实时三维斑点追踪技术评价频发室性早搏患者心功能损害情况

发布时间：2018-05-09 15:07

本文选题：室性早搏 + 超声心动描记术　；参考：《复旦大学》2014年硕士论文

【摘要】：背景及目的：室性早搏,亦称室性期前收缩(Premature Ventricular Complexes,PVCs)是临床上常见的心律失常,近年来研究表明频发室性早搏可能导致心功能恶化,可造成室性早搏介导的心肌病。既往传统方法并不能有效评估频发室性早搏患者早期心功能损害情况,实时三维超声斑点追踪技术(3D-STI)提供了一种新的简便无创的定量评价心功能的方法,本研究旨在应用3D-STI技术定量评价频发室性早搏患者心功能损害情况,对此类患者心功能的早期评估、临床治疗及长期随访提供指导。方法：1.收集2013年7月至2014年3月于我院住院的频发室性早搏患者40人(男性22例),连续24小时动态心电图记录室性早搏数量超过10000次,呈单源性室性早搏,所有病人常规体格检查未见异常,排除器质性心脏病。另选取健康志愿者40人(男性24例)作为正常对照组。2.受试者均行常规标准12导联心电图,记录正常QRS波形态、时限及室性早搏的形态、时限,动态心电图评估室性早搏负荷(PVC burden)。3.受试者均行常规二维超声心动图检查：常规检查切面观包括胸骨旁长轴观,胸骨旁短轴观(主动脉根部、二尖瓣水平、乳头肌水平、心尖水平),心尖位(四腔观、五腔观、二腔观、长轴观)；普通心脏M型超声检查测量主动脉根部内径、左房内径、左室舒张末期内径、左室收缩末期内径、室间隔厚度、左室后壁厚度；测量左室舒张末期和收缩末期容量并计算左室射血分数。4.受试者均行实时三维超声斑点追踪成像技术检查：探头置于心尖部,在显示心尖四腔心切而后切换至4D模式,采集实时全容积成像三维图像。脱机计算芹室整体纵向收缩峰值应变(GLS)、整体径向收缩峰值应变(GRS)、整体环向收缩峰值应变(GCS)、整体面积收缩峰值应变(GAS)及各节段应变值等数值,分析应变值对频发室性早搏患者心功能损害的诊断价值。结果：1.频发室性早搏组与正常对照组临床特点等基线具有可比性,年龄、性别、体表面积等比较未见明显差异(P0.05)。2.频发室性早搏组与正常对照组常规二维超声心动图检查：主动脉根部内径、左房内径、左室舒张末期内径、左室收缩末期内径、室间隔厚度、左室后壁厚度、左室射血分数等指标比较未见明显差异(P0.05)。3.频发室性早搏组与正常对照组三维超声斑点追踪成像技术(3D-STI)检查比较：左室整体纵向收缩峰值应变(GLS)(-13.50±3.00%vs-18.31±3.12%, P=0.001)、左室整体环向收缩峰值应变(GCS)(-13.21±4.52%vs-19.49±2.60%, P=0.001)、左室整体面积收缩峰值应变(GAS)(-22.43±5.02%vs-29.86±4.81％, P=0.001)及左室整体径向收缩峰值应变(GRS)(36.31±8.81%vs 49.61±10.12%, P=0.001),频发室性早搏组较正常对照组各整体应变值均明显减低,差异具有统计学意义(P0.05)。4.频发室性早搏组与正常对照组左室基底段、中间段及心尖段的纵向应变(LS)、环向应变(CS)、面积应变(AS)及径向应变(RS)值相比均明显减低,差异具有统计学意义(P0.05)。5.室性早搏负荷20%的患者与室性早搏负荷≥20%的患者的左室舒张末期容积、左室收缩末期容积、左室射血分数、GLS、GCS、GAS及GRS值比较,各指标未见显著差异(P0.05)。6.GLS、GCS、GAS、GRS与左室射血分数(LVEF)有良好的相关性,其中6CS与LVEF的相关性最好(r=-0.84,P=0.020)；各应变值观察者内及观察者间呈一致性的变化趋势,有着很好的重复性。结论：1.左室射血分数正常的频发室性早搏患者较正常对照组左室整体及节段三维应变值(纵向应变、径向应变、环向应变及面积应变)均减低。2.三维超声斑点追踪技术可敏感精确评价频发室性早搏患者隐匿性心功能损害情况。3.三维斑点追踪技术为定量评价左室功能提供了一种可行性高、重复性好、无创安全、简便有效的新方法。
[Abstract]:Background and purpose: ventricular premature beat, also known as Premature Ventricular Complexes (PVCs), is a clinically common arrhythmia. In recent years, studies have shown that frequent ventricular premature beats may cause cardiac deterioration and cause ventricular premature cardiac myopathy. Previous traditional methods do not effectively evaluate frequent ventricular premature beat patients. Early cardiac dysfunction, real-time three-dimensional ultrasound speckle tracking (3D-STI) provides a new and simple and noninvasive method for quantitative evaluation of cardiac function. This study aims to evaluate the cardiac function of patients with frequent ventricular premature beat by 3D-STI technique. Early assessment, clinical treatment and long-term follow-up of cardiac function in such patients. Methods: 1.. Methods: 40 patients with frequent ventricular premature beat (22 men) were collected from July 2013 to March 2014 in our hospital. The number of ventricular premature beats was more than 10000 times for 24 hours of ambulatory electrocardiogram (24 hour). 40 people (24 men) as the normal control group,.2. subjects all underwent routine standard 12 lead electrocardiogram, recorded normal QRS wave form, time limit and ventricular premature beat, time limit, and dynamic electrocardiogram assessment of ventricular premature beat load (PVC burden).3. subjects all performed routine Er Weichao echocardiography examination: routine examination of side view including parastenal length Axis view, short axis view beside the sternum (aortic root, mitral valve level, papillary muscle level, apical level), apical position (four cavities, five cavities, two cavities, long axis); common heart M ultrasound examination of the aortic root diameter, left atrium diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, interventricular septum thickness and left posterior wall thickness; The patients who measured left ventricular end diastolic and end systolic volume and calculated left ventricular ejection fraction.4. were examined by real time three-dimensional ultrasound speckle tracking imaging technique: the probe was placed in the apex of the apex, and the four cavity of the apex was displayed and then switched to the 4D mode, and the real time full volume imaging three-dimensional image was collected. The value of change (GLS), total radial contraction peak strain (GRS), overall circumferential peak strain (GCS), total area contraction peak strain (GAS) and each segment strain value were used to analyze the diagnostic value of strain value on cardiac dysfunction in patients with frequent ventricular premature beat. Results: the baseline of the clinical characteristics of 1. frequent ventricular premature beat group and normal control group Comparability, age, sex, and body surface area were not significantly different (P0.05).2. frequent ventricular premature beat group and normal control group routine two-dimensional echocardiography examination: aortic root diameter, left atrium diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, interventricular septum thickness, left ventricular posterior wall thickness, left ventricular ejection fraction and other index ratio No significant difference (P0.05).3. frequent ventricular premature beat group and normal control group three-dimensional ultrasound speckle tracking imaging (3D-STI) examination: left ventricular overall longitudinal contraction peak strain (GLS) (-13.50 + 3.00%vs-18.31 + 3.12%, P=0.001), left ventricular holistic circumferential peak strain (GCS) (-13.21 + 4.52%vs-19.49 + 2.60%, P=0.001), left ventricle, left ventricle The overall area systolic peak strain (GAS) (-22.43 + 5.02%vs-29.86 + 4.81%, P=0.001) and the overall left ventricular radial systolic peak strain (GRS) (36.31 + 8.81%vs 49.61 + 10.12%, P=0.001), the frequency of frequent ventricular premature beat groups were significantly lower than those of the normal control group, and the difference was statistically significant (P0.05) in the.4. frequent ventricular premature beat group and positive group. The longitudinal strain (LS), CS, area strain (AS) and radial strain (RS) were significantly lower in the left ventricular base segment, the middle segment and the apical segment, and the difference was statistically significant (P0.05).5. ventricular premature beat 20% patients and the left ventricular end diastolic volume and left ventricular end systolic volume in patients with ventricular premature beat more than 20% No significant difference (P0.05).6.GLS, GCS, GAS, GRS and left ventricular ejection fraction (LVEF) were not significantly different between the scores of left ventricular ejection fraction, GLS, GCS, GAS and GRS. The correlation between 6CS and LVEF was the best, and the trend of consistency between the observers and the observers was good. Conclusion: 1. the three dimensional strain values (longitudinal strain, radial strain, circumferential strain, and area strain) in the left ventricular global and segmental strain of normal ventricular premature beat patients with normal left ventricular ejection fraction are more sensitive and accurate in evaluating the occult cardiac function damage in patients with frequent ventricular premature beat.3. three dimensional (.2.). Speckle tracking technique provides a feasible, reproducible, noninvasive, safe, simple and effective method for quantitative evaluation of left ventricular function.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.7;R540.45

【共引文献】