应用三维斑点追踪技术评价冠心病患者左室扭转运动及位移的初步研究

发布时间：2018-07-27 11:45

【摘要】：目的：应用超声三维斑点追踪技术对冠心病(Coronary Artery Disease，CAD)患者左室扭转运动特征及位移参数进行评价，并探讨两者的相关性。方法：选取我院2012年9月至2013年3月行冠状动脉造影检查确诊为冠心病的患者120例，男75例，女45例，年龄36-81岁，平均（57.36土12.96）岁，依冠状动脉狭窄部位分为左前降支组(LAD组,n=47)、左旋支组（LCX组，n=25)、右冠状动脉组(RCA组，n=23)、多支病变组(n=25)，左主干病变归入多支组。选取40例健康志愿者作为正常对照组，其中男25例，女15例，年龄22～76岁，平均(49.14土12.57)岁，根据病史及体检、心电图、常规超声心动图等相关检查排除器质性心脏疾患。采用TOSHIBA ARTIDA彩色多普勒超声诊断仪，同步记录胸导联心电图，待患者平静呼吸后，采用PST-30SBT二维探头经胸采集常规超声参数，切换至PST-25SX三维探头，获取并存储左室三维全容积动态图像，随后运用三维斑点追踪软件对存储的图像进行脱机分析，仪器自动获得左室整体、基底段、中间段、心尖段扭转角度峰值（PGT、 PBT、PMT、PAT）及相应节段的达峰时间（Time-PGT、Time-PBT、Time-PMT、Time-PAT），左室射血分数（LVEF）、左室整体及各节段三维位移(three-dimensional displacement，P3DD)等指标。将CAD各组和对照组的上述指标进行对比研究，并分析左室扭转角度峰值与位移参数、LVEF的相关性。结果：1.一般临床资料比较：两组患者的年龄、身高、体重、心率、收缩压、舒张压相比，无明显差异（P0.05）。2.常规超声心动图参数比较：与对照组患者比较：CAD各组LVEF减低，差异均有统计学意义（P0.05）；LAD组、多支组LA、LVIDd、LVIDs增大，LVESV、LVEDV明显增加，LVEF减少,差异均有统计学意义（P0.05或0.01）。3.CAD组与对照组左室各节段收缩期扭转角度峰值及达峰时间的比较：与对照组比较：（1）CAD组PGT、PAT均减低，差异有统计学意义（P0.05或0.01）；（2）LCX组、RCA组心尖、心底水平左室收缩期扭转趋势与正常对照组一致，PBT、PMT有减低趋势，但差异无统计学意义；Time-PBT较对照组明显延迟，差异有统计学意义（P0.05），Time-PMT虽较对照组延迟，但差异无统计学意义（P0.05）；（3）LAD组PBT较对照组减低，差异有统计学意义（P0.05）；PMT较对照组减低，差异无统计学意义（P0.05），Time-PMT较对照组明显延迟，差异有统计学意义（P0.05）；（4）多支组PBT、PMT较对照组明显减低，差异均有统计学意义(P0.01)，各节段扭转角度达峰时间均较对照组减低，差异有统计学意义。4.CAD组与对照组左室各节段及整体三维位移比较：CAD组患者左室整体三维位移明显减低(P0.05)；与对照组相比，LAD组前壁各段、前侧壁基底段及中间段、侧壁心尖段、心尖部P3DD明显减低，差异有统计学意义（P0.05或0.01）；LCX组下间隔基底段及中间段、前间隔基底段及中间段、间隔心尖段P3DD明显减低，差异有统计学意义（P0.05或0.01），RCA组下侧壁基底段及中间段、下壁各段P3DD明显减低，差异有统计学意义（P0.05或0.01），多支病变组左室壁各节段收缩期峰值三维位移显著下降。5.参数相关性分析：CAD组PGT、PAT、PBT均与LVEF、P3DD呈正相关，PAT与LVEF、P3DD相关性好（r1=0.53，，P10.05；r2=0.44，P20.05），PGT与LVEF、P3DD相关性弱（r1=0.017，P10.05；r2=0.009，P20.05）。结论：3D-STI可以在三维空间内实时研究左室位移及扭转运动，从而敏感的检测CAD患者的左室收缩功能减低，为CAD的诊断提供重要线索，具有广阔的应用前景。
[Abstract]:Objective: To evaluate the left ventricular torsion and displacement parameters in patients with Coronary Artery Disease (CAD) by ultrasonic three-dimensional speckle tracking technique, and to explore the correlation between them.
Methods: 120 cases of coronary heart disease diagnosed by coronary angiography from September 2012 to March 2013 were selected, 75 men, 45 women, 36-81 years old, and the average (57.36 soil 12.96) years old. They were divided into left anterior descending group (group LAD, n=47), left circumflex group (group LCX, n=25), right coronary artery group (RCA group, n=23), multiple branch lesions. Group (n=25), left main artery disease was classified into multiple groups. 40 healthy volunteers were selected as normal control group, including 25 male, 15 female, 22~76 years old and average (49.14 soil 12.57) years old. The medical history and physical examination, electrocardiogram, routine echocardiography and other related examinations were used to exclude qualitative heart disease.
The TOSHIBA ARTIDA color Doppler ultrasound diagnostic instrument is used to synchronize the chest lead electrocardiogram. After the patient's calm breathing, the PST-30SBT two-dimensional probe is used to collect the conventional ultrasonic parameters through the chest, and switch to the PST-25SX three-dimensional probe to obtain and store the three-dimensional full volume dynamic image of the left ventricle, and then use the 3D speckle tracking software for the stored image. By off-line analysis, the instrument automatically obtained the left ventricular whole, the basal segment, the middle segment, the peak of the torsional angle of the apical segment (PGT, PBT, PMT, PAT) and the peak time of the corresponding segments (Time-PGT, Time-PBT, Time-PMT, Time-PAT), the left ventricular ejection fraction (LVEF), the left ventricular body and the three dimensional displacement of each segment (three-dimensional displacement, P3DD) and other indicators. The above indexes were compared in each group and the control group, and the correlation between the peak value of left ventricular twist and the displacement parameters and LVEF was analyzed.
Results: 1. comparison of general clinical data: compared with the age, height, weight, heart rate, systolic pressure and diastolic pressure in the two groups, there was no significant difference (P0.05).2. routine echocardiographic parameters: compared with the control group, LVEF decreased in each group of CAD, the difference was statistically significant (P0.05); LAD, LA, LVIDd, LVIDs, LVESV, LVED in group LAD V significantly increased, LVEF decreased, the difference was statistically significant (P0.05 or 0.01).3.CAD and the control group of the left ventricular systolic twist angle peak and peak time: (1) CAD group PGT, PAT decreased, the difference was statistically significant (P0.05 or 0.01); (2) LCX group, RCA group apex, left ventricular systolic twist The trend was in accordance with the normal control group, PBT, PMT had a decreasing trend, but the difference was not statistically significant; Time-PBT was significantly delayed in comparison with the control group (P0.05). Although Time-PMT was delayed in comparison with the control group, there was no significant difference (P0.05); (3) the PBT in the LAD group was lower than the control group (P0.05); PMT was compared with the control group. The difference was not statistically significant (P0.05), and Time-PMT was significantly delayed in comparison with the control group (P0.05). (4) multiple groups of PBT and PMT were significantly lower than those in the control group (P0.01), and the peak time of each segment was lower than that in the control group, and the difference was statistically significant between the.4.CAD group and the control group left ventricular segments. In group CAD, the three-dimensional displacement of the left ventricle decreased significantly (P0.05). Compared with the control group, the anterior wall of the LAD group, the basal and middle segment of the anterior wall, the apical segment of the lateral wall and the apical P3DD decreased significantly (P0.05 or 0.01), and the basal segment and the middle segment of the lower interval of group LCX, the basal segment of the anterior septum, and the basal segment of the anterior septum. In the middle segment, the apical P3DD was significantly reduced, the difference was statistically significant (P0.05 or 0.01). The lower lateral wall and the middle segment of the lower wall of the RCA group decreased significantly (P0.05 or 0.01). The three-dimensional displacement of the systolic peak value of the left ventricular wall in the left ventricular wall decreased significantly by the.5. parameter correlation analysis: CAD group PGT, P AT, PBT are positively related to LVEF, P3DD, PAT and LVEF, P3DD is good (r1=0.53, P10.05; r2=0.44, P20.05).
Conclusion: 3D-STI can be used to study the left ventricular displacement and torsional movement in three dimensional space, so as to detect the left ventricular systolic function of CAD patients sensitive and provide an important clue for the diagnosis of CAD, and it has a broad application prospect.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.4;R445.1

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