二维斑点追踪技术评价房间隔缺损患者封堵术前、后左室收缩功能的变化
发布时间：2018-07-17 05:53
【摘要】：【目的】房间隔缺损(atrial septal defect,ASD)是常见的先天性心脏病之一,持续的房水平左向右分流可导致右心室、右心房容量负荷增加,进而导致右心扩大以及肺动脉高压。右室增大导致室间隔与左室后壁同向运动,扩大的右室压迫左室,引起左心功能不同程度减低。严重者可导致心力衰竭,甚至死亡。近年来,随着微创医学的发展,经皮导管介入封堵术以其创面小、术后康复快、住院周期短以及并发症少等优势被临床认为是首选治疗。二维斑点追踪技术成像(Speckle Tracking Imaging,STI)从纵向、环向、径向多个方面对心肌力学特征进行多方位的评价,可以定量评价心肌运动速度、应变、应变率等,另外可获得心室的扭转运动参数,从而评价左室整体和区域心肌收缩功能。本实验主要是应用STI技术获得房间隔缺损患者封堵术前后左心室收缩期圆周应变与径向应变以及左心室旋转、扭转的相关参数的变化,来探讨房间隔缺损患者封堵手术前、后左室收缩功能的变化。为评价ASD封堵术前、后左心室收缩功能的评价提供新的方法。【方法】选取继发孔房间隔缺损(asd组)患者30例作为病例组;同期选择我院性别、年龄相匹配的健康正常人30例作为对照组(nc组)。分别于术前、术后2天、术后6月常规测量右房舒张末内径(rightatrialend-diastolicdiameter,rvdd)、右室舒张末内径(rightventricularend-diastolicdiameter,radd),左室舒张末内径(leftventricularend-diastolicdiameter,lvdd),左室舒张末容积(leftventricularend-diastolicvolume,lvedv)及左室收缩末容积(leftventricularend-systolicvolume,lvesv),并通过双平面改良simpson法获得左心室射血分数(leftventricularejectionfraction,lvef)及左室每搏输出量(leftventricularstrokevolume,lvsv)。留取左心室短轴三个水平(基底水平、中部及心尖水平)的动态二维超声图像,导入echopac工作站获取左心室应变参数以及扭转参数。第一部分:斑点追踪技术对房间隔缺损封堵术前、后左室短轴应变的定量评价通过sti分析后系统自动得出左心室各平面各节段的径向应变(radialstrain,sr)-时间曲线及圆周应变(circumferentialstrain,sc)-时间曲线。软件自动将左心室短轴分为六个节段:前间隔、前壁、侧壁、下壁、后壁及中后间隔。获取左室短轴各节段的圆周及径向应变峰值及达峰时间,将各节段应变峰值总和后取平均值作为整体应变峰值。将得到的数据进行统计分析。第二部分:二维斑点追踪技术对房间隔缺损封堵术前、后左心室扭转运动的定量评价同样经过sti分析后得到基底旋转角度-时间曲线、心尖旋转角度-时间曲线及左室扭转-时间曲线,分别测量旋转角度峰值、扭转角度的峰值及其对应的达峰时间,然后将进行统计学分析。【结果】(1)常规参数比较:病例组rv及ra术前舒张末内径大于对照组(p0.05),术后2天较术前组减小(p0.05)并接近对照组。病例组术前lv前后径、lv左右径小于对照组(p0.05),术后2天增加(p0.05)并接近于对照组。病例组术前lvedv、lvsv组均小于对照组(p0.05),术后2天较术前增大(p0.05),术后6个月进一步增大(p0.05)并接近于对照组。病例组lvesv、lvef术前小于对照组(p0.05),术后2天即较术前增大(p0.05)并接近于对照组。(2)左室各节段圆周应变比较:病例组封堵术前各节段的圆周应变峰值均低于对照组(p0.05)。前间隔、前壁、侧壁、后壁术后2天较术前显著增高(p0.05),亦高于对照组(p0.05),术后6个月减低(p0.05)接近于对照组。病例组下壁、中后间隔术后2天即增高(p0.05)并接近于对照组。(3)左室各节段径向应变比较:病例组除后壁外余左室各节段的径向应变峰值均低于对照组(p0.05),术后2天增高(p0.05)并接近于对照组;后壁径向应变术前高于对照组(p0.05),术后2天无明显变化,术后6个月减低(p㩳0.05),接近于对照组。(4)左心室整体应变的比较:病例组左室整体圆周应变术前低于对照组(p㩳0.05);封堵术后2天增高(p㩳0.05),亦高于对照组(p㩳0.05);术后6个月又降低(p㩳0.05)并接近于对照组。病例组左室整体径向应变术前与对照组无统计学差异,封堵术后2天增高(p㩳0.05),亦高于对照组(p㩳0.05),术后6个月降低(p㩳0.05)至正常。(5)左室基底水平各节段旋转角度峰值比较:与对照组比较,病例组术前左室基底水平除后壁外余各节段旋转角度峰值显著减低(p㩳0.05)。术后2天病例组左室基底水平前壁、侧壁旋转角度峰值较术前显著增高(p㩳0.05)并接近于对照组;前间隔、下壁及中后间隔术后2天无显著变化,至术后6个月增高(p㩳0.05)并接近正常水平。病例组左室基底水平后壁旋转角度峰值术前较对照组显著增高(p㩳0.05),术后2天即减低(p㩳0.05)并接近对照组。(6)左室心尖水平各节段旋转角度峰值比较:病例组术前左室心尖水平各节段的旋转角度峰值均高于对照组(p㩳0.05),术后2天无明显变化,术后6个月减低(p㩳0.05)并接近于对照组。(7)左室整体最大扭转角度的比较:病例组左室整体最大扭转角度术前小于对照组,术后2天即较术前增高(p㩳0.05)并接近于对照组。(8)左室应变达峰时间、旋转达峰时间及扭转达峰时间在病例组与对照组之间无统计学差异,且这些参数在病例组封堵术前、后亦无统计学差异。【结论】(1)本研究证实应用二维斑点追踪技术可以评价经皮导管介入封堵术前、后左室各节段及整体圆周应变、径向应变的变化,左室各节段旋转角度及整体扭转角度的变化。(2)右心容量负荷增加可引起左室收缩功能不同程度减低。(3)经皮导管介入封堵术阻断了房水平左向右分流,使得右心容量负荷减低,室间隔及左室后壁运动恢复正常,左室前负荷增加,扩张性增加,左室形态发生几何重构和逆转重构,左室的容积和收缩功能得到改善。(4)封堵术后左室即刻进行几何重构,持续逆转重构,直至术后六个月趋向于稳定。
[Abstract]:[Objective] atrial septal defect (ASD) is one of the common congenital heart diseases. The continuous left to right shunt of the atrial level can lead to the increased volume load of the right ventricle and the right atrium, which leads to the enlargement of the right heart and the high pressure of the pulmonary artery. The enlargement of the right ventricle leads to the same movement of the ventricular septum and the left ventricle, and the right ventricle enlarging the left ventricle, In recent years, with the development of minimally invasive medicine, percutaneous transcatheter closure is considered to be the preferred treatment for its advantages of small wound, fast postoperative recovery, short hospital stay and fewer complications. Two-dimensional dot tracking imaging (Speckle Tracking) Imaging, STI) multidimensional evaluation of myocardial mechanical characteristics from longitudinal, circumferential and radial aspects. It can evaluate myocardial velocity, strain, strain rate and so on. In addition, the torsional motion parameters of the ventricle can be obtained, and the systolic function of the whole and regional left ventricular myocardium is evaluated. This experiment is mainly to use STI technique to obtain the atrial septal defect. The changes in the relative parameters of left ventricular systolic circumference and radial strain and left ventricular rotation and torsion before and after occlusion were used to explore the changes in left ventricular systolic function before closure of atrial septal defect in patients with atrial septal defect. A new method was provided to evaluate the systolic function of left ventricle before ASD occlusion. 30 cases of orifice septal defect (Group ASD) were used as case group, and 30 cases of healthy and normal people with matched age were selected as control group (Group NC) at the same time. Before operation and 2 days after operation, the right chamber end diastolic diameter (rightatrialend-diastolicdiameter, rvdd), right ventricular end diastolic diameter (rightventricularend-diastoli) were measured in June after operation (rightventricularend-diastoli Cdiameter, Radd), left ventricular end diastolic diameter (leftventricularend-diastolicdiameter, LVDD), left ventricular end diastolic volume (leftventricularend-diastolicvolume, LVEDV) and left ventricular end systolic volume (leftventricularend-systolicvolume, LVESV), and the left ventricular ejection fraction (leftventricularejectionfrac) was obtained by improved Simpson method by double plane surface (leftventricularejectionfrac). Tion, LVEF) and left ventricular pacing output (leftventricularstrokevolume, lvsv). Dynamic two-dimensional ultrasound images with three levels of the left ventricular short axis (basal, central and apical) were taken, and the echopac workstation was introduced to obtain the left ventricular strain parameters and torsional parameters. Part 1: spot tracking technique was used before the atrial septal defect closure. The quantitative evaluation of left ventricular short axis strain was made by STI analysis. The radial strain (radialstrain, SR) time curve and circumferential strain (circumferentialstrain, SC) time curve of each segment of the left ventricle were automatically obtained. The short axis of the left ventricle was automatically divided into six segments: anterior, anterior, lateral, lower, posterior, and middle and posterior. The circumference and radial strain peak and peak time of each segment of the short axis of the left ventricle were obtained, and the total strain peak value was taken as the peak value of the whole strain. The data obtained were statistically analyzed. The second part: the quantitative evaluation of the left ventricular torsion movement before the occlusion of the atrial septal defect by two-dimensional speckle tracking technique also passed through the quantitative evaluation. After STI analysis, the base rotation angle time curve, the apical rotation angle time curve and the left ventricular torsion time curve were used to measure the peak value of the rotation angle, the peak of the torsion angle and the corresponding peak time respectively, and then the statistical analysis was then carried out. [results] (1) the routine parameters were compared: the internal diameter of the end diastolic end of the case group RV and RA was greater than that of the case group. The control group (P0.05) was less than the control group at 2 days after operation (P0.05). The diameter of LV before and after operation was smaller than that of the control group (P0.05), and increased (P0.05) on the 2 day after operation (P0.05) and was close to the control group. The case group was smaller than the control group before the operation (P0.05), and the 2 day after the operation (P0.05) and 6 months after the operation (P0.05). The case group was less than the control group. The case group LVESV was less than the control group (P0.05) before operation, and 2 days after the operation (P0.05) was increased (P0.05) and was close to the control group. (2) the circumferential strain of each segment of the left ventricle was compared with that of the control group (P0.05). The anterior septum, the anterior wall, the lateral wall and the posterior wall were significantly increased at 2 days after the operation. High (P0.05), and higher than the control group (P0.05), 6 months after the operation decreased (P0.05) close to the control group. The lower wall of the case group, 2 days after the middle and posterior septum increased (P0.05) and close to the control group. (3) the radial strain of each segment of the left ventricle was compared with that of the left ventricular segment of the left ventricle, which was lower than that of the control group (P0.05), and increased at 2 days after the operation (P 0.05) and close to the control group; the posterior wall radial strain was higher than the control group (P0.05), there was no obvious change at 2 days after operation, 6 months after the operation (P? 0.05), close to the control group. (4) the left ventricular overall strain was compared with the left ventricular circumference strain before the operation (P? 0.05), and 2 days after occlusion (P? 0.05), and higher than the control group (P? 0. 0 5); 6 months after the operation (P? 0.05) and close to the control group. There was no statistical difference between the left ventricular radial strain before operation and the control group, 2 days after the occlusion (P? 0.05), and higher than the control group (P? 0.05), and 6 months after the operation (P? 0.05) to normal. (5) the rotation angle peak of the left ventricular basal level was compared: compared with the control group, the disease was compared with the control group. The peak value of the rotation angle of the left ventricular basal level except the posterior wall of the left ventricle in the case group decreased significantly (P 0.05). At the 2 day after the operation, the lateral wall of the left ventricle was significantly higher than that before the operation (P? 0.05) and was close to the control group. The anterior septum, the lower wall and the middle posterior septum were not significantly changed at 2 days after the operation (P? 0.05). The left ventricular base level posterior wall rotation angle peak was significantly higher than the control group (P 0.05) before operation (P? 0.05) and close to the control group at 2 days after operation. (6) the peak value of rotation angle of each segment of the left ventricular apical level was compared with the control group (P? 0.). 05) there was no obvious change at 2 days after operation, 6 months after the operation (P? 0.05) and close to the control group. (7) the maximum torsional angle of the left ventricle was compared: the left ventricular maximum torsion angle was less than the control group before operation, 2 days after the operation (P? 0.05) and close to the control group. (8) the peak time of left ventricular strain, the time of rotation peak and twist There was no statistical difference between the case group and the control group, and there was no statistical difference between the case group and the control group. [Conclusion] (1) this study confirmed the application of two-dimensional speckle tracking technique to evaluate the changes of the left ventricular segment and the overall circumference strain, the change of the radial strain and the left ventricle before transcatheter transcatheter closure of transcatheter closure. (2) the increase of right heart capacity load may cause the left ventricular systolic function to decrease in different degrees. (3) transcatheter transcatheter closure blocking the left to right shunt of the atrial level, reducing the capacity load of the right heart, the movement of the ventricular septum and left ventricle back to normal, the increase of left ventricular preload and dilatation. The left ventricular geometry reconfiguration and reversion reconfiguration, the left ventricular volume and contractile function were improved. (4) the left ventricle was reconstructed immediately after occlusion, and the reconstruction was continued until the six months after the operation.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541.1
本文编号：2129302
[Abstract]:[Objective] atrial septal defect (ASD) is one of the common congenital heart diseases. The continuous left to right shunt of the atrial level can lead to the increased volume load of the right ventricle and the right atrium, which leads to the enlargement of the right heart and the high pressure of the pulmonary artery. The enlargement of the right ventricle leads to the same movement of the ventricular septum and the left ventricle, and the right ventricle enlarging the left ventricle, In recent years, with the development of minimally invasive medicine, percutaneous transcatheter closure is considered to be the preferred treatment for its advantages of small wound, fast postoperative recovery, short hospital stay and fewer complications. Two-dimensional dot tracking imaging (Speckle Tracking) Imaging, STI) multidimensional evaluation of myocardial mechanical characteristics from longitudinal, circumferential and radial aspects. It can evaluate myocardial velocity, strain, strain rate and so on. In addition, the torsional motion parameters of the ventricle can be obtained, and the systolic function of the whole and regional left ventricular myocardium is evaluated. This experiment is mainly to use STI technique to obtain the atrial septal defect. The changes in the relative parameters of left ventricular systolic circumference and radial strain and left ventricular rotation and torsion before and after occlusion were used to explore the changes in left ventricular systolic function before closure of atrial septal defect in patients with atrial septal defect. A new method was provided to evaluate the systolic function of left ventricle before ASD occlusion. 30 cases of orifice septal defect (Group ASD) were used as case group, and 30 cases of healthy and normal people with matched age were selected as control group (Group NC) at the same time. Before operation and 2 days after operation, the right chamber end diastolic diameter (rightatrialend-diastolicdiameter, rvdd), right ventricular end diastolic diameter (rightventricularend-diastoli) were measured in June after operation (rightventricularend-diastoli Cdiameter, Radd), left ventricular end diastolic diameter (leftventricularend-diastolicdiameter, LVDD), left ventricular end diastolic volume (leftventricularend-diastolicvolume, LVEDV) and left ventricular end systolic volume (leftventricularend-systolicvolume, LVESV), and the left ventricular ejection fraction (leftventricularejectionfrac) was obtained by improved Simpson method by double plane surface (leftventricularejectionfrac). Tion, LVEF) and left ventricular pacing output (leftventricularstrokevolume, lvsv). Dynamic two-dimensional ultrasound images with three levels of the left ventricular short axis (basal, central and apical) were taken, and the echopac workstation was introduced to obtain the left ventricular strain parameters and torsional parameters. Part 1: spot tracking technique was used before the atrial septal defect closure. The quantitative evaluation of left ventricular short axis strain was made by STI analysis. The radial strain (radialstrain, SR) time curve and circumferential strain (circumferentialstrain, SC) time curve of each segment of the left ventricle were automatically obtained. The short axis of the left ventricle was automatically divided into six segments: anterior, anterior, lateral, lower, posterior, and middle and posterior. The circumference and radial strain peak and peak time of each segment of the short axis of the left ventricle were obtained, and the total strain peak value was taken as the peak value of the whole strain. The data obtained were statistically analyzed. The second part: the quantitative evaluation of the left ventricular torsion movement before the occlusion of the atrial septal defect by two-dimensional speckle tracking technique also passed through the quantitative evaluation. After STI analysis, the base rotation angle time curve, the apical rotation angle time curve and the left ventricular torsion time curve were used to measure the peak value of the rotation angle, the peak of the torsion angle and the corresponding peak time respectively, and then the statistical analysis was then carried out. [results] (1) the routine parameters were compared: the internal diameter of the end diastolic end of the case group RV and RA was greater than that of the case group. The control group (P0.05) was less than the control group at 2 days after operation (P0.05). The diameter of LV before and after operation was smaller than that of the control group (P0.05), and increased (P0.05) on the 2 day after operation (P0.05) and was close to the control group. The case group was smaller than the control group before the operation (P0.05), and the 2 day after the operation (P0.05) and 6 months after the operation (P0.05). The case group was less than the control group. The case group LVESV was less than the control group (P0.05) before operation, and 2 days after the operation (P0.05) was increased (P0.05) and was close to the control group. (2) the circumferential strain of each segment of the left ventricle was compared with that of the control group (P0.05). The anterior septum, the anterior wall, the lateral wall and the posterior wall were significantly increased at 2 days after the operation. High (P0.05), and higher than the control group (P0.05), 6 months after the operation decreased (P0.05) close to the control group. The lower wall of the case group, 2 days after the middle and posterior septum increased (P0.05) and close to the control group. (3) the radial strain of each segment of the left ventricle was compared with that of the left ventricular segment of the left ventricle, which was lower than that of the control group (P0.05), and increased at 2 days after the operation (P 0.05) and close to the control group; the posterior wall radial strain was higher than the control group (P0.05), there was no obvious change at 2 days after operation, 6 months after the operation (P? 0.05), close to the control group. (4) the left ventricular overall strain was compared with the left ventricular circumference strain before the operation (P? 0.05), and 2 days after occlusion (P? 0.05), and higher than the control group (P? 0. 0 5); 6 months after the operation (P? 0.05) and close to the control group. There was no statistical difference between the left ventricular radial strain before operation and the control group, 2 days after the occlusion (P? 0.05), and higher than the control group (P? 0.05), and 6 months after the operation (P? 0.05) to normal. (5) the rotation angle peak of the left ventricular basal level was compared: compared with the control group, the disease was compared with the control group. The peak value of the rotation angle of the left ventricular basal level except the posterior wall of the left ventricle in the case group decreased significantly (P 0.05). At the 2 day after the operation, the lateral wall of the left ventricle was significantly higher than that before the operation (P? 0.05) and was close to the control group. The anterior septum, the lower wall and the middle posterior septum were not significantly changed at 2 days after the operation (P? 0.05). The left ventricular base level posterior wall rotation angle peak was significantly higher than the control group (P 0.05) before operation (P? 0.05) and close to the control group at 2 days after operation. (6) the peak value of rotation angle of each segment of the left ventricular apical level was compared with the control group (P? 0.). 05) there was no obvious change at 2 days after operation, 6 months after the operation (P? 0.05) and close to the control group. (7) the maximum torsional angle of the left ventricle was compared: the left ventricular maximum torsion angle was less than the control group before operation, 2 days after the operation (P? 0.05) and close to the control group. (8) the peak time of left ventricular strain, the time of rotation peak and twist There was no statistical difference between the case group and the control group, and there was no statistical difference between the case group and the control group. [Conclusion] (1) this study confirmed the application of two-dimensional speckle tracking technique to evaluate the changes of the left ventricular segment and the overall circumference strain, the change of the radial strain and the left ventricle before transcatheter transcatheter closure of transcatheter closure. (2) the increase of right heart capacity load may cause the left ventricular systolic function to decrease in different degrees. (3) transcatheter transcatheter closure blocking the left to right shunt of the atrial level, reducing the capacity load of the right heart, the movement of the ventricular septum and left ventricle back to normal, the increase of left ventricular preload and dilatation. The left ventricular geometry reconfiguration and reversion reconfiguration, the left ventricular volume and contractile function were improved. (4) the left ventricle was reconstructed immediately after occlusion, and the reconstruction was continued until the six months after the operation.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541.1
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