRSs、GCSs、GASs较对照组减低，差异有统计学意义（P0.05）；AF1组GLSa、GASa较对照组减低，差异有统计学意义（P0.05），AF1组GRSa、GCSa低于对照组，差异没有统计学意义（P0.05）。 3.随着AF发作频率及持续时间的增加，房壁运动异常程度加重，出现左房心肌的非同步性运动，AF1组、AF2组TLS、TRS、TCS、TAS以及GTLS、GTRS、GTCS、GTAS较对照组延迟，差异有统计学意义（P0.05）；AF1组、AF2组TLS-SD、TRS-SD、TCS-SD、TAS-SD较对照组增高，差异有统计学意义（P0.05）。 4.3D-DTI参数GLSs、GRSs、GCSs和GASs间具有较好的相关性，反应左房储存功能的GLSs、GRSs、GCSs、GASs指标及反应左房心肌运动不同步性的TLS-SD、TRS-SD、TCS-SD、TAS-SD指标均与LAEF具有较好相关性。 5.3D-STI整体应变参数GLSs、GRSs、GCSs和GASs的ROC曲线下面积分别为0.978、0.820、0.872、0.891；非同步参数TLS-SD、TRS-SD、TCS-SD和TAS-SD的ROC曲线下面积分别为0.771、0.576、0.730、0.738。纵向应变指标对于AF患者左房功能的诊断效能高于径向、圆周和面积应变。结论 AF患者在病变早期即出现心肌损害，随着AF发作频率及持续时间的加重，，左房壁心肌各节段的运动进一步出现异常，在3D-STI中表现为应变值逐渐减低，并且出现了非同步运动。3D-STI能检测AF患者的房壁心肌运动异常，定量评价AF患者左房心肌收缩功能及同步性的变化。
[Abstract]:PurposeThree-Dimension speckle tracking imaging3D-STI was used to study the changes of left atrial function in patients with paroxysmal atrial fibrillation and persistent atrial fibrillation. The effects of AF on left atrial function were investigated and the value of the technique in detecting left atrial function in patients with AF was evaluated.MethodThirty-seven patients with paroxysmal atrial fibrillation (PAF) and 40 healthy controls (control group, n = 37) and 40 healthy controls (n = 40) were collected and stored in full-volume left ventricular apical four chamber and two-chamber section. The results were analyzed by 3D-STI.To measure and compare the systolic longitudinal, radial, circumferential and area peak strain of left atrium in 16 segments of the left atrium at 1: 1. The peak strain of PLSN, PRSN, PCS, PASA, the whole longitudinal, radial, circumferential and area strain of left ventricular systolic phase in left atrium were measured and compared, and the whole longitudinal and radial of left atrial systolic phase were measured and compared, and the whole longitudinal and radial of left atrial systolic phase were measured.Systolic function parameters such as circumference and area strain GLSaG Sag GCSa-GASa2 left atrial 16 segments longitudinal, radial, circumferential and area strain peak time (TLS) TRST TCSTASU, left atrium overall longitudinal, radial, circumferential and area strain peak time GTLSGTRSTRSGTCSC GTASN, and left atrium longitudinal, radial, radial, and area strain peak time GTLSGTRSGTCSTTASN, and left atrial longitudinal, radial, radial, and area strain peak time GTLSGTRSGTCSTTASU, and left atrium longitudinal, radial, radial, and area strain peak time.The standard deviation of peak time of circumference and area strain is TLS-SDN TRS-SDN TCS-SD-TAS-SDS and other asynchronous parameters.To analyze the correlation between 3D-STI parameters and left atrial global function (Laff).Draw ROC curve of 3D-STI contraction function parameter and asynchronous parameter.Time parameters were corrected by heart rate.Result1.With the aggravation of AF, the regional systolic function of left atrial myocardium decreased in AF1 group.2.Left atrial storage function and pump function in AF1 group were significantly lower than those in control group (P 0.05). The difference was statistically significant (P 0.05). There was significant difference between AF1 group and control group (P 0.05). The GRSaGCSa of AF1 group was lower than that of control group (P 0.05), but the difference was not significant (P 0.05).3.With the increase of AF attack frequency and duration, the abnormal degree of atrial wall motion increased, and the TLSS-TRS TCSTAS and GTLS+ GTRCSCSTTAS in AF1 group were delayed compared with the control group, the difference was statistically significant (P0.05AF1 group AF2 group TLS-SDTRS-SDT TCSDS-TAS-SD increased compared with the control group.The difference was statistically significant (P 0.05).There was a good correlation between GCSs and GASs parameters of 4.3D-DTI parameters. GASs of GCSs and TLS-SDS-SDS-SDT TAS-SD, which reflected the storage function of left atrium, and TLS-SDS-SDS-SD-TAS-SD, which reflected the different motion of left atrium, were all correlated well with LAEF.The area under the ROC curve of the whole strain parameter of 5.3D-STI GLSS-GRSs and GASs is 0.978t 0.820 0.872U 0.891respectively, and the area under the ROC curve of TLS-SDS-SDS-SD and TAS-SD is 0.771U 0.5760.7300.738381.The area under the ROC curve is 0.771U 0.5760.7300.7381.The area under the ROC curve of TLS-SDS-SDCS-SD and TAS-SD is 0.771U 0.5760.7300.7381. respectively.The diagnostic efficacy of longitudinal strain index for left atrial function in AF patients was higher than that in radial, circumferential and area strain.ConclusionMyocardial damage occurred in the early stage of AF. With the exacerbation of AF attack frequency and duration, the motion of each segment of left atrial wall was further abnormal, and the strain value decreased gradually in 3D-STI.Asynchronous exercise. 3D-STI could detect the abnormal myocardial motion in AF patients, and quantitatively evaluate the changes of left atrial systolic function and synchronism in patients with AF.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541.75

【参考文献】