负荷超声斑点追踪应变及应变率分析诊断稳定型心绞痛的研究

发布时间：2018-05-07 00:33

本文选题：超声斑点追踪技术 + 多巴酚丁胺负荷试验　；参考：《暨南大学》2015年硕士论文

【摘要】：目的:本研究采用二维超声斑点追踪应变及应变率分析测定多巴酚丁胺负荷前后稳定型心绞痛患者节段性心肌收缩及舒张功能的变化,探讨多巴酚丁胺负荷二维超声斑点追踪应变及应变率分析早期诊断稳定型心绞痛的临床价值。方法:选取30例具有胸痛、胸闷等症状,临床怀疑为稳定型心绞痛的患者,进行多巴酚丁胺负荷试验,然后进一步行冠脉CTA或冠脉造影检查明确患者冠脉病变情况。根据冠脉CTA或冠脉造影检查结果将所有受检者分为冠心病组(20例)和无冠心病照组(10例)。分别在静息、最大负荷以及复负荷后10min、30min、60min、120min、240min进行超声心动图检查,采集并储存受检者左室短轴切面以及心尖四腔、两腔、三腔切面的5个心动周期的二维灰阶动态图像。进一步应用QLab软件对结果进行脱机分析,分析测量左室各节段心肌的纵向收缩期峰值应变及应变率、圆周向收缩期峰值应变及应变率、纵向和圆周向舒张早、晚期应变率,并比较各组局部心肌收缩和舒张功能在负荷前后的变化及随时间变化的情况。结果:静息及最大负荷时所有受检者常规超声均未见节段性室壁运动异常。静息时,对照组和冠心病组心肌各节段纵向收缩期峰值应变(LS)及应变率(LSr)、圆周向收缩期峰值应变(CS)及应变率(CSr)、纵向舒张早期、晚期应变率(LSRe、LSRa)及圆周向舒张早期、晚期应变率(CSRe、CSRa)均无明显差异(P0.05)。最大负荷状态下,冠心病组缺血节段心肌的LS、CS明显低于对照组及冠心病组非缺血节段心肌。最大负荷时,对照组、冠心病非缺血节段、缺血节段LSr、CSr均较同组静息状态下降,且停药后立即恢复基线水平。最大负荷时,对照组、冠心病非缺血节段和缺血节段的LSRe、LSRa、CSRe和CSRa均明显上升。停止使用多巴酚丁胺后LSRe立即下降,并低于基线水平,于30min恢复,CSRe缓慢下降低于基线,于60min恢复,LSRa、CSRa均缓慢下降30min到达基线水平。结论:本研究结果显示,二维超声多巴酚丁胺负荷试验未发现稳定型冠心病患者节段性室壁收缩及舒张功能异常,而二维超声斑点追踪应变及应变率分析多巴酚丁胺负荷试验发现稳定型冠心病患者出现节段性心肌收缩及舒张功能异常,说明二维超声斑点追踪应变及应变率分析多巴酚丁胺负荷试验对于早期诊断稳定型冠心病患者具有一定的临床意义。
[Abstract]:Objective: to investigate the changes of myocardial systolic and diastolic function in patients with stable angina pectoris before and after dobutamine loading by using two dimensional ultrasonic speckle tracing strain and strain rate analysis. To investigate the clinical value of dobutamine load two-dimensional ultrasonic speckle tracing strain and strain rate analysis in early diagnosis of stable angina pectoris. Methods: dobutamine stress test was performed in 30 patients with chest pain, chest tightness and suspected stable angina pectoris. Coronary artery disease was confirmed by coronary CTA or coronary angiography. According to the results of coronary CTA or coronary angiography, all the patients were divided into coronary heart disease group (n = 20) and no coronary heart disease group (n = 10). Echocardiography was performed at rest, maximum load and reload at 30 min or 60 min to 120 min or 240 min after reload, respectively. The dynamic images of the left ventricular short axis section, apical four chamber, two chamber and three lumen section of 5 cardiac cycles were collected and stored. The results were further analyzed by QLab software. The longitudinal peak systolic strain and strain rate, the circumferential systolic peak strain and strain rate, the longitudinal and circumferential diastolic early and late strain rates were measured. The changes of regional myocardial systolic and diastolic function before and after load and over time were compared. Results: no segmental wall motion abnormalities were found in all subjects at rest and maximum load. At rest, in the control group and coronary heart disease group, the longitudinal peak systolic strain (LSs) and the strain rate (LSR) and the strain rate (CSS) and the strain rate (CSR), the early longitudinal relaxation, the late strain rate (LSReLSRa) and the early circumferential relaxation were observed in the control group and the coronary heart disease group. There was no significant difference in late strain rate (CSReN CSRaA). Under the maximum load, the LSN CS of ischemic myocardium in coronary heart disease group was significantly lower than that in control group and coronary heart disease group. At the maximum load, the control group, coronary heart disease (CHD) non-ischemic segment and ischemic segment (LSR-CSR) decreased compared with the rest state of the same group, and recovered to baseline level immediately after withdrawal of the drug. In the control group, the LSReg LSRaI CSRe and CSRa increased significantly in the control group, non-ischemic segment and ischemic segment of coronary heart disease at the maximum load. LSRe decreased immediately after dobutamine was stopped and was lower than baseline level. After 30min recovery, CSRe decreased slowly below baseline, and 60min recovered LSRA CSRa slowly decreased 30min to baseline level. Conclusion: the results of this study showed that there was no abnormal systolic and diastolic function of segmental ventricular wall in patients with stable coronary heart disease by two dimensional ultrasound dobutamine stress test. Two-dimensional dobutamine stress test revealed segmental myocardial systolic and diastolic dysfunction in patients with stable coronary heart disease. The results indicate that the analysis of strain and strain rate by two dimensional ultrasonic speckle tracing is of clinical significance for the early diagnosis of stable coronary heart disease.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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