血流向量成像技术定量评估左室舒张功能异常患者的心腔内涡流分布与特征

发布时间：2018-08-06 12:38

【摘要】：目的：心腔内的血流模式是一个很敏感的指标,在心脏结构和功能发生改变的同时就会受到即刻影响,从而为心血管生理学的理解以及发展超早期诊断工具提供了新视野。血流向量成像技术在超声心动图中的引入使临床显像和分析心腔内涡流成为了可能,本研究应用血流向量成像技术探讨左室舒张功能不全患者的心腔内涡流分布与特征。方法：2014年9月至2015年3月在解放军总医院超声心动图室经常规超声检查确诊为左室舒张功能异常的患者93人,分为舒张功能轻度减低组39人(41.9%),中度减低组29人(31.2%),重度减低组25人(26.9%),22位健康成人作为对照组。所有患者行二维超声心动图检查、M型超声心动图检查、多普勒超声心动图检查后收集传统超声基线资料,再行血流向量成像技术检查并存图,原始图像导入东芝DAS-RS1脱机分析系统进行分析,部分患者(23人)行左心导管检查测量左室舒张末压。结果：①在正常组和舒张功能异常组,舒张早、晚期内皆有涡流出现。舒张早期涡流持续时间在重度异常组和中度异常组较轻度异常组和正常组显著增高(各自P0.05)；而重度异常组较中度异常组也有显著增高(P0.05)；而舒张晚期涡流持续时间在各组无明显差异；舒张早、晚期涡流最大面积在重度减低组较中度、轻度减低组及正常组显著升高,差异有统计学意义(各自P0.05)；舒张期平均能量损耗在正常组、轻度异常组、中度异常组和重度异常组逐渐升高(P0.05)。②舒张期平均能量损耗和左室舒张末内径、左室舒张末容积、左房前后径以及左房容积指数呈正相关(r=0.5237,P0.05;r=0.8022,P0.05;r=0.7167, P0.05;r=0.7572, P0.05);舒张期平均能量损耗和二尖瓣舒张早期峰值速度E及E/A呈正相关(r=0.5237,P0.05；r=0.6487,P0.05),与二尖瓣舒张晚期峰值速度A和舒张早期二尖瓣环速度e’呈负相关(r=-0.4673,P0.05；r=-0.6927,P0.05)。③VFM技术分析获得的舒张期平均能量损耗与E/e’呈正相关(r=0.7466,P0.05)。④VFM技术分析获得的舒张期平均能量损耗与导管室测得的左室舒张末压呈正相关(r=0.8612,P0.05)。结论：血流向量成像技术显像左室舒张功能不全患者的心腔内涡流,并可分析其分布与特征。涡流持续时间是研究涡流产生和演化的重要指标；舒张期平均能量损耗可能是区分不同程度舒张功能不全和评估左室充盈压的良好指标。
[Abstract]:Objective: the intracardiac blood flow pattern is a sensitive index, which will be affected immediately when the cardiac structure and function change, thus providing a new vision for understanding cardiovascular physiology and developing ultra-early diagnostic tools. The introduction of flow vector imaging in echocardiography makes it possible for clinical imaging and analysis of intracardiac eddy current. In this study, flow vector imaging was used to study the distribution and characteristics of intraventricular eddy current in patients with left ventricular diastolic dysfunction. Methods: from September 2014 to March 2015, 93 patients with abnormal left ventricular diastolic function were diagnosed by echocardiography in Chinese PLA General Hospital. There were 39 patients (41.9%) in the group of mild diastolic dysfunction, 29 (31.2%) in the moderate group and 25 (26.9%) in the severe group as control group. All patients were examined by two dimensional echocardiography and M-mode echocardiography. After Doppler echocardiography, the baseline data of traditional ultrasound were collected. The original images were analyzed with Toshiba DAS-RS1 offline analysis system. Left ventricular end-diastolic pressure was measured by left ventricular catheterization in some patients (23 patients). Results in normal group and abnormal diastolic function group, eddy current appeared in early diastolic phase and late diastolic phase. The duration of early diastolic eddy current in severe abnormal group and moderate abnormal group was significantly higher than that in mild abnormal group and normal group (P0.05), while that in severe abnormal group was significantly higher than that in moderate abnormal group (P0.05). However, there was no significant difference in the duration of late diastolic eddy current in each group. The maximum area of eddy-current in the group of early diastole and late stage was more moderate than that in the group of severe reduction, while that in the group of mild decrease and normal group was significantly increased (P0.05 respectively). The mean energy loss during diastolic phase increased gradually in normal group, mild abnormal group, moderate abnormal group and severe abnormal group (P0.05). There was a positive correlation between the anterior and posterior diameter of left atrium and the left atrial volume index (r = 0.5237a, P = 0.05, P = 0.8022, P = 0.05, P = 0.7572, P < 0.05), and a positive correlation between the mean energy loss during diastolic period and the peak velocity of early diastolic value of mitral valve E and E / P / A (r = 0.5237, P = 0.05, P < 0.05). There was a negative correlation between the peak velocity of late diastolic mitral valve A and the velocity of mitral annulus in early diastolic period (r = 0.4673, P 0.05). The mean energy loss in diastolic phase was positively correlated with E / E'(r = 0.7466P 0.05) .4VFM technique showed a positive correlation with the left ventricular end-diastolic pressure measured by catheterization (r = 0.8612P 0.05), and the diastolic energy loss obtained by VFM technique was positively correlated with that of E / E (r = 0.7466P 0.05) .4VFM technique showed a positive correlation with the left ventricular end-diastolic pressure measured by catheterization (r = 0.8612P, P < 0.05). Conclusion: the flow vector imaging can analyze the distribution and characteristics of intraventricular eddy current in patients with left ventricular diastolic dysfunction. Eddy current duration is an important index to study the generation and evolution of eddy current, and the average energy loss during diastolic period may be a good index to distinguish different degrees of diastolic insufficiency and to evaluate left ventricular filling pressure.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R540.45;R541.6

【相似文献】