三维斑点追踪成像技术评价病态窦房结综合征患者心房重构和电重构

发布时间：2018-06-09 23:19

  本文选题：病态窦房结综合征 + 三维斑点追踪成像　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的目前三维斑点追踪成像技术(3D-STI)主要应用于评价心室结构及功能的变化,对于心房的评估临床应用较少。病态窦房结综合征为临床常见的疾病之一,该疾病易并发多种房性心律失常,本研究通过三维斑点追踪成像技术测量心房的容积大小评估心房的结构重构程度,测量心房肌的整体应变率评估患者是否存在心房运动失同步性,评估患者心房电重构的程度。方法收集青岛大学医学院附属医院于2014.12-2016.10月初次诊断为病态窦房结综合征患者,根据是否合并慢快综合征分为2组,第一组为合并慢快综合征患者共25人(SSS1组),第二组为不合并慢快综合征共25人(SSS2组),并取正常人25人作为对照组。测定并记录所有患者左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房收缩前容积(LAVp),根据以上数据计算出左心房容积指数(LAVI)、左心房每搏量(LASV)、左心房被动射血分数(LAPEF)和左心房主动射血分数(LAAEF),同时测量右心房容积(RAV)并计算右心房容积指数(RAVI)。应用3D-STI技术获取左房整体纵向应变(GLPS)、径向应变(GRPS)、圆周应变(GCPS)、面积应变(GAPS)。记录所有数据,并应用SPSS17.0统计学软件进行处理。通过以上指标评价心房失同步性及结构的重构程度,并比较重构程度是否与患者合并慢快综合征有相关性。结果1.SSS1组与对照组相比较,LAVp增加(30.45±5.45vs 25.14±3.29),LAVI增加(31.39±5.83vs 29.72±2.84),LASV(27.83±8.11vs 30.25±2.54)、LAPEF(39.29±2.28vs50.39±3.84)、LAAEF(22.47±3.48vs31.74±2.59)均降低,差异具有统计学意义(P0.05);SSS2组与对照组相比较,LAVp增加(28.39±5.48vs 25.14±3.29),LAVI增加(31.29±3.29vs 29.72±2.84),LASV(28.02±3.53vs 30.25±2.54)、LAPEF(40.28±4.29vs50.39±3.84)、LAAEF(24.17±3.21vs31.74±2.59)均降低,差异具有统计学意义(P0.05),但SSS1组与SSS2组之间差异无统计学意义。2.SSS1组与对照组相比较,RAV(45.21±6.13vs36.50±4.60)、RAVI(23.96±1.87vs20.32±2.72)均增加,差异具有统计学意义(P0.05);SSS2组与对照组相比较,RAV(41.23±6.52vs36.50±4.60)、RAVI(23.05±3.52vs20.32±2.72)均增加,差异具有统计学意义(P0.05),但SSS1组与SSS2组之间无差异性。3.SSS1组、SSS2组、对照组三组相比,GLPS(24.52±2.35 vs 28.16±4.38 vs 30.46±5.02)、GRPS(23.54±4.65 vs 25.63±5.47 vs 28.82±6.15)、GCPS(17.52±3.58 vs19.89±5.23 vs23.15±4.08)、GAPS(50.72±5.65 vs54.38±7.25 vs 62.47±8.93)呈递增趋势,其中SSS1组最低,差异具有统计学意义(P0.05)。结论1、病态窦房结综合征患者与健康人相比,存在心房的电重构和结构重构。2、病态窦房结综合征患者中合并慢快综合征的电重构的程度较不合并慢快综合征的患者电重构的程度更加显著。3、3D-STI可定量评估心房肌的结构及功能的改变,可填补常规超声心动图的不足,应用于临床中,可对患者的评估更加及时、完善,为临床早期干预病态窦房结综合征的治疗提供参考。
[Abstract]:Objective at present, 3D-STI is mainly used to evaluate the changes of ventricular structure and function. Sick sinus syndrome (SSS) is one of the most common clinical diseases, which is prone to multiple atrial arrhythmias. In this study, the volume size of atrium was measured by three dimensional speckle tracing imaging to evaluate the degree of atrial structural remodeling. The global strain rate of atrial muscle was measured to assess whether there was atrial motion loss and the degree of atrial electrical remodeling. Methods patients with sick sinus syndrome (SSS) were collected from affiliated Hospital of Qingdao University Medical College from April to early October, 2014.The patients were divided into two groups according to whether they were complicated with slow and fast syndrome. The first group consisted of 25 patients with chronic fast syndrome and 25 patients with chronic fast syndrome. The second group consisted of 25 patients without slow fast syndrome and 25 normal subjects as control group. We measured and recorded the left atrium maximal volume, left atrial minimum volume, left atrial presystolic volume and left atrial presystolic volume. Based on the above data, we calculated the left atrial volume index (LVI), left atrial volume (LASV), left atrial passive ejection fraction (LAPEF1) and left atrial ejection fraction (LAPEF1), based on the above data, we calculated the left atrial volume index (LAVI), left atrial volume (LASV), left atrial passive ejection fraction (LAPEF). Atrial active ejection fraction (LAAEFV) and right atrial volume (RV) were measured and the right atrial volume index (RIA) was calculated. 3D-STI technique was used to obtain the whole longitudinal strain of left atrium (GLPS), radial strain (GRPS), circumferential strain (GCPS) and area strain (GAPS). All data were recorded and processed by SPSS 17.0 statistical software. The above indexes were used to evaluate the degree of atrial loss and structural remodeling, and to compare the correlation between the degree of remodeling and the patients with slow fast syndrome. 缁撴灉1.SSS1缁勪笌瀵圭収缁勭浉姣旇緝,LAVp澧炲姞(30.45卤5.45vs 25.14卤3.29),LAVI澧炲姞(31.39卤5.83vs 29.72卤2.84),LASV(27.83卤8.11vs 30.25卤2.54),LAPEF(39.29卤2.28vs50.39卤3.84),LAAEF(22.47卤3.48vs31.74卤2.59)鍧囬檷浣，

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