RT3D-STI技术评价无RWMA冠状动脉狭窄患者左心室整体及局部舒张功能

发布时间：2018-05-08 00:33

本文选题：超声心动描记术 + 冠状动脉　；参考：《承德医学院》2016年硕士论文

【摘要】：冠状动脉粥样硬化性心脏病,简称冠心病,多由冠状动脉狭窄、痉挛或供血不足引发的心肌功能发生障碍而出现的心肌坏死、重构等器质性病变。1979年世界卫生组织将冠心病分为5种临床类型,即:无症状性心肌缺血、心绞痛、心肌梗死、缺血性心力衰竭及猝死。近年来冠心病发病年龄向年轻化发展,发病率呈现出了明显的上升趋势,严重威胁着患者的生命,严重增加了社会和家庭的负担。因此,冠心病的早期发现、早期治疗及定期随访尤为重要。目前,冠心病的诊断方法较多,应用较普遍的有:(1)冠状动脉造影及冠状动脉加强CT:可以清晰显示冠状动脉病变情况,但是造影剂有明显的肾毒性,不适用于长期的随访;(2)心电图:部分心绞痛患者只有在心绞痛发作时才会有ST段的改变,且无特异性,当病情缓解后,心电图恢复正常,因此心电图正常的患者并不能排除冠心病;(3)放射性核素检查:可以观察室壁的运动及左室射血分数,但是其费用较高且放射性核素对身体有较大伤害;(4)磁共振成像:准确性好,可重复性高,但是无法进行实时观察,不能进行床旁检查;(5)超声心动图:无创、无辐射、费用低、安全、操作简单、可反复使用、准确率高,并可动态观察等特点,优于冠状动脉加强CT、心肌核素显像、心肌核磁共振等,另外超声心动图可以对危重、不适于移动的病人进行床旁检查,更适用于临床。因此超声心动图是冠心病患者不可或缺的辅助检查,对冠心病患者具有重要作用。第一部分RT3D-STI技术评价无RWMA冠状动脉狭窄患者左心室整体舒张功能目的:应用实时三维斑点追踪成像(real-time three-dimensional specke tracking imaging,RT3D-STI)技术获得左心室整体应变显像舒张功能指数(strain imaging diastolic index,SI-DI),评价无节段性室壁运动异常(regionalwallmotionabnormality,rwma)的冠状动脉病变患者左室的整体舒张功能,探讨rt3d-sti在早期诊断冠心病的价值。方法:根据冠状动脉造影(coronaryangiography,cag)结果将拟诊断为冠心病(coronaryheartdisease,chd)但无rwma的92例患者分为2组:对照组即冠状动脉无狭窄组,42例;病例组即冠状动脉狭窄组,50例。经胸超声心动图采集常规二维及三维全容积图像,获得常规参数二尖瓣舒张期血流频谱的e峰(e)、二尖瓣环组织多普勒的e峰(e’)等及左心室收缩末期的整体纵向应变(globlelongitudinalstrain,gls)、径向应变(globleradialstrain,grs)、面积应变(globleareastrain,gas)、圆周应变(globlecircumferentialstrain,gcs)及相应方向舒张期前1/3时的应变,进而根据公式计算四个方向应变显像舒张指数(si-di),分析各个参数对冠状动脉病变的诊断价值。结果:对照组和病例组两组之间相比,常规参数e、e’等及三维应变参数gls、grs、gcs、gas之间差异无统计学意义(p0.05);两组之间纵向应变显像舒张指数(longitudinalstrainimagingdiastolicindex,l-si-di)、径向应变显像舒张指数(radialstrainimagingdiastolicindex,r-si-di)、圆周应变显像舒张指数(circumferentialstrainimagingdiastolicindex,c-si-di)、面积应变显像舒张指数(areastrainimagingdiastolicindex,a-si-di)差异有统计学意义(p0.05);roc曲线表明l-si-di、r-si-di、a-si-di及c-si-di的灵敏性分别为90.5%、85.7%、81.0%、81.0%,特异性分别为82.0%、68.0%、78.0%、56.0%,l-si-di的特异度和灵敏度均最高;冠状动脉gensini积分与l-si-di、r-si-di、a-si-di有相关性(p0.05),r分别为-0.706、-0.410、-0.547。结论:冠状动脉狭窄患者左室整体舒张功能的减低较整体收缩功能早。rt-3d-sti技术明显优于常规二维超声心动图,并且可以定量评价冠状动脉狭窄患者左室整体舒张功能,对冠心病的早期诊断有重要的预期作用。第二部分rt3d-sti技术评价无rwma冠状动脉狭窄患者左心室局部舒张功能目的:应用RT3D-STI技术获得无RWMA的冠心病患者不同冠状动脉供血区局部心肌各方向的SI-DI,评价左心室局部舒张功能,探讨RT3D-STI技术对早期诊断冠状动脉病变的部位和程度的价值。方法:拟诊断为CHD但无RWMA的患者140例,共420支冠状动脉主要分支,根据CAG结果分为无冠状动脉狭窄组,共101支、轻度冠状动脉狭窄组(冠状动脉狭窄50%),共112支、中度冠状动脉狭窄组(冠状动脉狭窄50%~75%),共95支、重度冠状动脉狭窄组(冠状动脉狭窄75%),共112支。经胸采集动态三维全容积图像,计算各方向SI-DI,分析其对冠状动脉病变情况的诊断价值。结果:轻度冠状动脉狭窄组A-SI-DI、L-SI-DI、R-SI-DI均低于无冠状动脉狭窄组(P0.05);中度冠状动脉狭窄组L-SI-DI、A-SI-DI、R-SI-DI及C-SI-DI均低于无冠状动脉狭窄组(P0.05),A-SI-DI、L-SI-DI及C-SI-DI均低于轻度冠状动脉狭窄组(P0.05);重度冠状动脉狭窄组L-SI-DI、A-SI-DI、R-SI-DI及C-SI-DI均低于无冠状动脉狭窄组和轻度冠状动脉狭窄组(P0.05),A-SI-DI、L-SI-DI、R-SI-DI均低于中度冠状动脉狭窄组(P0.05)。ROC曲线结果显示L-SI-DI的灵敏度最高,是84.0%;A-SI-DI的特异度最高,是78.9%。结论:RT3D-STI技术对早期冠心病的发现和诊断有重要作用,缺血冠状动脉供血区局部心肌的舒张功能减低的出现较收缩功能早,心肌舒张功能对心肌缺血更敏感,SI-DI能够在一定程度上反映冠状动脉的狭窄程度和部位。
[Abstract]:Coronary atherosclerotic heart disease, referred to as coronary heart disease (CHD), is divided into 5 types of clinical types of coronary heart disease (.1979), namely, asymptomatic myocardial ischemia, angina, myocardial infarction, and lack of coronary heart disease, due to myocardial dysfunction caused by coronary artery stenosis, spasticity or insufficiency of blood supply. Congestive heart failure and sudden death. In recent years, the age of coronary heart disease has developed to a young age. The incidence of coronary heart disease has shown an obvious upward trend, which seriously threatens the life of the patients and seriously increases the burden of society and family. Therefore, early detection of coronary heart disease, early treatment and regular follow-up are particularly important. More widely used: (1) coronary arteriography and coronary artery strengthening CT: can clearly show the coronary artery disease, but the contrast agent has obvious renal toxicity and is not suitable for long-term follow-up. (2) electrocardiogram (ECG): partial angina patients only have ST segment changes when angina pectoris are made, and no specificity, when the condition is relieved, The electrocardiogram was restored to normal, so the patients with normal electrocardiogram could not exclude coronary heart disease; (3) radionuclide examination: can observe the movement of the wall and the left ventricular ejection fraction, but the cost is higher and the radionuclide has greater harm to the body; (4) magnetic resonance imaging: the accuracy is good, the repeatability is high, but can not be observed in real time, but can not be observed in real time, no It can carry out bedside examination; (5) echocardiography: noninvasive, no radiation, low cost, safety, simple operation, repeated use, high accuracy, and dynamic observation, it is superior to coronary artery CT, myocardial radionuclide imaging, myocardial MRI and so on. Besides, ultrasound cardiogram can be used for bedside examination of critical, unsuitable patients, more suitable for bedside examination. Therefore, echocardiography is an indispensable auxiliary examination for patients with coronary heart disease and plays an important role in patients with coronary heart disease. Part 1 RT3D-STI technique is used to evaluate the overall left ventricular diastolic function of patients without RWMA coronary artery stenosis: the application of real-time 3D three-dimensional specke tracking imag (real-time three-dimensional specke tracking imag) Ing, RT3D-STI) technique obtained the left ventricular overall strain imaging diastolic function index (strain imaging diastolic index, SI-DI), evaluate the overall diastolic function of the left ventricle of patients with coronary artery disease without segmental ventricular wall movement (regionalwallmotionabnormality, RWMA), and explore the value of rt3d-sti in early diagnosis of coronary heart disease. The results of coronaryangiography (CAG) were made to be diagnosed as coronaryheartdisease (CHD), but 92 patients without RWMA were divided into 2 groups: the control group, that is, the coronary artery stenosis group, 42 cases, the case group, the coronary artery stenosis group, and the 50 cases. The conventional two and three dimensional full volume images were collected by transthoracic echocardiography, and the conventional parameters were obtained. E peak (E) of the mitral diastolic blood flow spectrum, e peak of Doppler (E ') in mitral annulus and the overall longitudinal strain (globlelongitudinalstrain, GLS) at the end of left ventricular systole, radial strain (globleradialstrain, GRS), area strain (globleareastrain, gas), circumferential strain (globlecircumferentialstrain, GCS) and corresponding diastole The strain of the pre phase 1/3, and then the four directional strain imaging diastolic index (si-di) was calculated according to the formula, and the diagnostic value of each parameter to the coronary artery disease was analyzed. Results: compared with the two groups in the control group and the case group, the difference between the conventional parameters e, e 'and the three dimensional strain parameters GLS, GRS, GCS, gas was not statistically significant (P0.05); between the two groups, the difference was not statistically significant. Longitudinal strain imaging diastolic index (longitudinalstrainimagingdiastolicindex, l-si-di), radial strain imaging diastolic index (radialstrainimagingdiastolicindex, r-si-di), circumferential strain imaging diastolic index (circumferentialstrainimagingdiastolicindex, c-si-di), area strain imaging diastolic index (areastrainimagingdiastolicindex) The difference was statistically significant (P0.05), and the ROC curve showed that the sensitivity of l-si-di, r-si-di, a-si-di and c-si-di were 90.5%, 85.7%, 81%, 81% respectively, and the specificity and specificity were the highest, respectively, and the specificity and sensitivity of l-si-di were the highest, and the Gensini integral of the coronary artery was correlated with l-si-di, r-si-di, and a-si-di. 0.706, -0.410, -0.547. conclusion: the reduction of left ventricular diastolic function in patients with coronary artery stenosis is better than that of the whole systolic function earlier than that of the conventional two-dimensional echocardiography, and it can quantitatively evaluate the left ventricular diastolic function in patients with coronary artery stenosis, which has an important expected effect on the early diagnosis of cor pulmonale. Second parts have an important expected effect on the early diagnosis of coronary heart disease. Rt3d-sti technique was used to evaluate the left ventricular diastolic function of left ventricular in patients with RWMA coronary artery stenosis. RT3D-STI technique was used to obtain SI-DI in different directions of local myocardium in different coronary artery blood supply areas without RWMA, to evaluate the local diastolic function of left ventricle, and to explore the location and course of early diagnosis of coronary artery disease by RT3D-STI technique. Methods: 140 patients who were diagnosed as CHD but without RWMA were divided into 420 branches of coronary artery, which were divided into no coronary artery stenosis group, 101 branches, 50% mild coronary stenosis group (50% coronary stenosis), 112 branches of moderate coronary artery stenosis (coronary artery stenosis 50%~75%), a total of 95 branches and severe coronary stenosis. The narrow group (coronary artery stenosis 75%), with a total of 112 branches. The dynamic three-dimensional full volume images were collected through the chest and the SI-DI was calculated in all directions. Results: the A-SI-DI, L-SI-DI, and R-SI-DI in the mild coronary artery stenosis group were lower than those without the coronary stenosis group (P0.05), and the moderate coronary stenosis group L-SI-DI, A-SI-DI, R-SI-. Both DI and C-SI-DI were lower than those without coronary artery stenosis (P0.05), A-SI-DI, L-SI-DI and C-SI-DI were lower than those in mild coronary stenosis group (P0.05), and L-SI-DI, A-SI-DI, R-SI-DI and C-SI-DI in severe coronary stenosis group were lower than those in no coronary stenosis group and mild coronary stenosis group (P0.05). The results of the arterial stenosis group (P0.05).ROC curve showed that the sensitivity of L-SI-DI was the highest, it was 84%, and the specificity of A-SI-DI was the highest. It was the 78.9%. conclusion: RT3D-STI technology had an important role in the detection and diagnosis of early coronary heart disease. The diastolic function of the local myocardium in the ischemic coronary artery supply area was earlier than that of the contractile function, and the cardiac diastolic function was in the heart. Myocardial ischemia is more sensitive. SI-DI can reflect the degree and location of coronary artery to a certain extent.

【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4;R816.2

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