速度向量成像技术评价右束支阻滞心室不同步的特点
发布时间：2019-03-24 21:14
【摘要】：目的:通过速度向量成像技术(VVI)研究右束支阻滞患者心室收缩的不同步性,以指导临床心脏再同步化治疗的优化。方法:选取2014年12月至2016年12月期间前来青岛大学附属医院的完全性右束支阻滞患者共20人作为试验组;选取与试验组年龄、性别等相匹配的健康志愿者20人作为对照组。对实验对象进行数据测量:1)应用常规超声测量:左心房内径、左心室舒张末内径、左心室舒张末容积、左心室收缩末内径、左心室收缩末容积、EF值、Sm值(左室侧壁基底段)、E/A值、二尖瓣反流,右心房内径、右心室横径、右心室流出道内径、Sm值(右室侧壁基底段)、E/A值、三尖瓣反流。2)应用VVI测量:左室短轴切面16节段径向应变达峰时间(Tsr)、周向应变达峰时间(Tsc)、旋转角度达峰时间(Tra);右室室间隔及游离壁的基底段、中间段、心尖段共6个节段的应变(收缩)速度达峰时间(Tsl)。分别计算每个实验对象的各节段达峰时间标准差(Tsr-SD、Tsc-SD、Tra-SD、Tsl-SD)并进行比较分析。结果:1.CRBBB组与对照组相比较,常规超声测得的左室数据无差别(无统计学意义,即P0.05),在右室E/A值、三尖瓣反流率上有差别(有统计学意义,即P0.05);2.CRBBB组与对照组相比较,VVI测得的左室Tsc-SD、Tra-SD有统计学意义(即P0.05),Tsr-SD无统计学意义(即P0.05);右室Tsl-SD有统计学意义(即P0.05);3.应用VVI进行数据测量,CRBBB组左室Tsc及Tra最早位于后间隔,最晚位于侧壁;对照组左室Tsc及Tra最早位于前间隔,最晚位于下后壁。4.CRBBB组右室Tsl最早位于室间隔中间段,最晚位于游离壁基底段;对照组右室Tsl最早位于室间隔基底段,最晚位于游离壁心尖段。5.左室达峰顺序:CRBBB组起自后间隔,同时沿顺时针和逆时针向两个方向顺序达峰,最后到达侧壁;对照组起自前间隔,呈大致顺时针方向顺序达峰,最后到达下后壁。右室达峰顺序:CRBBB组起自室间隔中间段,按室间隔中间段-室间隔基底段-室间隔心尖段-游离壁心尖段-游离壁中间段顺序达峰,最终达游离壁基底段;对照组起自室间隔基底段,按室间隔基底段-室间隔心尖段-室间隔中间段-游离壁基底段-游离壁中间段顺序达峰,最终达游离壁心尖段。结论:1.CRBBB患者右心室收缩功能正常,舒张功能减低。左心室各节段周向应变及旋转角度应变不同步(P0.05),且收缩达峰顺序与健康人有差异。2.常规超声不能发现CRBBB患者左室内不同步性,VVI技术可以评价CRBBB心肌运动的同步性。3.CRBBB患者右室内收缩不同步、延迟,且收缩达峰顺序与健康人不同。
[Abstract]:Aim: to study the unsynchronism of ventricular contraction in patients with right bundle block by velocity vector imaging (VVI) in order to guide the optimization of cardiac resynchronization therapy. Methods: from December 2014 to December 2016, 20 patients with complete right bundle obstruction were selected as the test group, and 20 healthy volunteers matched with the age and sex of the test group were selected as the control group. The results were as follows: 1) the left atrium diameter, left ventricular end diastolic volume, left ventricular end systolic diameter, left ventricular end systolic volume and EF were measured by routine ultrasound. Sm value (left ventricular lateral wall basal segment), E / A value, mitral regurgitation, right atrial diameter, right ventricular transverse diameter, right ventricular outflow tract diameter, Sm value (right ventricular lateral wall basal segment), E / A value, Tricuspid regurgitation. 2) VVI measurement: peak time of radial strain in 16 segments of left ventricular short axial section (Tsr), peak time of circumferential strain peak time (Tsc), rotation angle peak time (Tra); Peak time of strain (contraction) velocity in 6 segments of right ventricular septum and free wall: basal segment, middle segment and apex segment The peak-to-peak time standard deviation (Tsr-SD,Tsc-SD,Tra-SD,Tsl-SD) of each segment was calculated and analyzed. Results: compared with the control group, there was no difference in left ventricular data measured by conventional ultrasound in 1.CRBBB group (P 0.05). There was significant difference in E / A value and tricuspid regurgitation rate (P 0.05) in right ventricular E / A value and tricuspid valve regurgitation rate (P 0.05). Compared with the control group, the left ventricular Tsc-SD,Tra-SD measured by VVI in 2.CRBBB group was statistically significant (P0.05), but there was no significant difference in Tsr-SD (P0.05); right ventricular Tsl-SD was statistically significant (P0.05); 3. Left ventricular Tsl-SD was statistically significant (P0.05); VVI was used to measure the left ventricular Tsc and Tra in the CRBBB group. The left ventricular Tsc and Tra were located in the posterior septum at the earliest and the lateral wall at the latest. The left ventricular Tsc and Tra in the control group were located in the anterior septum and the inferior posterior wall at the earliest, and the right ventricular Tsl in the 4.CRBBB group was the earliest in the middle segment of the ventricular septum and the last in the basal segment of the free wall. In the control group, the right ventricular Tsl was located at the basal segment of ventricular septum at the earliest, and the apical segment of the free wall at the latest. Left ventricular peak order: CRBBB group from the posterior septum, at the same time along the clockwise and counterclockwise two directions to the peak, finally to the lateral wall; control group from the anterior septum, approximately clockwise order of peak, finally to the lower posterior wall. The peak order of the right ventricle in the CRBBB group was from the middle segment of the interventricular septum, and reached the peak sequence according to the middle segment of the interventricular septum, the basal segment of the ventricular septum, the middle segment of the ventricular septum apex and the free wall, and finally reached the free wall basal segment. The control group began from the basal segment of the ventricular septum and reached the peak according to the order of the basal segment of the ventricular septum, the apical segment of the ventricular septum, the middle segment of the ventricular septum, the basal segment of the free wall and the free wall, and finally reached the apex segment of the free wall. Conclusion: right ventricular systolic function is normal and diastolic function is decreased in 1.CRBBB patients. The circumferential strain and rotational angular strain of each segment of left ventricle were out of sync (P0.05), and the peak order of contraction was different from that of healthy persons. Conventional ultrasound can not find left ventricular synchrony in patients with CRBBB. VVI technique can evaluate the synchrony of CRBBB myocardial motion. 3. The right ventricular contraction in patients with CRBBB is out of sync, delayed, and the order of peak of contraction is different from that of healthy people.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7
本文编号：2446688
[Abstract]:Aim: to study the unsynchronism of ventricular contraction in patients with right bundle block by velocity vector imaging (VVI) in order to guide the optimization of cardiac resynchronization therapy. Methods: from December 2014 to December 2016, 20 patients with complete right bundle obstruction were selected as the test group, and 20 healthy volunteers matched with the age and sex of the test group were selected as the control group. The results were as follows: 1) the left atrium diameter, left ventricular end diastolic volume, left ventricular end systolic diameter, left ventricular end systolic volume and EF were measured by routine ultrasound. Sm value (left ventricular lateral wall basal segment), E / A value, mitral regurgitation, right atrial diameter, right ventricular transverse diameter, right ventricular outflow tract diameter, Sm value (right ventricular lateral wall basal segment), E / A value, Tricuspid regurgitation. 2) VVI measurement: peak time of radial strain in 16 segments of left ventricular short axial section (Tsr), peak time of circumferential strain peak time (Tsc), rotation angle peak time (Tra); Peak time of strain (contraction) velocity in 6 segments of right ventricular septum and free wall: basal segment, middle segment and apex segment The peak-to-peak time standard deviation (Tsr-SD,Tsc-SD,Tra-SD,Tsl-SD) of each segment was calculated and analyzed. Results: compared with the control group, there was no difference in left ventricular data measured by conventional ultrasound in 1.CRBBB group (P 0.05). There was significant difference in E / A value and tricuspid regurgitation rate (P 0.05) in right ventricular E / A value and tricuspid valve regurgitation rate (P 0.05). Compared with the control group, the left ventricular Tsc-SD,Tra-SD measured by VVI in 2.CRBBB group was statistically significant (P0.05), but there was no significant difference in Tsr-SD (P0.05); right ventricular Tsl-SD was statistically significant (P0.05); 3. Left ventricular Tsl-SD was statistically significant (P0.05); VVI was used to measure the left ventricular Tsc and Tra in the CRBBB group. The left ventricular Tsc and Tra were located in the posterior septum at the earliest and the lateral wall at the latest. The left ventricular Tsc and Tra in the control group were located in the anterior septum and the inferior posterior wall at the earliest, and the right ventricular Tsl in the 4.CRBBB group was the earliest in the middle segment of the ventricular septum and the last in the basal segment of the free wall. In the control group, the right ventricular Tsl was located at the basal segment of ventricular septum at the earliest, and the apical segment of the free wall at the latest. Left ventricular peak order: CRBBB group from the posterior septum, at the same time along the clockwise and counterclockwise two directions to the peak, finally to the lateral wall; control group from the anterior septum, approximately clockwise order of peak, finally to the lower posterior wall. The peak order of the right ventricle in the CRBBB group was from the middle segment of the interventricular septum, and reached the peak sequence according to the middle segment of the interventricular septum, the basal segment of the ventricular septum, the middle segment of the ventricular septum apex and the free wall, and finally reached the free wall basal segment. The control group began from the basal segment of the ventricular septum and reached the peak according to the order of the basal segment of the ventricular septum, the apical segment of the ventricular septum, the middle segment of the ventricular septum, the basal segment of the free wall and the free wall, and finally reached the apex segment of the free wall. Conclusion: right ventricular systolic function is normal and diastolic function is decreased in 1.CRBBB patients. The circumferential strain and rotational angular strain of each segment of left ventricle were out of sync (P0.05), and the peak order of contraction was different from that of healthy persons. Conventional ultrasound can not find left ventricular synchrony in patients with CRBBB. VVI technique can evaluate the synchrony of CRBBB myocardial motion. 3. The right ventricular contraction in patients with CRBBB is out of sync, delayed, and the order of peak of contraction is different from that of healthy people.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7
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