二维斑点追踪技术对评价左室射血分数正常的心力衰竭的价值

发布时间：2018-05-12 17:02

本文选题：左室射血分数正常的心力衰竭 + 无症状左室舒张功能障碍　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：本研究应用二维斑点追踪技术(2DSTI)，观察、分析左室射血分数正常的心力衰竭(HFNEF)患者和无症状的左室舒张功能障碍(LVDD)患者左心室长轴方向的纵向应变、应变率及心肌运动的同步性等指标，同时观察2DSTI测得的指标和血浆NT-proBNP水平之间的相关性。旨在探讨2DSTI在HFNEF患者诊断和评价其左室舒张、收缩功能及心肌运动同步性中的应用价值。方法：实验组HFNEF23例，对照组无症状的LVDD17例，记录其身高、体重等基本信息及血浆NT-proBNP水平，比较之间的差异。同时行常规超声心动图检查记录左房内径、左室舒张末期内径、左室射血分数、二尖瓣血流流速、二尖瓣环运动速度等指标。采集心尖四腔、三腔、二腔心切面动态二维图像导入Qlab8.1软件进行脱机处理，分析后获得四腔、三腔、二腔心三个切面及总体左室长轴纵向应变及应变率随时间的变化曲线，记录左室整体及各切面的收缩期期纵向应变峰值(LSs)，舒张早期纵向应变率峰值(LSRe)，16节段、12节段、6节段收缩应变达峰时间的标准差(Ts-SD)，任意对应两节段的收缩应变达峰时间的最长时间间隔(Ts-diff)。用SPSS软件分析2DSTI获得的应变及应变率、达峰时间的标准差及对应节段的最长时间间隔与NT-proBNP的相关性；比较实验组和对照组2DSTI获得的各指标之间的差异。结果：1、HFNEF组血浆NT-proBNP水平明显高于无症状的LVDD组(p0.05)；LogNT-proBNP与左室整体舒张早期纵向应变率峰值(GLSRe)、16节段收缩应变达峰时间的标准差(Ts-SD16)显著相关。 2、HFNEF组和无症状的LVDD组LVEF无明显差异(p0.05)；HFNEF组整体及两腔心切面收缩期纵向应变峰值(GLSs、02-LSs)明显减低，差异有统计学意义(p0.05)；左室整体及两腔、三腔、四腔心切面舒张早期纵向应变率峰值(GLSRe、02-LSRe、03-LSRe、04-LSRe)明显减低，差异有统计学意义(p0.05)。 3、HFNEF组较无症状的LVDD组16节段、12节段的Ts-SD增大，Ts-diff延长，差异有统计学意义(p0.05)。Ts-SD、Ts-diff与整体收缩期纵向应变峰值(GLSs)、整体舒张早期纵向应变率峰值(GLSRe)显著相关。结论：1.2DSTI测得的部分指标与血浆NT-proBNP水平显著相关，应变和应变率是评价HFNEF的良好指标。2.对于HFNEF患者，2DSTI对左室收缩功能的评价优于LVEF，，能够早期发现左室收缩功能的改变；2DSTI对舒张功能的改变有较高的敏感性，可评价其受损程度，同时能够测定心肌运动的同步性，为舒张功能障碍的分级及HFNEF的诊断和治疗提供新的思路。
[Abstract]:Objective: to observe and analyze the longitudinal strain of left ventricular long axis in patients with heart failure with normal left ventricular ejection fraction (LVNEF) and asymptomatic left ventricular diastolic dysfunction (LVDDD). Strain rate and synchronism of myocardial movement were also observed. The correlation between 2DSTI and plasma NT-proBNP level was observed. To investigate the value of 2DSTI in the diagnosis and evaluation of left ventricular diastolic, systolic function and myocardial synchronism in patients with HFNEF. Methods: the patients with HFNEF23 in the experimental group and those with asymptomatic LVDD17 in the control group were compared with each other in terms of their height, weight and plasma NT-proBNP level. At the same time, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, mitral flow velocity and mitral annular velocity were recorded by conventional echocardiography. The dynamic 2D images of apical four cavities, three cavities and two cavities were imported into Qlab8.1 software for offline processing. The curves of longitudinal strain and strain rate with time of four cavities, three cavities, two cavities, three sections and the whole left ventricular long axis were obtained. The peak value of longitudinal strain during systolic period and the peak value of early diastolic longitudinal strain rate in left ventricular whole and each section were recorded. The peak value of early diastolic longitudinal strain rate and the standard deviation of peak time of peak systolic strain of 12 segments and 6 segments of 16 segments and 12 segments of left ventricle were recorded, and the peak time of contraction strain of two segments was arbitrarily corresponding to the peak time of contraction strain. The longest time interval between them is Ts-diffen. The strain and strain rate obtained by 2DSTI, the standard deviation of peak time and the correlation between the longest interval of corresponding segment and NT-proBNP were analyzed by SPSS software, and the differences between the indexes obtained by 2DSTI in experimental group and control group were compared. Results compared with asymptomatic LVDD group, the plasma NT-proBNP level was significantly higher in the 1: 1 HFNEF group than that in the asymptomatic LVDD group. There was a significant correlation between the plasma NT-proBNP level and the peak value of the left ventricular early diastolic longitudinal strain rate and the peak time of peak systolic strain in the left ventricular early diastolic phase. 2There was no significant difference in LVEF between HFNEF group and asymptomatic LVDD group. GLSRe02-LSRe03-LSRe04-LSRe04-LSRe03-LSRe03-LSRe04-LSRe04-LSRe03-LSRe03-LSRe03-LSRe03-LSRe03-LSRe04-LSRe04-LSRe04-L@@ (3) the Ts-SD of 16 segments and 12 segments of LVDD group was significantly longer than that of asymptomatic LVDD group. The difference was statistically significant (p 0.05). Ts-SDN Ts-diff was significantly correlated with the peak of global longitudinal strain and the peak value of global early diastolic longitudinal strain rate. Conclusion some of the indexes measured by 1. 2DSTI have a significant correlation with plasma NT-proBNP level. Strain and strain rate are good indexes to evaluate HFNEF. The evaluation of left ventricular systolic function by 2D STI in HFNEF patients was superior to that of LVEF. It could be found that the change of left ventricular systolic function was sensitive to the changes of diastolic function in early stage. It could be used to evaluate the degree of damage and to measure the synchronism of myocardial movement. To provide a new idea for the classification of diastolic dysfunction and the diagnosis and treatment of HFNEF.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541.6

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