应用VFM及STI对风湿性二尖瓣狭窄患者左室涡流与心肌应变的相关性研究

发布时间：2018-11-13 20:21

【摘要】：目的 1.应用血流向量成像技术（vector flow mapping, VFM）定量评价风湿性二尖瓣狭窄患者左室涡流，分析瓣膜活动对涡流产生的影响； 2.应用斑点追踪成像技术（speckle tracking imaging, STI）测量左室各壁基底段收缩期纵向应变及应变率，探讨二尖瓣狭窄患者左室涡流与局部心肌功能的相关性。方法 1.研究对象：选取对照组35例健康志愿者，疾病组65例临床诊断为风湿性二尖瓣狭窄患者。 2.仪器：采用ALOKA α10彩色多普勒超声显像系统配有DSA-RSl工作站及GE Vivid7彩色多普勒超声显像系统配有Echo PAC工作站。 3.方法：经常规超声心动图检查后，再分别应用血流向量成像技术与斑点追踪成像技术测量舒张期及等容收缩期左室涡流参数与左室基底段各壁收缩期纵向应变参数，比较各参数的组间差异，并将涡流参数与应变参数进行相关性分析。结果 1.舒张期与等容收缩期总涡流强度从对照组到轻、中度组逐渐增大（P0.05），重度组舒张期总涡流强度与中度组比较差异无统计学意义（P0.05），等容收缩期总涡流强度较中度组减小（P0.05）。 2.舒张期平均涡流强度从对照组到轻、中度组逐渐增大，重度组较中度组明显减小（P0.05）；等容收缩期平均涡流强度重度组较中度组明显减小（P0.05），其余各组间比较差异无统计学意义（P0.05）。 3.与对照组比较，，疾病组左室基底段各壁收缩期纵向峰值应变及应变率降低（P0.05）,而中度组与重度组比较无显著性差异（P0.05）。 4.舒张期及等容收缩期总涡流强度与左室基底段收缩期平均峰值应变及应变率呈负相关（r=-0.637~-0.828，P0.001）。 5.二尖瓣开放幅度CE与舒张期平均涡流强度呈负相关（r=-0.767，P0.001），其与等容收缩期平均涡流强度无显著相关性（P0.05）。结论 1. VFM可用于定量评估风湿性二尖瓣狭窄患者的左室涡流，具有良好的可重复性，为评价异常血流动力学状态下的心肌功能提供新的视角。 2. VFM联合STI证实了血流动力学改变与心肌应变密切相关，对轻中度二尖瓣狭窄患者早期的干预治疗具有重要的临床意义。
[Abstract]:Objective 1. Flow vector imaging (vector flow mapping, VFM) was used to quantitatively evaluate the left ventricular eddy current in patients with rheumatic mitral stenosis and to analyze the effect of valvular activity on the eddy current. 2. The longitudinal strain and strain rate of basal segment of left ventricle were measured by dot-tracing imaging (speckle tracking imaging, STI) in order to investigate the correlation between left ventricular eddy current and regional myocardial function in patients with mitral stenosis. Method 1. Participants: 35 healthy volunteers and 65 patients with rheumatic mitral stenosis were selected. 2. Instrument: the ALOKA 伪 10 color Doppler ultrasound imaging system is equipped with DSA-RSl workstation and GE Vivid7 color Doppler ultrasound imaging system with Echo PAC workstation. 3. Methods: after routine echocardiography, blood flow vector imaging and dot-tracing imaging were used to measure the parameters of left ventricular eddy current during diastolic and isovolumic systolic periods and the longitudinal strain parameters of left ventricular basal segments. The correlation between eddy current parameters and strain parameters was analyzed. Result 1. The total eddy current intensity in diastolic and isovolumic contraction period increased gradually from control group to mild and moderate group (P0.05), but there was no significant difference between severe group and moderate group (P0.05). The total eddy current intensity in isovolumic contraction period was lower than that in moderate group (P0.05). 2. The mean eddy-current intensity increased gradually from control group to mild group and moderate group, and decreased significantly in severe group compared with moderate group (P0.05). The mean eddy-current intensity in isovolumic contraction period in severe group was significantly lower than that in moderate group (P0.05), but there was no significant difference between other groups (P0.05). 3. Compared with the control group the longitudinal peak strain and strain rate of left ventricular basal segment were decreased in the disease group (P0.05) but there was no significant difference between the moderate group and the severe group (P0.05). 4. The total eddy current intensity in diastolic and isovolumic systolic period was negatively correlated with the mean peak strain and strain rate of left ventricular basal segment (r = 0.637 ~ (-1) -0.828 ~ (-1) P 0.001). 5. The open amplitude of mitral valve (CE) was negatively correlated with the mean eddy-current intensity during diastolic period (r ~ (-0.767) P ~ (0.001), but had no significant correlation with the mean eddy-current intensity during isovolumic contraction (P0.05). Conclusion 1. VFM can be used to quantitatively evaluate left ventricular eddy current in patients with rheumatic mitral stenosis. It has good reproducibility and provides a new perspective for evaluating myocardial function in abnormal hemodynamics. 2. VFM combined with STI confirmed that hemodynamic changes were closely related to myocardial strain and had important clinical significance for early intervention in patients with mild to moderate mitral stenosis.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

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