自动功能成像在原发性高血压左室纵向收缩功能中的价值
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摘要
目的探讨实时三切面自动功能成像(AFI)在评价原发性高血压患者心脏左室心肌纵向收缩功能中的价值。方法选择2016年5月～2017年5月不伴左心室肥厚的原发性高血压患者60例(B组)及伴有左心室肥厚的高血压患者60例(C组)和健康体检者60例(A组)为研究对象,分别获取左室心尖实时三平面二维动态灰阶图像并存储,应用AFI软件检测得到左室17节段的整体收缩期纵向应变值(GLS)及局部收缩期峰值应变值(RLS),对获取的相应数据进行两两比较并分析。结果①B组及C组高血压患者在不同水平-基底段、中间段及心尖段的局部峰值应变值较A组健康人低,差异有统计学意义(P<0.05);C组在基底段、中间段的局部峰值应变值较B组低,差异有统计学意义(P<0.05),②B组的整体峰值应变值在LAX及2C两个切面均较A组低,差异有统计学意义(P<0.05);C组的整体平均峰值应变值(AVg)较B组低,差异有统计学意义(P<0.05)。③B组在所有不同节段收缩期局部峰值应变值较A组低,差异有统计学意义(P<0.05),C组在不同节段仅前壁及后壁收缩期局部峰值应变较B组低,差异有统计学意义(P<0.05)。④高血压B组及C组在部分不同节段的ROC曲线下面积比较,差异有统计学意义(P<0.05)。结论原发性高血压患者在早期左室收缩功能正常,构型未发生改变时,心肌即可出现整体及局部应变减低;在构型发生改变后与构型未发生改变时,心肌整体及局部应变值的变化比较,差异无统计学意义。AFI技术可早期准确地定量评估原发性高血压患者早期左室心肌的整体及局部纵向收缩功能改变。
Objective To investigate the value of real-time three-section auto-imaging AFI in the evaluation of longitudinal systolic function in patients with essential hypertension. Methods 60 patients with essential hypertension without left ventricular hypertrophy from May 2016 to May 2017(group B), 60 patients with left ventricular hypertrophy(group C) and 60 healthy persons(group A) were selected in the present study. The real-time three-plane two-dimensional dynamic grayscale images of left ventricular apex were recorded. The AFI software was used to detect the global systolic longitudinal strain(GLS) and local systolic peak strain(RLS) in 17 segments of the left ventricle, and the corresponding data were compared and analyzed. Results The local peak strain of hypertension patients in group B and group C at different levels-basal, middle and apical segments was lower than that of healthy group A(P<0.05). The local peak strain in the basal segment and the middle segment was lower than that in the B group(P<0.05). The whole peak strain value in both LAX and 2 C in group B was lower than in that in group A(P<0.05). The overall average peak strain AVg in group C was lower than that in group B.(P<0.05). The local peak strain in group B was lower than that in group A at the systolic phase in all segments(P<0.05). In group C, the local peak strain in the systolic phase of the anterior and posterior wall was lower than that of B in different segments.Conclusion When the left ventricular systolic function is normal in patients with essential hypertension, and the configuration did not change, the whole and local strains of the heart muscle could be reduced. Changes in global and local strain values are not statistically significant, when the configuration is changed and when the configuration is not changed. AFI technology can accurately and quantitatively assess the early and overall longitudinal systolic function changes of left ventricular myocardium in patients with essential hypertension.
Objective To investigate the value of real-time three-section auto-imaging AFI in the evaluation of longitudinal systolic function in patients with essential hypertension. Methods 60 patients with essential hypertension without left ventricular hypertrophy from May 2016 to May 2017(group B), 60 patients with left ventricular hypertrophy(group C) and 60 healthy persons(group A) were selected in the present study. The real-time three-plane two-dimensional dynamic grayscale images of left ventricular apex were recorded. The AFI software was used to detect the global systolic longitudinal strain(GLS) and local systolic peak strain(RLS) in 17 segments of the left ventricle, and the corresponding data were compared and analyzed. Results The local peak strain of hypertension patients in group B and group C at different levels-basal, middle and apical segments was lower than that of healthy group A(P<0.05). The local peak strain in the basal segment and the middle segment was lower than that in the B group(P<0.05). The whole peak strain value in both LAX and 2 C in group B was lower than in that in group A(P<0.05). The overall average peak strain AVg in group C was lower than that in group B.(P<0.05). The local peak strain in group B was lower than that in group A at the systolic phase in all segments(P<0.05). In group C, the local peak strain in the systolic phase of the anterior and posterior wall was lower than that of B in different segments.Conclusion When the left ventricular systolic function is normal in patients with essential hypertension, and the configuration did not change, the whole and local strains of the heart muscle could be reduced. Changes in global and local strain values are not statistically significant, when the configuration is changed and when the configuration is not changed. AFI technology can accurately and quantitatively assess the early and overall longitudinal systolic function changes of left ventricular myocardium in patients with essential hypertension.
引文
[1] T Tudor,S Stephan,T Adrienn,et al.The agreement between 3D,standard 2D and triplane 2D speckle tracking:effects of image quality and 3D volume rate[J].Echo Research & Practice,2014,17(3):236-238.
[2] 朱丽萍,严继萍.超声二维斑点显像技术在心脏疾病诊断中的临床应用进展[J].中华医学超声杂志,2014,11(4):298-301.
[3] 贺声,赵文锐,李馨,等.自动功能成像牛眼图评价心肌缺血的可靠性分析[J].临床超声医学杂志,2016,14(2):737-741.
[4] 姚婧璠,杨骏,贾娇坤,等,欧洲高血压学会/欧洲心脏病学会:高血压管理指南[J].中国卒中杂志,2014,9(9):328-350.
[5] 喻丽华,赵季红,蔡伟,等.斑点成像技术在心肌梗死左室心肌应变能力中的应用[J].医疗卫生装备,2015,36(4):69-71.
[6] 尹丽,郭丽苹,薛炜.斑点追踪技术评价肥厚性心肌病左室收缩功能[J].中国医学影像学杂志,2015,31(2):164-166.
[7] Liu YW,Tsai WC,Su CT,et al.Evidence of left ventricular systolic dysfunction detected by automated function imaging in patients with heart failure and preserved left ventricular ejection fraction[J].J Card Fail,2013,14(15):782-789.
[8] 张芳,何涛,郭盛兰,等.应变率成像评价急性心肌梗死患者左室局部收缩功能的研究[J].广西医学,2016,38(8):989-991.
[9] 牟晓雯,王志斌.实时三平面应变率成像评价原发性高血压左室心肌肥厚对长轴舒张功能的影响[J].中国临床医学影像杂志,2014,25(5):245-247.
[10] Luo XX,Fang F,Lee AP,et al.What can three-dimensional speckle-tracking echocardiography contribute to evaluate global left ventricular systolic performance in patients with heart failure [J].Int J Cardiol,2014,113(172):132-137.
[11] MJ Moulton,BD Hong,TW Secom,et al.Simulation of Left Ventricular Dynamics Using a Low-Order Mathematical Model [J].Cardiovasc Eng Technol,2013,12(8):1040-1042.
[12] 田雨,姜志荣,吕启凤,等.实时三维超声评价心肌梗死后左心室收缩功能及室壁运动同步性[J].中国医学影像技术,2015,31(4):541-545.
[13] A Shalbaf,H Behnam,Z Alizadesani,et al.Automatic assessment of regional and global wall motion abnormalities in echocardiography images by nonlinear dimensionality reductioni [M].Medical Physics,2013,78(16)2:82-84.
[14] Biswas M,Sudhakar S,Nanda NC,et al.Two-and three-dimensional speckle tracking echocardiography:clinical applications and future directions [M].Echocardiography,2013,59(30):88-105.
[15] 张妍,马春燕,刘爽,等.二维斑点追踪技术评价不同程度冠状动脉狭窄患者心肌应变改变[J].中国超声医学杂志,2014,30(3):223-225.
[16] 陈银花,陈勇,马勇,等.自动功能成像预测冠状动脉左前降值严重狭窄[J].中国医学影像技术,2017,33(10):1501-1505.
[17] van Dalen BM,Vletter WB,Soliman OI,et al.Importance of transducer position in the assessment of apical rotation by speckle trackingechocardiography[J].Am Soc Echocardiogr,2016 ,21 (8):895-898.
[18] 宋家琳,黎春雷,童春,等.斑点追踪显像技术对正常成人左室扭转和解旋运动的初期研究[J].中国超声医学杂志,2015,31 (9):925-932.
[19] 刘开薇,任卫东,孙璐,等.三维径向应变评价早期慢性肾病患者左心室心肌收缩功能改变[J].中国超声医学杂志,2016,32(4):532-534.
[20] Fine NM,Chen L,Bastiansen PM,et al.Reference Values for Right Ventricular Strain in Patients without Cardiopulmonary Disease:A Prospective Evaluation and Meta‐Analysis[M].Echocardiography,2015,63(32):367-370.
[2] 朱丽萍,严继萍.超声二维斑点显像技术在心脏疾病诊断中的临床应用进展[J].中华医学超声杂志,2014,11(4):298-301.
[3] 贺声,赵文锐,李馨,等.自动功能成像牛眼图评价心肌缺血的可靠性分析[J].临床超声医学杂志,2016,14(2):737-741.
[4] 姚婧璠,杨骏,贾娇坤,等,欧洲高血压学会/欧洲心脏病学会:高血压管理指南[J].中国卒中杂志,2014,9(9):328-350.
[5] 喻丽华,赵季红,蔡伟,等.斑点成像技术在心肌梗死左室心肌应变能力中的应用[J].医疗卫生装备,2015,36(4):69-71.
[6] 尹丽,郭丽苹,薛炜.斑点追踪技术评价肥厚性心肌病左室收缩功能[J].中国医学影像学杂志,2015,31(2):164-166.
[7] Liu YW,Tsai WC,Su CT,et al.Evidence of left ventricular systolic dysfunction detected by automated function imaging in patients with heart failure and preserved left ventricular ejection fraction[J].J Card Fail,2013,14(15):782-789.
[8] 张芳,何涛,郭盛兰,等.应变率成像评价急性心肌梗死患者左室局部收缩功能的研究[J].广西医学,2016,38(8):989-991.
[9] 牟晓雯,王志斌.实时三平面应变率成像评价原发性高血压左室心肌肥厚对长轴舒张功能的影响[J].中国临床医学影像杂志,2014,25(5):245-247.
[10] Luo XX,Fang F,Lee AP,et al.What can three-dimensional speckle-tracking echocardiography contribute to evaluate global left ventricular systolic performance in patients with heart failure [J].Int J Cardiol,2014,113(172):132-137.
[11] MJ Moulton,BD Hong,TW Secom,et al.Simulation of Left Ventricular Dynamics Using a Low-Order Mathematical Model [J].Cardiovasc Eng Technol,2013,12(8):1040-1042.
[12] 田雨,姜志荣,吕启凤,等.实时三维超声评价心肌梗死后左心室收缩功能及室壁运动同步性[J].中国医学影像技术,2015,31(4):541-545.
[13] A Shalbaf,H Behnam,Z Alizadesani,et al.Automatic assessment of regional and global wall motion abnormalities in echocardiography images by nonlinear dimensionality reductioni [M].Medical Physics,2013,78(16)2:82-84.
[14] Biswas M,Sudhakar S,Nanda NC,et al.Two-and three-dimensional speckle tracking echocardiography:clinical applications and future directions [M].Echocardiography,2013,59(30):88-105.
[15] 张妍,马春燕,刘爽,等.二维斑点追踪技术评价不同程度冠状动脉狭窄患者心肌应变改变[J].中国超声医学杂志,2014,30(3):223-225.
[16] 陈银花,陈勇,马勇,等.自动功能成像预测冠状动脉左前降值严重狭窄[J].中国医学影像技术,2017,33(10):1501-1505.
[17] van Dalen BM,Vletter WB,Soliman OI,et al.Importance of transducer position in the assessment of apical rotation by speckle trackingechocardiography[J].Am Soc Echocardiogr,2016 ,21 (8):895-898.
[18] 宋家琳,黎春雷,童春,等.斑点追踪显像技术对正常成人左室扭转和解旋运动的初期研究[J].中国超声医学杂志,2015,31 (9):925-932.
[19] 刘开薇,任卫东,孙璐,等.三维径向应变评价早期慢性肾病患者左心室心肌收缩功能改变[J].中国超声医学杂志,2016,32(4):532-534.
[20] Fine NM,Chen L,Bastiansen PM,et al.Reference Values for Right Ventricular Strain in Patients without Cardiopulmonary Disease:A Prospective Evaluation and Meta‐Analysis[M].Echocardiography,2015,63(32):367-370.