VVI新参数评价左心舒张功能临床应用研究

发布时间：2018-08-14 09:55

【摘要】：目的:研究速度向量成像技术(VVI)新参数评估左心室舒张功能障碍及严重程度的可行性;探讨新参数评估左心室舒张功能障碍的诊断效能;并进一步研究诊断效能较好的参数测量位置的选择及新参数与影响因素年龄的相关性。方法:纳入因心血管症状就诊于我院的门诊及住院患者共129例,根据2016年由ASE和EACVI联合发布的左心室舒张功能评估指南分为两组,即左心室舒张功能正常组(30例)和左心室舒张功能障碍组(99例),后者根据严重程度又细分为左心室舒张功能I级障碍组57例、II级障碍组37例、III级障碍组5例。同期选取就诊我院的健康体检者124例作为对照组。所有受试者行超声心动图检查,留存心尖四腔心、三腔心及两腔心二维动态图像,利用机器内置的VVI软件进行后处理。记录左心室纵向心肌层相应指标:舒张早期左心室纵向各节段心肌峰值速度(Ev)的平均值(G-MEv)、二尖瓣环6个心肌节段Ev的平均值(6MEv)、心尖四腔心切面二尖瓣环侧壁Ev和室间隔Ev及两者的平均值(2MEv),并记录舒张早期二尖瓣环6个心肌节段峰值应变率(Esr)的平均值(6MEsr),根据舒张早期二尖瓣口血流峰值速度(E),6MEv,6MEsr,计算E/6MEv和E/6MEsr。结果:1.左心室舒张功能障碍组的6MEv和6MEsr均较对照组减小(P0.05),但上述参数在左心室舒张功能I级障碍组、II级障碍组、III级障碍组两两间比较差异无统计学意义。左心室舒张功能III级障碍组的E/6MEv和E/6MEsr均较对照组、I级障碍组、II级障碍组增大(P0.05),左心室舒张功能II级障碍组的E/6MEv和E/6MEsr也均较对照组、I级障碍组增大(P0.05),但左心室舒张功能I级障碍组的E/6MEv和E/6MEsr与对照组比较差异无统计学意义。与对照组比较,左心室舒张功能障碍组(合计值)、左心室舒张功能正常组的6MEv和6MEsr均减小,E/6MEv和E/6MEsr均增大(P0.05)。2.6MEv、6MEsr、E/6MEv和E/6MEsr的ROC曲线下面积分别为0.95、0.80、0.79、0.62,P均0.05。6MEv诊断舒张功能障碍的阈值为4.9cm/s;6MEsr诊断舒张功能障碍的阈值为1.3s-1;E/6MEv和E/6MEsr诊断II级障碍及以上的阈值分别为17、53cm,诊断III级障碍的阈值分别为21、77cm。3.6MEv、6MEsr、E/6MEv、E/6MEsr与左心室舒张功能障碍的相关系数rp分别为-0.77、-0.52、0.51、0.20,P均0.01。4.左心室舒张功能障碍组的侧壁Ev、室间隔Ev、2MEv、6MEv和G-MEv与对照组比较均具有差异性(P0.05),但上述参数在左心室舒张功能I级障碍组、II级障碍组、III级障碍组两两间比较差异均不具有统计学意义。5.侧壁Ev、室间隔Ev、2MEv、6MEv及G-MEv的ROC曲线下面积分别为0.85、0.87、0.89、0.95、0.95,P均0.0001;相应的诊断舒张功能障碍的阈值分别为4.6cm/s、5.8cm/s、4.9cm/s、4.9cm/s、4.0cm/s。6.在对照组中,6MEv、6MEsr、E/6MEv与年龄均有不同程度的相关性(P0.05);但在左心室舒张功能障碍组中,三者与年龄的相关性均不具有统计学意义。而在两组中,E/6MEsr与年龄的相关性均不具有统计学意义。结论:1.VVI新参数在左心室舒张功能评估方面具有临床应用价值,能早期识别心肌功能异常。2.6MEv或6MEsr仅能评估左心室舒张功能障碍,如若进一步评价其严重程度,需要结合E/6MEv或E/6MEsr综合评定。3.6MEv相对于6MEsr、E/6MEv、E/6MEsr是一个较好的指标,诊断左心室舒张功能障碍效能较优。4.2MEv是一个相对较好反映左心室舒张功能的测量位点;但当多节段心肌功能异常时,G-MEv是较好的测量位点。5.在评价左心室舒张功能时,应注意年龄对VVI新参数的影响。
[Abstract]:Objective: To study the feasibility of new parameters of velocity vector imaging (VVI) in assessing left ventricular diastolic dysfunction and severity, to explore the diagnostic efficacy of new parameters in assessing left ventricular diastolic dysfunction, and to further study the choice of parameters with better diagnostic efficacy and the correlation between new parameters and influencing factors. A total of 129 outpatients and inpatients with cardiovascular symptoms were enrolled in our hospital. According to the assessment guidelines of left ventricular diastolic function issued jointly by ASE and EACVI in 2016, they were divided into two groups: normal left ventricular diastolic function group (30 cases) and left ventricular diastolic dysfunction group (99 cases). The latter was further divided into left ventricular diastolic function I according to the severity. Fifty-seven patients with grade I disorder, 37 patients with grade II disorder and 5 patients with grade III disorder were enrolled in the study. 124 healthy subjects were selected as the control group. All subjects were examined by echocardiography, and two-dimensional dynamic images of apical four-chamber, three-chamber and two-chamber heart were preserved. Corresponding indices: Mean value of peak velocity (Ev) of left ventricular longitudinal segments (G-MEv), mean value of six segments of mitral annulus (6MEv), mean value of side wall Ev of mitral annulus (Ev) and mean value of ventricular septum Ev (2MEv) of both (2MEv) on apical four-chamber view, and peak strain rate (Esr) of six segments of mitral annulus in early diastolic period were recorded. E/6MEv and E/6MEsr were calculated according to the peak velocity of mitral orifice flow (E), 6MEv and 6MEsr. Results: 1. The 6MEv and 6MEsr in the left ventricular diastolic dysfunction group were significantly lower than those in the control group (P 0.05), but the above parameters were not statistically significant in the left ventricular diastolic dysfunction group I, II and III. The E/6MEv and E/6MEsr of the patients with grade III left ventricular diastolic dysfunction were both higher than those of the control group, the E/6MEv and E/6MEsr of the patients with grade I left ventricular diastolic dysfunction were higher than those of the control group (P 0.05), but the E/6MEv and E/6MEsr of the patients with grade I left ventricular diastolic dysfunction were higher than those of the control group (P 0.05). Compared with the control group, left ventricular diastolic dysfunction group (total value), left ventricular diastolic function group 6MEv and 6MEsr decreased, E/6MEv and E/6MEsr increased (P 0.05). 2.6MEv, 6MEsr, E/6MEv and E/6MEsr ROC curves below the integral were 0.95, 0.80, 0.79, 0.62, P 0.05.6MEv diagnostic threshold for diastolic dysfunction. The diagnostic thresholds of E/6MEsr and E/6MEsr were 17,53 cm and above, respectively. The diagnostic thresholds of E/6MEsr and E/6MEsr were 21,77 cm.3.6 MEv, 6 MEsr, E/6MEsr, and the correlation coefficients of E/6MEsr with left ventricular diastolic dysfunction RP were - 0.77, - 0.52, 0.51, 0.20, P 0.01.4, respectively. Side wall Ev, interventricular septum Ev, 2MEv, 6MEv and G-MEv in the diastolic dysfunction group were significantly different from those in the control group (P 0.05), but the above parameters were not statistically significant in the left ventricular diastolic dysfunction group I, II and III. The corresponding thresholds for diastolic dysfunction were 4.6 cm/s, 5.8 cm/s, 4.9 cm/s, 4.0 cm/s, and 4.0 cm/s, respectively. The correlation between E/6MEsr and age was not statistically significant in both groups. Conclusion: 1. The new parameters of VVI have clinical value in assessing left ventricular diastolic function and can identify early abnormal myocardial function. Combined with E/6MEv or E/6MEsr, 3.6MEv was a better index for diagnosing left ventricular diastolic dysfunction than 6MEsr, E/6MEsr and E/6MEsr. 4.2MEv was a relatively good site for measuring left ventricular diastolic function, but G-MEv was a better site for evaluating left ventricular diastolic function in patients with multi-segmental abnormalities. In diastolic function, we should pay attention to the effect of age on new parameters of VVI.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6;R540.45

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