二维斑点追踪联合组织多普勒对肺心病左心功能及同步性评价的研究
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摘要
目的研究二维斑点追踪(STI)与组织多普勒(TDI)技术评价肺心病左心功能及同步性的应用价值。方法回顾性分析进行STI与TDI检查的肺源性心脏病患者115例,分为代偿组64例与失代偿组51例,以60例无心肺疾病者为对照组,分析比较各组间左室射血分数(LVEF)、二尖瓣环舒张早期运动速度峰值(Em)、左室心肌17节段纵向应变、径向应变、圆周应变的达峰时间。结果对照组、代偿组与失代偿组平均年龄及性别构成无差异。方差分析显示LVEF在失代偿组较另两组显著下降(P=0.02)。TDI模式下Em在三组间差异具有统计学意义(F=32.496,P<0.01)。心肌各节段各向达峰时间均无明显差异,组间比较失代偿组达峰时间与其他两组具有差异(P<0.01)。结论肺源性心脏病随着病理进展,左室舒张功能逐渐下降,左室收缩功能经历代偿期后亦显著降低,与左心室各节段心肌收缩同步性具有一致性。STI技术可在心肌纵向、径向、圆周应变方向上定量分析局部心肌运动参数,可以全面准确的评价心肌收缩功能的同步性。
Objective To evaluate the clinical value of two-dimensional speckle tracking(STI)and tissue Doppler imaging(TDI)in evaluating left ventricular function and synchrony in patients with pulmonary heart disease.Methods A retrospective analysis of 115 patients with pulmonary heart disease who underwent STI and TDI from was divided into compensation group(n=64)and decompensation group(n=51).Sixty patients with no cardiopulmonary disease were compared.The left ventricular ejection fraction(LVEF),the early mitral annulus velocity(Em),the left ventricular myocardium 17 segment longitudinal strain,radial strain,and circumference were analyzed.The peak time of the strain.Results There was no difference in the mean age and gender composition between the control group,the compensation group and the decompensation group.Analysis of variance showed that LVEF was significantly lower in the decompensated group than in the other two groups(P=0.02).The difference between the three groups in the TDI mode was statistically significant(F=32.496,P<0.01).There was no significant difference in the peak time of each segment of the myocardium.The peak time of the decompensated group between the groups was different from the other two groups(P<0.01).Conclusions The left ventricular diastolic function gradually decreased during the progression of pulmonary heart disease,and the left ventricular systolic function decreased significantly after the compensatory period,which was consistent with the systolic synchronism of the left ventricular segments.STI technique can quantitatively analyze the local myocardial motion parameters in the direction of longitudinal,radial and circumferential strain of myocardium,and can evaluate the synchronism of myocardial contractile function completely and accurately.
Objective To evaluate the clinical value of two-dimensional speckle tracking(STI)and tissue Doppler imaging(TDI)in evaluating left ventricular function and synchrony in patients with pulmonary heart disease.Methods A retrospective analysis of 115 patients with pulmonary heart disease who underwent STI and TDI from was divided into compensation group(n=64)and decompensation group(n=51).Sixty patients with no cardiopulmonary disease were compared.The left ventricular ejection fraction(LVEF),the early mitral annulus velocity(Em),the left ventricular myocardium 17 segment longitudinal strain,radial strain,and circumference were analyzed.The peak time of the strain.Results There was no difference in the mean age and gender composition between the control group,the compensation group and the decompensation group.Analysis of variance showed that LVEF was significantly lower in the decompensated group than in the other two groups(P=0.02).The difference between the three groups in the TDI mode was statistically significant(F=32.496,P<0.01).There was no significant difference in the peak time of each segment of the myocardium.The peak time of the decompensated group between the groups was different from the other two groups(P<0.01).Conclusions The left ventricular diastolic function gradually decreased during the progression of pulmonary heart disease,and the left ventricular systolic function decreased significantly after the compensatory period,which was consistent with the systolic synchronism of the left ventricular segments.STI technique can quantitatively analyze the local myocardial motion parameters in the direction of longitudinal,radial and circumferential strain of myocardium,and can evaluate the synchronism of myocardial contractile function completely and accurately.
引文
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[2]SONG P M,REN W D,MA C Y,et al.Speckle tracking imaging in evaluation of radial strain of subendocardial and epicardial myocardium in canine acute myocardial ischemia and reperfusion[J].Chinese Journal of Medical Imaging Technology,2013,29(2):173-176.
[3]韩伟,谢明星,王新房.超声斑点追踪显像技术评价健康人左室心肌整体和局部扭转运动特征的临床初步研究[J].中国超声医学杂志,2008,24(8):714-717.
[4]YAN S,WANG Y,LIU P,et al.Baicalin Attenuates HypoxiaInduced Pulmonary Arterial Hypertension to Improve Hypoxic Cor Pulmonale by Reducing the Activity of the p38 MAPK Signaling Pathway and MMP-9[J].Evidence-based Complementary and Alternative Medicine:eCAM,2016,25(4):1-9.
[5]刘利,王志刚,任建丽.实时三维超声心动图与二维斑点追踪成像技术共同评价冠心病患者左心室收缩功能与同步性及二者相关性初探[J].中国超声医学杂志,2012,28(10):917-920.
[6]BURCHFIELD J S,XIE M,HILL J A.Pathological ventricular remodeling:mechanisms:part 1of 2[J].Circulation,2015,128(4):388-400.
[7]BELADAN C C,CLIN A,RO爦CA M,et al.Left ventricular twist dynamics:principles and applications[J].Heart,2014,100(9):731-740.
[8]李秀昌,刘燕,张家君.三维斑点追踪技术评价正常成人左室三维扭转功能的初步研究[J].中国超声医学杂志,2012,28(12):1093-1096.
[9]ROBERTS W C,SHAFII A E,GRAYBURN P A,et al.Clinical and morphologic features of acute,subacute and chronic cor pulmonale(pulmonary heart disease)[J].American Journal of Cardiology,2015,115(5):697-703.
[10]ADEL W,ROUSHDY A M,NABIL M.Mitral Annular Plane Systolic Excursion-Derived Ejection Fraction:A Simple and Valid Tool in Adult Males With Left Ventricular Systolic Dysfunction[J].Echocardiography,2016,33(2):179.
[11]GRABKA M,WITA K,BOCHENEK T,et al.Imaging in dysynchrony and ventricular function:Techniques[J].European Heart Journal Cardiovascular Imaging,2012,13(1):i166-168.
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