2D-STI评价射血分数保留性心力衰竭心房间不同步的临床研究

发布时间：2018-06-05 17:47

本文选题：二维斑点追踪成像 + 心房间不同步　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的运用二维斑点追踪成像(2D-STI)评价射血分数保留性心力衰竭(HFPEF)人群中心房间机械收缩延迟(IAMDs),分析IAMDs与左房结构、左房功能及P波间期的相关性,并探讨IAMDs对HFPEF的预测价值。方法研究纳入射血分数保留性心力衰竭患者34例(HFPEF组),同期射血分数降低的心力衰竭23例(HFREF组)及左室舒张功能异常者29例(LVDD组),以及22例体检健康者作为健康对照组。所有受检者均行常规超声检查,测量并计算二尖瓣口舒张早期血流速度与瓣环组织运动速度比值(E/e′),实时三维超声心动图测量左房容积(LAV_(max)、LAVmin、LAVpre),计算左房射血分数(LATEF、LAPEF、LAAEF),通过体表面积较正后计算左房最大容积指数(LAV_(max)I)。2D-STI测量IAMDs及收缩期左房平均峰值应变LAm Ss。记录静息心电图,测量P波间期、PR及QRS间期。分析IAMDs与左房容积指数、左房功能等指标及P波间期的相关性。绘制IAMDs、E/e′及LAV_(max)I预测HFPEF的ROC曲线,分析曲线下面积(AUC),探讨IAMDs在射血分数保留性心力衰竭中的预测价值。结果与正常对照组及左室舒张功能异常组比较,HFPEF组具有明显的心房间不同步,IAMDs分别为(28.36±7.09ms VS38.1±14.48 ms VS55.09±13.43ms,P0.05),而HFREF组心房间不同步更加明显(69.55±10.58ms)。IAMDs与LAm Ss、LAV_(max)、LAV_(max)I、LATEF、E/e′相关性好(r=-0.67、0.58、0.55、-0.52、0.50,P0.01),而与P波间期无明显相关。ROC曲线显示IAMDs、E/e′及LAV_(max)I的预测HFPEF的AUC分别为0.856、0.844、0.773;当IAMDs为41.5ms时,其诊断HFPEF的灵敏度为78.1%,特异度为78.0%。结论2D-STI能够定量评估心房间不同步,随着左房扩大、左房功能降低及左室充盈压升高,心房间不同步更加明显,且IAMDs预测射血分数保留性心力衰竭效能较E/e′及LAV_(max)I更高。
[Abstract]:Objective to evaluate the central room mechanical systolic delay (IAMDS) in patients with ejection fraction reserved heart failure (HFPEF) by two-dimensional speckle tracing imaging (2D STI), and to analyze the correlation between IAMDs and left atrial structure, left atrial function and P wave interval, and to explore the predictive value of IAMDs for HFPEF. Methods Thirty-four patients with retained heart failure with ejection fraction (HFPEF), 23 patients with heart failure with decreased ejection fraction (HFREF), 29 patients with abnormal left ventricular diastolic function (LVDD) and 22 healthy controls were enrolled. All the subjects were examined by conventional ultrasound. The ratio of mitral orifice early diastolic velocity to annular tissue velocity and E / E / E / E ratio were measured and calculated. The left atrial volume was measured by real-time three-dimensional echocardiography. The left atrial ejection fraction (LVEF) and left atrial ejection fraction (LVEF) were calculated. Large volume index (LVI) was used to measure IAMDs and mean peak strain of left atrium (LAm Ss). Resting electrocardiogram was recorded and P wave interval PR and QRS interval were measured. The correlation between IAMDs and left atrial volume index, left atrial function and P wave interval was analyzed. The ROC curves for predicting HFPEF were drawn and the area under the curve was analyzed. The predictive value of IAMDs in ejection fraction reserved heart failure was discussed. Results compared with the normal control group and the abnormal left ventricular diastolic function group, the IAMDs in the HFPEF group were 28.36 卤14.48ms VS55.09 卤14.48ms VS55.09 卤13.43ms VS55.09 卤13.43ms P0.05, respectively, while in the HFREF group, the atrial asynchrony was more obvious, 69.55 卤10.58ms).IAMDs, and LAm Sslavi maxLAVVVV / E / E / R = r = -0.670.580.55t -0.520.50m P0.01a, respectively, and the correlation with the P wave interval was higher than that in the HFPEF group (P < 0.05), but it was significantly higher in the HFREF group than in the normal control group and the left ventricular diastolic dysfunction group (HFPEF group). The correlation between IAMDs in the HFPEF group and in the HFREF group was better than that in the control group. No significant correlation. ROC curve showed that the AUC of HFPEF predicted by LAV_(max)I and E / E 'were 0.856 / 0.844 / 0.773.When IAMDs was 41.5ms, The sensitivity and specificity of HFPEF were 78. 1% and 78. 0% respectively. Conclusion 2D-STI can quantitatively evaluate atrial asynchrony. With the enlargement of left atrium, left atrial function decreased and left ventricular filling pressure increased, and atrial asynchrony was more obvious. IAMDs was more effective than E / E 'and LAV_(max)I in predicting ejection fraction reserved heart failure.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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