三维斑点追踪技术评价急性心肌梗死PCI术后近期左室壁运动及收缩功能

发布时间：2018-05-25 05:46

本文选题：三维斑点追踪技术 + 急性心肌梗死　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:利用实时三维斑点追踪技术(three dimensional speckle tracking imaging,3D-STI)评价中老年急性心肌梗死患者经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)后心肌各节段应变、左室整体应变、左室旋转、左室扭转、左室扭力与左心室整体收缩功能,阐明其PCI术后早期心肌应变及扭转、旋转参数改变特点及其临床价值。材料与方法:选取因左前降支病变行PCI术患者30例纳入病例组,同期选取健康中老年人30例纳入对照组,常规获取二维超声资料后,运用三维斑点追踪技术对两组受试者进行心肌运动及收缩功能检测,收集左心室各节段及整体纵向应变(global longitudinal strain,GLS)、径向应变(global radial strain,GRS)、圆周应变(global circumferential strain,GCS)和面积应变值(global area strain,GAS)、左心室基底平面各个节段的收缩期扭转角度峰值(peak basal twist peak apical twist,Ptw-B),左心室心尖平面的各个节段的扭转角度峰值(peak apical twist,Ptw-A),左心室整体扭转角度峰值(left ventricular twist,LVtw),左心室基底平面各个节段的旋转角度峰值(peak basal rotation,Prot-B),左心室心尖平面的各个节段的旋转角度峰值(peak apical rotation,Prot-A),左心室整体旋转角度峰值(left ventricular rotation,LVrot),左心室基底平面的各个节段扭力峰值(peak basal torsion,Ptor-B),左心室心尖平面的各个节段的扭力峰值(peak apical torsion,Ptor-A),左心室整体扭力峰值(left ventricular rotation,LVtor),左室射血分数(left ventricular ejection fraction,LVEF)。结果:1.与对照组比较,病例组整体应变值低于对照组对应节段的整体应变值。2.各节段应变值中,病例组左心室9/16节段的纵向应变值(LS)减低,8/16节段的圆周应变值(CS)减低,5/16节段的径向应变值(RS)减低,11/16节段的面积应变值(AS)减低(p0.05);应变值减低节段主要集中于前壁基底段、前壁中间段、前壁心尖段、前间隔基底段、前间隔中间段、后间隔基底段、后间隔中间段、后间隔心尖段。3.与对照组比较,左室整体旋转角度、左室整体扭转角度、左室整体扭力均低于正常对照组,差值有统计学意义。基底平面和心尖平面相应节段的收缩期扭转角度峰值、收缩期旋转角度峰值、收缩期扭力都较正常组减低且差值有统计学意义。(P0.05)4.病例组GLS、GAS、GCS、GRS与LVEF呈正相相关关系(r=0.819,r=0.897,r=0.807,r=0.862,P0.0001)。5.病例组左室整体旋转角度峰值、扭转角度峰值、扭力峰值与LVEF呈正相相关关系(r=0.834,P0.0001;r=0.779,P0.0001;r=0.839,P0.0001)。结论:1.3D-STI能够定量分析AMI患者PCI术后早期左心室整体心肌与局部心肌应变值改变。2.3D-STI可以发现AMI患者PCI术后早期左心室旋转、扭转运动的变化,PCI术后早期病变心肌整体及局部心肌扭转、旋转值均下降。3.3D-STI参数中,左室整体应变、左室整体旋转角度、左室旋转角度、左室整体扭力都与左室收缩功能具有良好的相关性,可以反映左室整体收缩功能。
[Abstract]:Objective: to evaluate the myocardial strain, global strain of left ventricle, rotation of left ventricle and torsion of left ventricle after percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) by using three dimensional speckle tracking imaging3D-STI technique. Left ventricular torsion and global left ventricular systolic function were used to elucidate the characteristics and clinical value of early myocardial strain, torsion and rotation parameters after PCI. Materials and methods: 30 patients with left anterior descending branch disease underwent PCI operation were included in the case group, and 30 healthy elderly patients were included in the control group. Three dimensional speckle tracing technique was used to detect myocardial motion and systolic function in two groups. Global longitudinal strains, global radial strains, global area strains, area strain values, peak systolic torsion angle of all segments of the left ventricular basal plane, left ventricle, left heart, left ventricle, left ventricle Peak apical twist-angle peak at each segment of the ventricular apex plane, left ventricular twist-LVtwa peak at the global left ventricular torsion angle, peak rotation angle peak value at each segment of the left ventricular basal plane and peak basal rotation at each segment of the left ventricular apical plane, rotation of each segment of the left ventricular apical plane Peak apical rotation, left ventricular rotation, peak basal torsion, peak apical torsion, left ventricular global torsion, left ventricular basal plane, peak basal torsion, peak apical torsion, left ventricular global torsion, left ventricular total torsion peak, left ventricular total torsion peak. Ventricular rotation, left ventricular ejection fractionation, left ventricular ejection fraction (LVEF), left ventricular ejection fraction (LVEF). The result is 1: 1. Compared with the control group, the whole strain value of the case group was lower than that of the corresponding segment of the control group. In the strain values of each segment, In the case group, the longitudinal strain value of the left ventricular segment of 9 / 16 segment was reduced, and the circumferential strain value of the segment of 8 / 16 segment was decreased. (CSS) the radial strain value of the segment of 5 / 16 segment was reduced and the area strain value of the segment of 11 / 16 segment was decreased by the area strain value of the segment of 11 / 16 segment. The decrease of the strain value segment was mainly concentrated in the anterior wall basal segment. Middle segment of anterior wall, apical segment of anterior wall, basal segment of anterior septum, middle segment of anterior septum, basal segment of posterior septum, middle segment of posterior septum, apical segment of posterior septum. Compared with the control group, the global rotation angle and the global torsion of the left ventricle were lower than those of the normal control group, and the difference was statistically significant. The peak of systolic torsion angle, peak systolic rotation angle and systolic torsion of the corresponding segment of basal plane and apical plane were lower than those of normal group, and the difference was statistically significant. There was a positive correlation between GRS and LVEF in the case group. In the case group, there was a positive correlation between the peak value of rotation angle and torsion of the left ventricle and the LVEF. There was a positive correlation between the peak value of rotation angle and the peak value of torsion in the left ventricle. There was a positive correlation between the peak value of torsion and LVEF. Conclusion the strain changes of whole and local myocardium of left ventricle in patients with AMI can be quantitatively analyzed by 1: 1.3D-STI. The early left ventricular rotation after PCI in AMI patients can be detected by 2.3 D-STI. The changes of torsion motion were correlated with the global and local myocardial torsion after PCI. In the parameters of 3.3D-STI, the global strain of the left ventricle, the rotation angle of the left ventricle, and the rotation angle of the left ventricle were decreased. The whole left ventricular torsion has good correlation with the left ventricular systolic function, which can reflect the left ventricular global systolic function.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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