斑点追踪及组织同步显像技术评价心肌桥noble分级与左心室心肌功能的关系
发布时间：2018-11-23 08:01
【摘要】：目的:应用斑点追踪成像技术(speckle tracking imaging,STI)及组织同步显像技术(tissue synchronization imaging,TSI)研究冠状动脉左前降支单纯性心肌桥患者左室局部心肌的应变值及左室收缩同步性指标,以期通过各种定量指标评价STI及TSI在定量分析心肌桥患者的左室收缩舒张功能方面的临床意义,从而为临床医师干预治疗提供准确依据。方法:40例正常对照者、30例单纯性心肌桥致壁冠状动脉狭窄Noble I-II级患者、16例单纯性心肌桥致壁冠状动脉狭窄Noble III级患者。三组均接受传统超声检查,并用斑点追踪技术获得左室心尖三腔心切面、左室心尖二腔心切面和左室心尖四腔心切面的图像,分析左室心肌17节段纵向收缩期峰值应变指标。并用组织同步显像技术测量上述三切面基底段及中间段的收缩期纵向应变达峰时间(Tssl).获得左室各壁12节段达峰时间标准差(Tssl-SD)及节段达峰时间最大差值(Tssl-Dif),以Tssl-SD33 ms作为左室收缩不同步标准。结果:1比较三组之间的年龄、体重、收缩压、左房最大前后径(LA)、舒张末期左室最大内径(LV)、左室射血分数(EF)等指标,差异无统计学差异(P0.05)。与正常对照组相比,心肌桥Noble I-II、心肌桥Noble III两组左室舒张期二尖瓣前向血流频谱E/A比值减小,差异有统计学意义(P0.05)。心肌桥Noble I-II、心肌桥Noble III两组之间比较,左室舒张期二尖瓣前向血流频谱E/A比值差异无统计学意义(P0.05)。2与正常对照组比较,心肌桥Noble I-II、心肌桥Noble III两组前壁中间段及心尖段、前间隔中间段及心尖段Ss明显降低,差异有统计学意义(P0.05)?其中,心肌桥Noble I-II组与心肌桥Noble III组相比,差异无统计学意义(P0.05)。3正常对照组与Noble I-II组的收缩期纵向Tssl-SD及Tssl-diff相比差异无统计学意义(P0.05);与Noble III组相比,Noble I-II组和对照组相的收缩期纵向Tssl-SD及Tssl-Dif差异有统计学意义(P0.05)。4以Tssl-SD33 ms作为左室收缩不同步标准,Noble I-II组左室收缩不同步率为16.67%(5/30),Noble III组左室收缩不同步率25%(4/16),Noble I-II组与Noble III组间不同步率比较无统计学差异(P0.05)。5 logistic回归分析高血压和壁冠状动脉Noble III级是左室收缩不同步的两个主要危险因素。壁冠状动脉Noble III级组(优势比:8.569,95%CI 2.325-28.48,P0.05),高血压组(优势比:15.44,95%CI:1.273-146.4,P0.05)。结论:1 STI技术可以定量评估单纯性心肌桥患者左室心肌的应变能力,可为临床医师干预治疗提供可靠依据。2当单纯心肌桥组Noble III级时,左室纵向Tssl-SD和Tssr-Dif等指标可较敏感的反映出左室壁相应节段收缩不同步。3以Tssl-SD33 ms作为左室收缩不同步标准,能比较准确快速的判断心肌桥患者的左室收缩不同步。4高血压和壁冠状动脉Noble III级更容易导致心肌桥患者的左室收缩不同步的发生。
[Abstract]:Objective: to study the regional strain and systolic synchronism of left ventricle in patients with left anterior descending coronary artery myocardial bridge by (speckle tracking imaging,STI and (tissue synchronization imaging,TSI. The purpose of this study was to evaluate the clinical significance of quantitative analysis of left ventricular systolic and diastolic function by STI and TSI in patients with myocardial bridge, so as to provide an accurate basis for the intervention of clinicians. Methods: 40 normal controls, 30 patients with Noble I-II grade coronary artery stenosis caused by simple myocardial bridge and 16 patients with Noble III grade coronary artery stenosis caused by simple myocardial bridge were studied. All the three groups were examined by conventional ultrasound. The images of left ventricular apical atrium, left ventricular apical two-chamber and left ventricular apical four-chamber were obtained by dot tracing technique, and the longitudinal peak systolic strain index of 17 segments of left ventricular myocardium was analyzed. Measurement of the peak time of longitudinal strain in the basal and middle segments of the above three sections by using tissue synchronization imaging technique (Tssl). The peak time standard deviation (Tssl-SD) and maximum peak time difference (Tssl-Dif) of 12 segments of left ventricular wall were obtained. Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. Results: 1 there was no significant difference in age, body weight, systolic blood pressure, left atrial maximum anteroposterior diameter (LA), left ventricular end diastolic diameter (LV), left ventricular ejection fraction (EF) between the three groups (P0.05). Compared with normal control group, myocardial bridge Noble I-II and myocardial bridge Noble III decreased the ratio of E / A to E / A in left ventricular diastolic mitral flow spectrum (P 0.05). There was no significant difference in E / A ratio between myocardial bridge Noble I-II and myocardial bridge Noble III in left ventricular diastolic mitral flow spectrum (P0.05). 2 compared with normal control group, myocardial bridge Noble I-II-2, left ventricular diastolic mitral valve forward flow spectrum E / A ratio was not significantly different between the two groups (P0.05). The Ss of anterior wall and apical segment, anterior septal middle segment and apical segment of myocardial bridge Noble III group were significantly lower than that of control group (P0.05). There was no significant difference between myocardial bridge Noble I-II group and myocardial bridge Noble III group (P0.05). 3 there was no significant difference in systolic longitudinal Tssl-SD and Tssl-diff between normal control group and Noble I-II group (P0.05). Compared with Noble III group, the systolic phase longitudinal Tssl-SD and Tssl-Dif in Noble I-II group and control group were significantly different (P0.05). 4 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. The left ventricular systolic unsynchronism rate in Noble I-II group was 16.67% (5 / 30), Noble III group), and the left ventricular systolic non-synchronous rate was 25% (4 / 16) in 5 / 30), Noble III group. There was no significant difference between Noble I-II group and Noble III group (P0.05). 5 logistic regression analysis showed that hypertension and Noble III grade of mural coronary artery were the two main risk factors of left ventricular systolic asynchrony. Mural coronary artery Noble III grade group (odds ratio: 8.569c95 CI 2.325-28.48), hypertension group (odds ratio: 15.44-95CI: 1.273-146.4p0.05). Conclusion: (1) STI technique can quantitatively evaluate the strain-ability of left ventricular myocardium in patients with simple myocardial bridge, and can provide reliable evidence for the intervention of clinicians. (2) when the patients with simple myocardial bridge group have Noble III grade, The indexes of left ventricular longitudinal Tssl-SD and Tssr-Dif were sensitive to reflect that the corresponding segments of left ventricular wall were out of sync. 3 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. High blood pressure and Noble III grade of the mural coronary artery are more likely to cause the left ventricular systolic asynchrony in the patients with myocardial bridge.
【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】：R541.1
本文编号：2350864
[Abstract]:Objective: to study the regional strain and systolic synchronism of left ventricle in patients with left anterior descending coronary artery myocardial bridge by (speckle tracking imaging,STI and (tissue synchronization imaging,TSI. The purpose of this study was to evaluate the clinical significance of quantitative analysis of left ventricular systolic and diastolic function by STI and TSI in patients with myocardial bridge, so as to provide an accurate basis for the intervention of clinicians. Methods: 40 normal controls, 30 patients with Noble I-II grade coronary artery stenosis caused by simple myocardial bridge and 16 patients with Noble III grade coronary artery stenosis caused by simple myocardial bridge were studied. All the three groups were examined by conventional ultrasound. The images of left ventricular apical atrium, left ventricular apical two-chamber and left ventricular apical four-chamber were obtained by dot tracing technique, and the longitudinal peak systolic strain index of 17 segments of left ventricular myocardium was analyzed. Measurement of the peak time of longitudinal strain in the basal and middle segments of the above three sections by using tissue synchronization imaging technique (Tssl). The peak time standard deviation (Tssl-SD) and maximum peak time difference (Tssl-Dif) of 12 segments of left ventricular wall were obtained. Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. Results: 1 there was no significant difference in age, body weight, systolic blood pressure, left atrial maximum anteroposterior diameter (LA), left ventricular end diastolic diameter (LV), left ventricular ejection fraction (EF) between the three groups (P0.05). Compared with normal control group, myocardial bridge Noble I-II and myocardial bridge Noble III decreased the ratio of E / A to E / A in left ventricular diastolic mitral flow spectrum (P 0.05). There was no significant difference in E / A ratio between myocardial bridge Noble I-II and myocardial bridge Noble III in left ventricular diastolic mitral flow spectrum (P0.05). 2 compared with normal control group, myocardial bridge Noble I-II-2, left ventricular diastolic mitral valve forward flow spectrum E / A ratio was not significantly different between the two groups (P0.05). The Ss of anterior wall and apical segment, anterior septal middle segment and apical segment of myocardial bridge Noble III group were significantly lower than that of control group (P0.05). There was no significant difference between myocardial bridge Noble I-II group and myocardial bridge Noble III group (P0.05). 3 there was no significant difference in systolic longitudinal Tssl-SD and Tssl-diff between normal control group and Noble I-II group (P0.05). Compared with Noble III group, the systolic phase longitudinal Tssl-SD and Tssl-Dif in Noble I-II group and control group were significantly different (P0.05). 4 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. The left ventricular systolic unsynchronism rate in Noble I-II group was 16.67% (5 / 30), Noble III group), and the left ventricular systolic non-synchronous rate was 25% (4 / 16) in 5 / 30), Noble III group. There was no significant difference between Noble I-II group and Noble III group (P0.05). 5 logistic regression analysis showed that hypertension and Noble III grade of mural coronary artery were the two main risk factors of left ventricular systolic asynchrony. Mural coronary artery Noble III grade group (odds ratio: 8.569c95 CI 2.325-28.48), hypertension group (odds ratio: 15.44-95CI: 1.273-146.4p0.05). Conclusion: (1) STI technique can quantitatively evaluate the strain-ability of left ventricular myocardium in patients with simple myocardial bridge, and can provide reliable evidence for the intervention of clinicians. (2) when the patients with simple myocardial bridge group have Noble III grade, The indexes of left ventricular longitudinal Tssl-SD and Tssr-Dif were sensitive to reflect that the corresponding segments of left ventricular wall were out of sync. 3 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. High blood pressure and Noble III grade of the mural coronary artery are more likely to cause the left ventricular systolic asynchrony in the patients with myocardial bridge.
【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】：R541.1
【参考文献】
相关期刊论文 前8条
1 鲁明军;王玮;许玲玲;苏楠;罗福全;;前降支单纯性心肌桥与左心结构及功能关系研究[J];中国实用医药;2013年19期
2 姚鸿梅;李江波;林建兰;黄宝涛;黄鹤;;面积应变评估正常构型高血压左室收缩功能[J];生物医学工程学杂志;2013年02期
3 蔡伟;董彦;李学文;周瑞娟;赵季红;姜铁民;;应变及应变率成像评估心肌桥患者局部心肌缺血的价值[J];中华实用诊断与治疗杂志;2012年07期
4 贾妍;郭瑞强;陈金玲;周青;;实时三维超声心动图和斑点追踪显像技术评价心肌梗死患者左心室收缩同步性[J];中华超声影像学杂志;2011年02期
5 王俊利;尹立雪;郭智宇;李文华;武彤;;应变成像评价犬左心室急性心肌缺血边缘区跨壁力学状态[J];中华超声影像学杂志;2010年01期
6 张峰;钱菊英;吴鸿谊;路艳;葛均波;;血管内超声对心肌桥及其邻近节段冠状动脉结构特点的研究[J];中华超声影像学杂志;2008年02期
7 韩艳丽;王营;姜红菊;左岩霞;朱靖;王健;刘芳;李继福;陈玉国;;心肌桥与冠状动脉粥样硬化关系的探讨[J];中国心血管病研究杂志;2006年03期
8 杨娅;李治安;;冠状动脉血流显像分析冠状动脉左前降支心肌桥血流储备[J];中华超声影像学杂志;2008年10期
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