斑点追踪成像评估不同构型原发性高血压患者左心室扭转及解旋运动

发布时间：2018-06-12 17:40

本文选题：超声心动描记术 + 二维　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:应用斑点追踪成像(speckle tracking imaging,STI)评价左心室不同构型原发性高血压患者左心室旋转和扭转运动,得到左心室整体扭转角度和解旋速率,分析原发性高血压患者在左心室重构过程中心室扭转动力学变化,并进一步探讨斑点追踪成像技术在评估心功能中的应用价值。方法:选取170例原发性高血压患者和50例健康志愿者。测量所有受试者收缩压(SBP)、舒张压(DBP)和体质量指数(BMI);在胸骨旁左心室长轴切面测量左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVST)和左心室后壁厚度(LVPWT),计算左心室质量指数(LVMI)和相对室壁厚度(RWT);在心尖四腔心切面用脉冲多普勒测量二尖瓣口血流频谱,包括舒张早期E峰、舒张晚期A峰和减速时间DT,利用组织多普勒测量二尖瓣环舒张早期运动速度Em和晚期运动速度Am,并计算E/Em;在心尖四腔心和两腔心切面利用改良Simpson双平面法测量左心室舒张末期容积(LVEDV),左心室收缩末期容积(LVESV)、左心室每搏量(LVSV)和左心室射血分数(LVEF);在胸骨旁采集一系列左心室短轴二维动态图像进行存储,进入QLAB工作站进行脱机分析,运用STI分别测量左心室短轴切面基底段旋转角度(PBR)、心尖段旋转角度(PAR)、左心室整体扭转角度(Ptw)以及左心室解旋速率(PUV)。结果:与正常对照组相比,高血压向心性肥厚(CCH)组与离心性肥厚(ECH)组左心室收缩末期内径和舒张末期内径显著增加(P0.01),组间比较上述两项指标均有显著差异(P0.01);与正常对照组比较,高血压向心性重构(CCR)组与向心性肥厚(CCH)组左心室质量指数和相对室壁厚度均显著增加(P0.01),组间比较上述两项指标无明显差异(P0.05);与正常对照组相比,高血压向心性重构(CCR)组与向心性肥厚(CCH)组Ptw均增加(P0.01),离心性肥厚(ECH)组Ptw减小(P0.01);与正常对照组相比,向心性重构(CCR)组与向心性肥厚(CCH)组PUV增加(P0.01),离心性肥厚(ECH)组PUV较小(P0.05)。结论:1.高血压患者左心室发生向心性重构和向心性肥厚时左心室扭转运动代偿性加强,解旋速率也相应增加;当发生离心性肥厚时左心室扭转减弱,解旋速率也减小。2.STI可以定量分析不同分级、不同构型原发性高血压患者左心室扭转及解旋运动,可以早期、敏感的反映左心室心肌收缩功能的改变,为预防和治疗心肌损害提供可靠的理论依据,为高血压患者的疗效评价和预后分析提供了一种新的、无创的、准确的检测手段。
[Abstract]:Objective: to evaluate left ventricular rotation and torsion motion in patients with essential hypertension with different left ventricular configurations by speckle tracking imaging with speckle tracking imaging (speckle STI), and to obtain the global left ventricular torsion angle and rotation rate. The dynamic changes of ventricular torsion during left ventricular remodeling in patients with essential hypertension were analyzed and the value of dot-tracing imaging in evaluating cardiac function was discussed. Methods: 170 patients with essential hypertension and 50 healthy volunteers were selected. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI) were measured in all subjects. Left ventricular end-diastolic diameter (LVEDDD), left ventricular end-systolic diameter (LVESD), ventricular septal thickness (IVSTT) and left ventricular posterior wall thickness (LVPWTT) were measured on the long axis of left ventricle beside sternum. The left ventricular mass index (LVMI) and relative ventricular wall thickness (RWTT) were calculated. The mitral orifice blood flow spectrum was measured by pulsed Doppler on the apical four-chamber section. Including early diastolic E peak, Late diastolic peak A and deceleration time (DTT), mitral annular diastolic velocities (Em) and late diastolic velocities (Amm) were measured by tissue Doppler, and E / E / E / E / E / E / E / E / E / E / E / E / E / E / E were calculated. Left ventricular end-diastolic volume (LVEDVV), left ventricular end-systolic volume (LVESVV), left ventricular volume (LVSVV) and left ventricular ejection fraction (LVVEFV), and left ventricular ejection fraction (LVVEFV) were collected next to the sternum to store a series of dynamic images of the short axis of the left ventricle. After entering Qlab workstation for offline analysis, STI was used to measure left ventricular basal segment rotation angle, apical segment rotation angle, left ventricular global torsion angle and left ventricular unspin rate respectively. Results: compared with the normal control group, the left ventricular end-systolic and end-diastolic diameter were significantly increased in the CCH group and ECH group, and there were significant differences between the two groups. Left ventricular mass index (LVMI) and relative ventricular wall thickness in CCR group and CCH group were significantly increased (P 0.01), but there was no significant difference between the two groups (P 0.05), compared with normal control group, the left ventricular mass index (LVMI) and relative ventricular wall thickness (RVD) in CCR group were significantly higher than those in control group (P < 0.05). Ptw increased in CCR group and CCH group, and decreased in ECH group. Compared with normal control group, PUV increased in CCR group and CCH group, and PUV in ECH group was lower than that in ECH group. The PUV of CCR group and CCH group was higher than that of ECH group, and the PUV of eccentric hypertrophy group was lower than that of normal control group. Conclusion 1. In hypertensive patients, concentric remodeling of the left ventricle and concentric hypertrophy of the left ventricle increased compensatory left ventricular torsion, and the rate of resolution increased correspondingly, and the left ventricular torsion weakened when eccentric hypertrophy occurred. STI can quantitatively analyze the left ventricular torsion and unspin motion in patients with essential hypertension with different configurations, which can reflect the changes of left ventricular systolic function in the early stage. It provides a reliable theoretical basis for the prevention and treatment of myocardial injury, and provides a new, noninvasive and accurate method for the evaluation of curative effect and prognosis of hypertensive patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R544.1

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