二维斑点追踪技术对微创治疗心房颤动效果的评估研究

发布时间：2018-05-06 07:23

本文选题：斑点追踪成像 + 二维应变　；参考：《第二军医大学》2014年硕士论文

【摘要】：第一部分二维斑点追踪成像技术评价正常人左心房功能的研究目的：运用斑点追踪成像技术（speckle tracking imaging, STI）评价不同年龄段正常人左心房的功能，总结代表左心房储存功能、管道功能及辅助泵功能的应变及应变率参数的变化趋势，为进一步研究病理状态下左心房功能变化提供基础资料。方法：选取2012年3月～2013年3月期间在长海医院超声科行心脏超声检查的90例健康体检者，男53例，女37例；年龄23～81岁，平均54.7±11.82岁；按其年龄分为三组：青年组30例：年龄≤45岁，平均33.5±7.91（23～45）岁，中年组30例：45＜年龄≤65岁，平均54.9±8.15（46～65）岁；老年组30例：年龄＞65岁，72.3±5.83（66～81）岁。常规行超声心动图检查，记录左心房及左心室相应测量数据，采集相应时相及切面的左心房二维超声动态图像并存盘，运用STI技术对三组受检查者的二维超声动态图像进行脱机分析处理并建立相应数据库，比较分析各个年龄段左心房常规超声测量指标及应变和应变率参数测量指标的差异，总结其变化趋势。结果：1.青年组、中年组及老年组间在性别、心率、收缩压、舒张压等方面差异无统计学意义（P＞0.05）；老年组二维超声心动图测得的左心室舒张末期内径（LVIDd）、左心室收缩末期内径（LVIDs）值均大于青、中年组，左心室射血分数（LVEF）值小于青、中年组，但无显著性差异（P＞0.05）；老年组左房内径（LAD）及左心房最大容积（LAVmax）、左心房最小容积（LAVmin）值均较青年组及中年组高，且左心房总射血分数（TLAEF）、左心房被动射血分数（PLAEF）值均有不同程度降低，以左心房被动射血分数（PLAEF）降低明显，差异有统计学意义（P＜0.05）；老年组左心房收缩前容积（LAVpreA）、左心房主动射血分数（ALAEF）较青、中年组高（P＜0.05）；老年组E峰、A峰值与青年组及中年组比较无显著性差异（P＞0.05），但E/A比值明显降低、E峰减速时间（DT）显著延长（P＜0.05）。 2.三组受检者左心房侧壁的应变率值（SR）最高，房间隔最低（P＜0.05），前壁和后壁之间差异无统计学意义（P＞0.05）；左心房各壁基底段的应变率最高（P＜0.05），中间段和上段差异无统计学意义（P＞0.05）；老年组收缩期及舒张早期应变率（SRs、SRe）均较青、中年组低，且以侧壁和前壁的基底段下降明显，舒张晚期的应变率（SRa）较青、中年组高（P＜0.05）。 3.老年组基底段达峰时间较青年组和中年组长（P＜0.05），中年组大于青年组，但差异无统计学意义（P＞0.05）；老年组与中年组中间段达峰时间较青年组长，而中年组与老年组间无显著差异（P＞0.05）； 4.左心房整体的应变率SRs与TLAEF、SRe与PLAEF、SRa与ALAEF良好的相关性。结论：STI技术能够准确评价左心房的功能，并得出各年龄段左心房正常的应变及应变率参考值；且随着年龄的增长，，左心房功能逐渐下降，左心房下壁及侧壁的应变参数是其功能早期改变的敏感预测指标。第二部分二维斑点追踪成像技术评价心房颤动患者在射频消融术前后左心房功能的变化目的：运用STI技术评价心房颤动患者在经导管射频消融术前及术后不同阶段左心房功能的变化情况，检测左心房壁各节段应变参数的变化趋势和规律，总结经导管射频消融术后左心房功能变化的敏感指标，确定判断房颤复发可能性的预测指标，为其疗效的判定、后期治疗及预后提供影像学依据。方法：选取2012年1月～2013年12月期间在长海医院心内科行导管射频消融术治疗的心房颤动患者48例，其中阵发性房颤33例，年龄49～76岁，平均65.8±12.41岁，男18例，女15例，持续性房颤15例，年龄55～81岁，平均68.6±11.48岁，男9例，女6例；记录其相应临床资料；分别于术前1天、术后3天、3个月、6个月行超声心动图检查，记录左心房及左心室相应测量数据，采集相应时相及切面的左心房二维超声动态图像并存盘，运用STI技术对受检查者的二维超声动态图像进行脱机分析处理并建立相应数据库。对比分析其常规超声心动图参数、二维应变参数的变化情况。结果：所有的房颤患者在射频消融术后即时均成功转复为窦性心律，在术后的6个月随访中，33例阵发性房颤患者中有4例患者出现房颤复发，余29例均维持窦性心律；15例持续性房颤患者中6例在术后维持窦性心律，余9例患者均出现房颤复发。 1.持续性房颤组、阵发性房颤组在性别、收缩压、舒张压等方面与正常对照组之间的差异无统计学意义（P＞0.05）；持续性房颤组的心率较正常对照组快（P＜0.05），阵发性房颤组与正常对照组无显著性差异（P＞0.05）。 2.阵发性房颤组、持续性房颤术前及术后的3天、3月、6月随访中在LVIDd、LVIDs、LVEF等方面与正常对照组比较，差异均无统计学意义（P＞0.05）； 3.阵发性房颤组术前LAD较正常对照组大，E/A比值降低，且DT时间延长（P＜0.05）；术后3月E/A值增加，DT时间缩短，但与术前相较差异无统计学意义（P＞0.05）；术后6月E/A值较术前增加明显，DT也明显减少，但均低于正常对照组水平（P＜0.05）； 4.持续性房颤组在术前左心房各壁的应变率值均较正常对照组低（P＜0.05），阵发性房颤组则与正常对照组无显著性差异（P＞0.05）； 5.术后3天，阵发性房颤组、持续性房颤组左心房各壁的上段应变率值均较术前降低，术后3月，其上段应变率值有不同程度升高，但均低于正常对照组（P＜0.05）； 6.术后6月维持窦性心律的患者，其左心房各壁的应变率值较术前增高，而复发房颤的患者，其应变率值进一步下降（P＜0.05）。结论：房颤患者较同龄正常人左心房功能降低，尤其是持续性房颤的患者；在导管消融术后，左心房上段心肌形变能力减低；STI技术能够评估房颤患者左心房功能，并且可以作为房颤复发的预测指标。
[Abstract]:Part two evaluation of left atrial function in normal subjects by two-dimensional speckle tracking imaging
Objective: To evaluate the function of left atrium in normal people of different ages by speckle tracking imaging (STI), and to summarize the change trend of strain and strain rate parameters representing the left atrium storage function, the function of the pipe and the function of auxiliary pump, so as to provide the basic data for the further study of the changes of left atrium function under the pathological condition.
Methods: from March 2012 to March 2013, 90 healthy subjects, 53 males and 37 females, were enrolled in the ultrasound department of Changhai Hospital. The age was 23~81 years old and the average was 54.7 + 11.82 years old. According to their age, there were three groups: the young group was 30 cases, the average age was 33.5 + 7.91 (23~45) years, and the middle-aged group was less than equal. The average 54.9 + 8.15 (46~65) years old and 30 aged group: age > 65 years and 72.3 + 5.83 (66~81) years. Routine echocardiography was performed to record the left atrium and left ventricle of the left atrium. The two-dimensional ultrasound dynamic images of the left atrium and the left atrium were collected and the STI technique was applied to the two-dimensional ultrasound dynamic map of the three groups. The difference between the conventional ultrasonic measurement indexes of the left atrium and the parameters of the strain rate and strain rate parameters of the left atrium in all ages was compared, and the trend of the change was summarized.
Results: there was no significant difference in gender, heart rate, systolic pressure and diastolic pressure between the middle age group and the elderly group (P > 0.05). The left ventricular end diastolic diameter (LVIDd) and the left ventricular end diameter (LVIDs) value of the elderly group were greater than those of the old group, and the left ventricular end systolic diameter (LVIDs) values were all larger than those of the old group, and the middle age group and the left ventricular ejection fraction (LVEF) were less than those in the old group. In the middle-aged group, there was no significant difference (P > 0.05). The left atrium diameter (LAD) and the left atrial maximum volume (LAVmax) and the left atrial minimum volume (LAVmin) were higher in the elderly group than in the young group and the middle age group, and the left atrium total ejection fraction (TLAEF), the left atrial passive ejection fraction (PLAEF) decreased in varying degrees, and the left atrial passive ejection fraction (P). LAEF) decreased significantly (P < 0.05), the volume of left atrial pre systolic volume (LAVpreA) and left atrial active ejection fraction (ALAEF) were higher in the elderly group than in the middle age group (P < 0.05); the peak of E in the elderly group had no significant difference between the young group and the middle age group (P > 0.05), but the E/A ratio decreased significantly, and the E peak deceleration time (DT) was significantly extended. Long (P < 0.05).
2. the left atrial lateral wall strain rate (SR) was the highest (P < 0.05), and there was no significant difference between the anterior and posterior walls (P > 0.05). The strain rate of the basal segments of the left atrium was the highest (P < 0.05), and the difference between the middle and upper segments was not statistically significant (P > 0.05), and the systolic and early diastolic strain rates (SRs, SR) in the elderly group (SRs, SR). E) were lower than those in the young and middle-aged group, and the basal segments of the lateral and anterior wall decreased significantly. The strain rate (SRa) of late diastolic phase was higher than that of the green group and the middle age group was higher (P < 0.05).
3. the peak time of the basal segment of the aged group was more than that of the young group and the middle age group (P < 0.05), the middle age group was larger than the young group, but the difference was not statistically significant (P > 0.05); the middle period of the elderly group and the middle age group was longer than the young group, but there was no significant difference between the middle age group and the elderly group (P > 0.05).
4. there is a good correlation between the strain rate SRs of left atrium and TLAEF, SRe and PLAEF, SRa and ALAEF.
Conclusion: STI technique can accurately evaluate the function of left atrium and draw a reference value for the normal strain and strain rate of left atrium in all ages. With the increase of age, the function of left atrium gradually decreases, and the strain parameters of the lower and lateral walls of the left atrium are sensitive predictors of early functional changes of the left atrium.
The second part two dimensional speckle tracking imaging is used to evaluate the changes of left atrial function before and after radiofrequency ablation in patients with atrial fibrillation.
Objective: To evaluate the changes of left atrial function in patients with atrial fibrillation before and after transcatheter radiofrequency ablation by STI technique, to detect the change trend and regularity of the strain parameters of each segment of the left atrial wall, and to sum up the sensitive index of the changes of left atrial function after catheter radiofrequency ablation, and to determine the possibility of recurrence of atrial fibrillation. The predictive indexes provide the imaging evidence for the judgement of the curative effect, the later treatment and the prognosis.
Methods: from January 2012 to December 2013, 48 patients with atrial fibrillation treated by catheter radiofrequency ablation in Department of Cardiology, Changhai Hospital, including 33 cases of paroxysmal atrial fibrillation, age 49~76 years old, average 65.8 + 12.41 years, 18 men, 15 women, 15 cases of persistent atrial fibrillation, average age 55~81 years, average 68.6 + 11.48 years, male 9, female 6, were recorded. The corresponding clinical data were performed 1 days before the operation, 3 days after the operation, 3 months and 6 months after the operation, and the left atrium and left atrium were recorded by the echocardiography. The two-dimensional ultrasound dynamic images of the left atrium and the left atrium were collected and the STI technique was used to analyze and process the two-dimensional ultrasonic dynamic images of the examiners. Establish a corresponding database, and compare the changes of conventional echocardiographic parameters and two-dimensional strain parameters.
Results: all patients with atrial fibrillation were successfully converted to sinus rhythm after radiofrequency ablation. During the 6 month follow-up, 4 of 33 patients with paroxysmal atrial fibrillation had recurrent atrial fibrillation, 29 remained sinus rhythm, 6 of 15 patients with persistent atrial fibrillation maintained sinus rhythm after operation and 9 patients had atrial fibrillation. Relapse.
1. in the group of persistent atrial fibrillation, there was no significant difference in sex, systolic pressure and diastolic pressure in paroxysmal atrial fibrillation group (P > 0.05), and the heart rate of persistent atrial fibrillation group was faster than that of normal control group (P < 0.05), and there was no significant difference between paroxysmal atrial fibrillation group and normal control group (P > 0.05).
2. paroxysmal atrial fibrillation group, 3 days before and after the operation of persistent atrial fibrillation, in March, June, in the LVIDd, LVIDs, LVEF and other aspects compared with the normal control group, the difference was not statistically significant (P > 0.05).
The preoperative LAD of 3. paroxysmal atrial fibrillation group was larger than that of the normal control group, the ratio of E/A decreased and the time of DT prolonged (P < 0.05). The E/A value increased in March and the time of DT shortened, but there was no statistical difference between the preoperative and preoperative (P > 0.05). The value of E/A in June after the operation was significantly higher than that before the operation, and the DT also decreased, but all were lower than the normal control group (P < 0.05).
4. the strain rate of all the left atrial walls in the continuous atrial fibrillation group was lower than that in the normal control group (P < 0.05), but there was no significant difference between the paroxysmal atrial fibrillation group and the normal control group (P > 0.05).
5. after 3 days, the strain rate of the left atrium in the paroxysmal atrial fibrillation group was lower than that before the operation. In March after the operation, the strain rate of the upper segment increased in different degrees, but all were lower than that of the normal control group (P < 0.05).
The strain rate of each wall in the left atrium was higher than that before operation in the patients who maintained the sinus rhythm in June after 6., and the strain rate of the patients with recurrent atrial fibrillation was further decreased (P < 0.05).
Conclusion: Patients with atrial fibrillation have lower left atrial function than normal people of the same age, especially in patients with persistent atrial fibrillation. After catheter ablation, the deformation ability of the left atrium in the left atrium is reduced; STI technique can evaluate the left atrial function in patients with atrial fibrillation and can be used as a predictor of atrial fibrillation recurrence.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.75;R540.45

【参考文献】