左室舒张功能与前降支近段狭窄程度相关性的研究

发布时间：2018-07-03 17:52

本文选题：左室舒张功能 + 血管内超声(IVUS)　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:探讨冠心病患者左室舒张功能与血管内超声(IVUS)指导下的前降支近段病变狭窄程度的相关性。方法:入选标准:稳定型心绞痛和不稳定型心绞痛患者且冠脉造影显示为前降支单支病变。排除标准:急性和陈旧性心肌梗死,射血分数降低的心力衰竭,房颤,肾功能不全,心肌病,心脏瓣膜病,先心病,贫血,甲状腺疾病,肿瘤,自身免疫性疾病,急性脑血管病,急性感染。所有稳定型心绞痛和不稳定型心绞痛准备行冠脉造影检查的患者入院后均常规行彩色多普勒超声心动图检查,分别测定左房内径(LAD)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左心室射血分数(LVEF)、E峰、A峰及E/A比值。根据冠脉造影结果,将有单支病变且为前降支近段病变需行IVUS检查的患者纳入研究。在行IVUS检查过程中测量患者病变狭窄最严重部位最大管腔直径(Max MLD)、最小管腔直径(MLD)、管腔面积(LCSA)、中膜面积(EEM CSA)、斑块负荷,并根据术中IVUS测量的病变狭窄程度将患者分为A组(最小管腔面积≥4.0mm2)和B组(最小管腔面积4.0mm2),分析两组患者的临床特点(年龄、高血压、糖尿病病史、血脂等),比较两组患者心脏超声结果有无统计学差异。同时根据IVUS所测斑块负荷数值将患者分为C组(斑块负荷≥70%)和D组(斑块负荷70%),分析两组患者的临床特点(年龄、高血压、糖尿病病史、血脂等),比较两组患者心脏超声结果有无统计学差异,探讨左室舒张功能不全与前降支近段病变狭窄程度的相关性。1选择性冠状动脉造影由心内科专业医师操作,经桡动脉或股动脉入路,Judkins法取多体位行冠状动脉造影,病变直径狭窄比例≥50%为阳性病变,其中单支病变且为前降支近段病变需行IVUS检查的患者纳入研究。2 IVUS检查应用Boston Scientific公司的IVUS设备,探头频率为30MHz,以0.5mm/s速度回撤,选择病变狭窄最严重处测量最大管腔直径(Max MLD)、最小管腔直径(MLD)、管腔面积(LCSA)、中膜面积(EEM CSA)及斑块负荷。其中斑块面积=EEM CSA-LCSA,斑块负荷=斑块面积/中膜面积×100%。3彩色多普勒超声心动图检查取患者胸骨旁左室长轴切面测量左房内径(LAD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD),同时在此切面下,利用超声仪改良Simpson’s法计算LVEDV、LVESV、左室射血分数(LVEF);记录舒张期经二尖瓣口血流多普勒E峰(E),A峰(A)流速,E峰峰值速度与A峰峰值速度的比值(E/A)。上述指标测量3个心动周期,求其均值,所有超声资料进行存储。为避免误差,每个病人由专人按统一方法操作。结果:1 A组与B组比较,A组LAD(3.42±0.32cm)、LVEDD(4.75±0.34cm)、LVESD(3.01±0.46cm)均低于B组LAD(3.62±0.39cm)、LVEDD(5.00±0.51cm)、LVESD(3.30±0.56cm),两者有统计学差异(P0.05),说明血管内超声测量的前降支近段病变的最小管腔面积≥4.0mm2和最小管腔面积4.0mm2比较,其左房内径(LAD)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)有统计学差异。2 C组与D组比较,C组LAD(3.61±0.34cm)、LVEDD(5.02±0.55cm)、LVESD(3.33±0.65cm)均高于D组LAD(3.45±0.35)、LVEDD(4.79±0.34cm)、LVESD(3.05±0.34cm),两者比较有统计学差异(P0.05),说明血管内超声测量的前降支近段病变的斑块负荷≥70%和斑块负荷70%比较,其左房内径(LAD)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)有统计学差异。因左房内径(LAD)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)已证明是代表左室舒张功能的指标,故A组与B组、C组与D组比较,其左室舒张功能有统计学差异。3 A组与B组、C组与D组比较,左室射血分数(LVEF)、E峰、A峰及E/A比值均无显著统计学差异(P值0.05)。这是因为在冠心病患者舒张功能不全的早期阶段,E峰降低,A峰增高,E/A是降低的;随着心力衰竭逐渐加重,E峰流速增高,E/A变为正常;当心力衰竭更为严重时,E峰增高,A峰降低,E/A比值增大。此研究中的各组冠心病患者处于舒张功能不全的不同时期,故E、A、E/A比值比较无显著统计学差异。结论:无论是从IVUS测量的病变处最小面积角度还是从斑块负荷角度比较,前降支近段病变与左室舒张功能有着良好的相关性。
[Abstract]:Objective: To investigate the correlation between left ventricular diastolic function and the degree of narrowing of anterior descending proximal diseased stenosis under the guidance of intravascular ultrasound (IVUS). Methods: criteria: stable angina and unstable angina pectoris and coronary angiography as a single branch of anterior descending branch. Acute and old myocardial infarction, ejection fraction Heart failure, atrial fibrillation, renal insufficiency, cardiomyopathy, valvular heart disease, congenital heart disease, anemia, thyroid disease, tumor, autoimmune disease, acute cerebrovascular disease, acute infection. All patients with stable angina and unstable angina pectoris were routinely treated with color Doppler echocardiography after admission to the hospital. The left atrium diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), E peak, A peak and E/A ratio were measured respectively. According to the results of coronary angiography, the patients with single branch lesion and the anterior descending proximal lesion needed IVUS examination were included in the study. The patients' lesions were measured during the procedure of IVUS examination. The maximum lumen diameter (Max MLD), the smallest lumen diameter (MLD), the area of the lumen (LCSA), the area of the middle membrane (EEM CSA), the plaque load, were divided into A group (minimum lumen area > 4.0mm2) and B group (4.0mm2 lumen area 4.0mm2) according to the degree of stenosis measured during the intraoperative IVUS. The clinical characteristics of the two groups were analyzed (age, high). Blood pressure, diabetes history, blood lipid, etc., compared to the two groups of patients with no statistical difference in echocardiographic results. According to the plaque load values of the IVUS group, the patients were divided into group C (plaque load > 70%) and group D (plaque load 70%), and the clinical characteristics of the two groups (age, hypertension, diabetes history, blood lipid, etc.) were analyzed, and the heart of the two groups was compared. There is no statistical difference between the results of ultrasound and the correlation between the left ventricular diastolic dysfunction and the degree of stenosis of the proximal descending branch of the anterior descending branch..1 selective coronary angiography is operated by a professional physician in the Department of Cardiology. Through the radial or femoral artery approach, the Judkins method takes the multiple position for coronary angiography, and the proportion of the diameter of the lesion is more than 50%. Patients with single lesion and anterior descending branch of the proximal segment requiring IVUS examination were included in the study of the.2 IVUS examination of the IVUS equipment of the Boston Scientific company, the probe frequency was 30MHz, the speed of 0.5mm/s was retraced, the maximum lumen diameter (Max MLD), the smallest lumen diameter (MLD), the lumen area (LCSA), and the area of middle membrane were measured. Plaque area (CSA) and plaque area =EEM CSA-LCSA, plaque load = patch area / medium membrane area * 100%.3 color Doppler echocardiography examination of left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and at the same time under this section, using a supersonic instrument. A good Simpson 's method was used to calculate LVEDV, LVESV, and left ventricular ejection fraction (LVEF), and the ratio of Doppler E peak (E), A peak (A) flow, E peak peak velocity to A peak velocity (E/A) was recorded during diastole. The above indexes were measured by 3 cardiac cycles, and all ultrasonic data were stored. Results: 1 A group was compared with group B, group A was LAD (3.42 + 0.32cm), LVEDD (4.75 + 0.34cm), LVESD (3.01 + 0.46cm) were lower than LAD (3.62 + 0.39cm) in B group, and (5 + 3.30), and there were statistical differences (3.30 +), and the minimum lumen area of the anterior descending proximal segment of the intravascular ultrasound measurement was more than equal and minimum. Compared with 4.0mm2, the left atrium diameter (LAD), left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were statistically different between.2 C group and D group, C group LAD (3.61 + 0.34cm), LVEDD (5.02 + 0.55cm), 3.45 + 0.35, 3.05 + 0.35. P0.05, indicating that the plaque load of the anterior descending proximal segment of the intravascular ultrasound was more than 70% and the plaque load 70%, the left atrium diameter (LAD), the left ventricular end diastolic diameter (LVEDD) and the left ventricular end systolic diameter (LVESD) were statistically different. The left atrial diameter (LAD), the left ventricular end diastolic diameter (LVEDD), and the left ventricular end systolic diameter (LVESD) had proved to be the generation. Compared with group B, group C and group D, the left ventricular diastolic function in group A and group C was statistically different from that in group.3 A and group B. There was no significant difference in left ventricular ejection fraction (LVEF), E peak, A peak and ratio between group C and D group (0.05). This is due to the reduction of peak peak in the early stage of diastolic dysfunction in coronary heart disease patients. The increase of E/A was reduced; with the gradual increase of heart failure, the flow rate of E peak increased and E/A changed to normal. When the heart failure was more serious, the E peak was increased, the A peak decreased, and the E/A ratio increased. There was no significant difference in the ratio of E, A and E/A in each group of coronary heart disease in this study. Conclusion: the ratio of E, A, and E/A was no significant difference. Conclusion: from I, no matter from I. The minimum area angle of lesion measured by VUS or compared with the plaque load angle, there is a good correlation between the proximal segment lesion and left ventricular diastolic function.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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