UCG和ECG诊断高血压左室肥厚一致性及STI技术评价左室功能的研究
发布时间：2018-11-26 14:32
【摘要】：目的:研究超声心动图(Echocardiography,UCG)和心电图(Electrocardiogram,ECG)在诊断左室肥厚(Left Ventricular Hypertrophy,LVH)上是否一致,探索两者在筛查LVH以及预测心血管疾病上的优点。运用二维斑点追踪成像技术(Two-dimensional Speckle Tracking Imaging,2D-STI)对高血压LVH伴有心电图表现出T波改变患者的左心室功能进行早期判断,旨在为临床提供有效的诊断价值,帮助临床最大限度地降低心血管事件的发生率和死亡率。方法:采用前瞻性研究方法,通过超声心动图左室质量指数(Left ventricular mass index,LVMI)和/或心电图Sv1+Rv5为指标收集原发性高血压左室肥厚患者74例,分析两种诊断方法在诊断LVH上是否一致及其相关性。采用2D-STI技术评价各个节段心肌收缩功能,观察高血压T波改变组和T波正常组之间应变值是否存在差异,以及心电图Sv1+Rv5值与超声心动图收缩、舒张功能值、STI应变值之间的相关性。结果:1.高血压各组的IVSTd、LVPWTd、LVMI、RWT、Rv5、Sv1+Rv5均比正常对照组高,差异有统计学意义(P0.05);其中高血压T波改变组的LVMI、Sv1、Rv5、Sv1+Rv5高于T波正常组,差异具有统计学意义(P0.05)。2.高血压T波改变组的LVEF、FS比T波正常组稍高,但差异无统计学意义(P0.05)。3.高血压各组的E/A比值明显低于正常对照组,差异有统计学意义(P0.05),但在高血压T波正常和T波改变组比较无统计学意义(P0.05)。高血压各组的Ea/Aa比值明显低于正常对照组,差异有统计学意义(P0.05);高血压T波改变组的E/Ea比正常对照组和高血压T波正常组高,与两者的差异有统计学意义(P0.05);高血压各组的左房容积指数比正常对照组高,差异有统计学意义(P0.05)。4.高血压各组纵向应变(Longitudinal strain,LS)峰值变化规律:为形态紊乱的负向峰值曲线,并于收缩末期达负向峰值;四腔心、两腔心、心尖长轴切面的LS峰值及整体纵向应变值(Global longitudinal strain,GLS)在三组中呈递减趋势,高血压两组与正常对照组之间比较差异有统计学意义(P0.05),但高血压两组之间差异无统计学意义(PP0.05)。5.高血压各组圆周应变(Circumferential strain,CS)峰值变化规律:为形态紊乱的负向峰值曲线,并于收缩末期达负向峰值;高血压各组基底段、中间段、心尖段CS峰值及整体圆周应变值(Global circumferential strain,GCS)均比正常对照组低,差异有统计学意义(P0.05),其中高血压T波改变组的心尖段CS峰值及GCS值进一步减低,与高血压T波正常组比较差异有统计学意义(P0.05)。6.高血压各组径向应变(Radial strain,RS)峰值变化规律:为形态紊乱的正向峰值曲线,并于收缩末期达正向峰值;高血压各组在各个节段、基底段、中间段、心尖段RS峰值及整体径向应变值变(Global radial strain,GRS)均比正常组低,差异有统计学意义(P0.05),但高血压两组间比较差异不具统计学意义(P0.05)。7.超声心动图和心电图均能同时诊断出LVH占24.32%,超声心动图能诊断LVH而心电图不能诊断的占75.68%;LVMI与Sv1+Rv5呈正相关关系(r=0.623,P0.05)。8.心电图电压Sv1+Rv5与GLS、GCS、GRS值呈负相关关系(r=-0.264,-0.352,-0.202,P均0.05)。结论:1.二维斑点追踪成像技术可用于评价高血压患者左室整体及局部收缩功能。2.组织多普勒成像(Tissue Doppler imaging,TDI)及E/Ea比值能客观反映左室舒张功能。3.高血压T波改变组GCS比高血压T波正常组明显减低。4.采用左室质量指数为诊断左室肥厚的标准,超声心动图诊断高血压左室肥厚患者中,相当大一部分未能同时作出一致的诊断;超声心动图LVMI与心电图Sv1+Rv5呈中度正相关关系。5.心电图Sv1+Rv5值与GLS、GCS及GRS呈负相关关系。
[Abstract]:Objective: To study whether the echocardiogram (UCG) and the electrocardiogram (ECG) were consistent in the diagnosis of left ventricular hypertrophy (LVH) and to explore the advantages of the two methods in the screening of LVH and the prediction of cardiovascular diseases. Two-dimensional speckle tracking imaging (2D-STI) was used to evaluate the left ventricular function of patients with high blood pressure LVH with ECG, and the aim of this study was to provide effective diagnostic value for clinical application. help to minimize the incidence and mortality of cardiovascular events. Methods: 74 patients with essential hypertension left ventricular hypertrophy were collected by the left ventricular mass index (LVMI) and/ or the electrocardiogram (Sv1 + Rv5) by a prospective study. The myocardial contractility of each segment was evaluated by the 2D-STI technique. It was observed that there was a difference in the strain value between the T-wave changing group and the T-wave normal group, and the correlation between the electrocardiogram Sv1 + Rv5 value and the echocardiogram, the diastolic function value and the STI strain value. Results: 1. The IVSTd, LVPWTd, LVMI, RWT, Rv5 and Sv1 + Rv5 in the essential hypertension group were higher than those in the normal control group (P <0.05). The LVMI, Sv1, Rv5, Sv1 + Rv5 of the group were higher than that of the normal control group (P0.05). The LVEF and FS of the T-wave-change group were slightly higher than that in the T-wave group, but the difference was not significant (P0.05). The ratio of E/ A in each group was significantly lower than that in the control group (P0.05). The ratio of Ea/ Aa in the hypertension group was significantly lower than that in the control group (P <0.05). The E/ Ea ratio of the T-wave changing group in the hypertension group was higher than that of the normal control group and the normal group of the hypertension, and the difference between the two groups was statistically significant (P0.05). The left atrial volume index in each group was higher than that in the normal control group (P0.05). The peak value of longitudinal strain (LS) in each group of high blood pressure was: the negative peak curve of the form disorder, and the negative peak at the end of the contraction; the LS peak value and the whole longitudinal strain value (GLS) of the four-chamber heart, the two-cavity heart and the apical long-axis section showed a decreasing trend in the three groups, The difference between the two groups was statistically significant (P0.05), but there was no significant difference between the two groups (PP0. 05). The peak value of the circumferential strain (CS) of the hypertension group was: the negative peak curve of the form disorder and the negative peak value at the end of the contraction; the basal segment, the middle segment, the apical segment CS peak value and the total circumferential strain value (GCS) of the hypertension group were lower than that of the normal control group, The difference was significant (P0.05), in which the peak value of CS and the value of GCS in the apical segment of the T-wave changing group were further reduced, and the difference of CS peak and GCS in the normal group of T-wave of hypertension was statistically significant (P0.05). The peak value of radial strain (RS) in each group of hypertension was: the positive peak curve of the form disorder and the forward peak at the end of systole; and the peak and the overall radial strain value of the hypertension group at each segment, the basal segment, the middle segment, the apical segment RS and the overall radial strain value (Global radial strain, The difference of GRS was lower than that in the normal group (P0.05), but the difference between the two groups was not statistically significant (P0.05). Both echocardiography and electrocardiogram were able to diagnose the LVH at 24. 32% at the same time. The diagnosis of LVH by echocardiography was 75. 68%, and the LVMI was positively correlated with Sv1 + Rv5 (r = 0.623, P0.05). There was a negative correlation between the ECG voltage (Sv1 + Rv5) and the GLS, GCS, and GRS (r =-0.264,-0.352,-0.202, P 0.05). Conclusion: 1. the two-dimensional spot-tracking imaging technique can be used to evaluate the whole and local contraction of the left chamber of a hypertensive patient. Tissue Doppler imaging (TDI) and E/ Ea ratio can objectively reflect the left ventricular diastolic function. The normal group GCS of the T wave of hypertension was significantly lower than that in the normal group of the hypertension T wave. The left ventricular mass index was used as the standard for the diagnosis of left ventricular hypertrophy. In the patients with left ventricular hypertrophy, a significant proportion of the patients with left ventricular hypertrophy failed to make a consistent diagnosis at the same time, and the LVMI of the echocardiogram was in a moderate positive correlation with the electrocardiogram Sv1 + Rv5. The values of the ECG Sv1 + Rv5 were negatively correlated with the GLS, GCS and GRS.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.3;R540.4
本文编号：2358825
[Abstract]:Objective: To study whether the echocardiogram (UCG) and the electrocardiogram (ECG) were consistent in the diagnosis of left ventricular hypertrophy (LVH) and to explore the advantages of the two methods in the screening of LVH and the prediction of cardiovascular diseases. Two-dimensional speckle tracking imaging (2D-STI) was used to evaluate the left ventricular function of patients with high blood pressure LVH with ECG, and the aim of this study was to provide effective diagnostic value for clinical application. help to minimize the incidence and mortality of cardiovascular events. Methods: 74 patients with essential hypertension left ventricular hypertrophy were collected by the left ventricular mass index (LVMI) and/ or the electrocardiogram (Sv1 + Rv5) by a prospective study. The myocardial contractility of each segment was evaluated by the 2D-STI technique. It was observed that there was a difference in the strain value between the T-wave changing group and the T-wave normal group, and the correlation between the electrocardiogram Sv1 + Rv5 value and the echocardiogram, the diastolic function value and the STI strain value. Results: 1. The IVSTd, LVPWTd, LVMI, RWT, Rv5 and Sv1 + Rv5 in the essential hypertension group were higher than those in the normal control group (P <0.05). The LVMI, Sv1, Rv5, Sv1 + Rv5 of the group were higher than that of the normal control group (P0.05). The LVEF and FS of the T-wave-change group were slightly higher than that in the T-wave group, but the difference was not significant (P0.05). The ratio of E/ A in each group was significantly lower than that in the control group (P0.05). The ratio of Ea/ Aa in the hypertension group was significantly lower than that in the control group (P <0.05). The E/ Ea ratio of the T-wave changing group in the hypertension group was higher than that of the normal control group and the normal group of the hypertension, and the difference between the two groups was statistically significant (P0.05). The left atrial volume index in each group was higher than that in the normal control group (P0.05). The peak value of longitudinal strain (LS) in each group of high blood pressure was: the negative peak curve of the form disorder, and the negative peak at the end of the contraction; the LS peak value and the whole longitudinal strain value (GLS) of the four-chamber heart, the two-cavity heart and the apical long-axis section showed a decreasing trend in the three groups, The difference between the two groups was statistically significant (P0.05), but there was no significant difference between the two groups (PP0. 05). The peak value of the circumferential strain (CS) of the hypertension group was: the negative peak curve of the form disorder and the negative peak value at the end of the contraction; the basal segment, the middle segment, the apical segment CS peak value and the total circumferential strain value (GCS) of the hypertension group were lower than that of the normal control group, The difference was significant (P0.05), in which the peak value of CS and the value of GCS in the apical segment of the T-wave changing group were further reduced, and the difference of CS peak and GCS in the normal group of T-wave of hypertension was statistically significant (P0.05). The peak value of radial strain (RS) in each group of hypertension was: the positive peak curve of the form disorder and the forward peak at the end of systole; and the peak and the overall radial strain value of the hypertension group at each segment, the basal segment, the middle segment, the apical segment RS and the overall radial strain value (Global radial strain, The difference of GRS was lower than that in the normal group (P0.05), but the difference between the two groups was not statistically significant (P0.05). Both echocardiography and electrocardiogram were able to diagnose the LVH at 24. 32% at the same time. The diagnosis of LVH by echocardiography was 75. 68%, and the LVMI was positively correlated with Sv1 + Rv5 (r = 0.623, P0.05). There was a negative correlation between the ECG voltage (Sv1 + Rv5) and the GLS, GCS, and GRS (r =-0.264,-0.352,-0.202, P 0.05). Conclusion: 1. the two-dimensional spot-tracking imaging technique can be used to evaluate the whole and local contraction of the left chamber of a hypertensive patient. Tissue Doppler imaging (TDI) and E/ Ea ratio can objectively reflect the left ventricular diastolic function. The normal group GCS of the T wave of hypertension was significantly lower than that in the normal group of the hypertension T wave. The left ventricular mass index was used as the standard for the diagnosis of left ventricular hypertrophy. In the patients with left ventricular hypertrophy, a significant proportion of the patients with left ventricular hypertrophy failed to make a consistent diagnosis at the same time, and the LVMI of the echocardiogram was in a moderate positive correlation with the electrocardiogram Sv1 + Rv5. The values of the ECG Sv1 + Rv5 were negatively correlated with the GLS, GCS and GRS.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.3;R540.4
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