老年冠心病患者超声三维空间运动指标及其与左心室收缩功能的关系
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摘要
目的观察老年冠心病患者心脏超声心动图特征,分析三维空间运动指标与左心室收缩功能的相关性。方法选择2016年1月至2018年1月宝鸡市中心医院收治的65例老年冠心病患者纳入观察组,50例健康志愿者作为对照组,均接受心脏三维超声检查。比较两组受检者心脏三维空间面积应变参数[左心室整体扭转角度峰值(PGT)、左心室整体扭转角度达峰值时间(T_(PGT))、左室基底段扭转角度峰值时间(PBT)、左室基底段扭转角度峰值时间(T_(PBT))、左室中间段扭转角度峰值(PMT)、左室中间段扭转角度峰值(T_(PMT))、左室心尖段扭转角度峰值(PAT)、左室心尖段扭转角度峰值时间(T_(PAT))、左心室整体长轴应变(GLS)]和左心室收缩功能参数[左室射血分数(LVEF)、左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV)]的差异,分析面积应变参数和左心室收缩功能参数的相关性。结果观察组和对照组受检者的PAT [(9.52±3.65)°vs (11.95±4.52)°]、GLS [(10.32±2.61)%vs (15.34±3.06)%]比较差异均有统计学意义(P<0.05),而PGT、PBT、PMT、T_(PGT)、T_(PBT)、T_(PMT)、T_(PAT)与对照组比较差异均无统计学意义(P>0.05);观察组与对照组受检者的LVEF [(46.38±5.89)%vs (68.02±10.03)%]、LVEDV [(96.35±15.24) mL vs (75.12±10.20) mL]、LVESV [(53.62±12.35) mL vs (35.61±8.15) mL]比较差异均有统计学意义(P<0.05);PGT、PAT、GLS与LVEF呈正相关(r=0.301、0.779、0.695,P<0.05),与LVEDV、LVESV呈负相关[r=(-0.305)～(-0.625),P<0.05]。结论三维超声心动技术对评估老年冠心病患者左心室收缩功能有重要价值,其中心脏扭转面积应变参数PAT、PGT、GLS与LVEF、LVEDV、LVESV有着良好的相关性。
Objective To observe the echocardiographic characteristics of elderly patients with coronary heart disease and analyze the correlation between three-dimensional spatial motion and left ventricular systolic function.Methods Sixty-five elderly patients with coronary heart disease in Baoji Central Hospital from January 2016 to January 2018 were selected as the observation group, and 50 healthy volunteers were selected as the control group. All patients underwent three-dimensional echocardiography. The two groups of patients were compared in three-dimensional strain parameters of cardiac area(peak value of left ventricular global torsion angle [PGT], peak time of left ventricular global torsion angle [T_(PGT)], peak value of left ventricular basal torsion angle [PBT], peak time of left ventricular basal torsion angle [T_(PBT)], peak value of left ventricular middle torsion angle [PMT], peak time of left ventricular middle torsion angle [T_(PMT)], peak value of left ventricular apical torsion angle [PAT], peak time of left ventricular apical torsion angle [T_(PAT)], global long-axis strain [GLS]) and left ventricular systolic function parameters(left ventricular ejection fraction [LVEF], left ventricular end-diastolic volume [LVEDV] and left ventricular end-systolic volume[LVESV]). The correlation between area strain parameters and left ventricular systolic function parameters was analyzed. Results The two groups showed statistically significant difference in PAT and GLS(P<0.05): PAT(9.52 ±3.65)° vs(11.95±4.52)°, GLS(10.32±2.61)% vs(15.34±3.06)%, but they had no significant difference in PGT, PBT,PMT, T_(PGT), T_(PBT), T_(PMT), T_(PAT)(P>0.05). The two groups also showed significant difference in LVEF, LVEDV, LVESV(P<0.05): LVEF,(46.38±5.89)% in the observation group vs(68.02±10.03)% in the control group; LVEDV,(96.35±15.24) m L vs(75.12±10.20) mL; LVESV,(53.62±12.35) mL vs(35.61±8.15) mL. PGT, PAT and GLS were positively correlated with LVEF(r=0.301, 0.779, 0.695, P<0.05) and negatively correlated with LVEDV and LVESV(r=-0.305 to -0.625,P<0.05). Conclusion Three-dimensional echocardiography plays an important role in evaluating left ventricular systolic function in elderly patients with coronary heart disease. PAT, PGT, GLS have good correlation with LVEF, LVEDV, and LVESV.
Objective To observe the echocardiographic characteristics of elderly patients with coronary heart disease and analyze the correlation between three-dimensional spatial motion and left ventricular systolic function.Methods Sixty-five elderly patients with coronary heart disease in Baoji Central Hospital from January 2016 to January 2018 were selected as the observation group, and 50 healthy volunteers were selected as the control group. All patients underwent three-dimensional echocardiography. The two groups of patients were compared in three-dimensional strain parameters of cardiac area(peak value of left ventricular global torsion angle [PGT], peak time of left ventricular global torsion angle [T_(PGT)], peak value of left ventricular basal torsion angle [PBT], peak time of left ventricular basal torsion angle [T_(PBT)], peak value of left ventricular middle torsion angle [PMT], peak time of left ventricular middle torsion angle [T_(PMT)], peak value of left ventricular apical torsion angle [PAT], peak time of left ventricular apical torsion angle [T_(PAT)], global long-axis strain [GLS]) and left ventricular systolic function parameters(left ventricular ejection fraction [LVEF], left ventricular end-diastolic volume [LVEDV] and left ventricular end-systolic volume[LVESV]). The correlation between area strain parameters and left ventricular systolic function parameters was analyzed. Results The two groups showed statistically significant difference in PAT and GLS(P<0.05): PAT(9.52 ±3.65)° vs(11.95±4.52)°, GLS(10.32±2.61)% vs(15.34±3.06)%, but they had no significant difference in PGT, PBT,PMT, T_(PGT), T_(PBT), T_(PMT), T_(PAT)(P>0.05). The two groups also showed significant difference in LVEF, LVEDV, LVESV(P<0.05): LVEF,(46.38±5.89)% in the observation group vs(68.02±10.03)% in the control group; LVEDV,(96.35±15.24) m L vs(75.12±10.20) mL; LVESV,(53.62±12.35) mL vs(35.61±8.15) mL. PGT, PAT and GLS were positively correlated with LVEF(r=0.301, 0.779, 0.695, P<0.05) and negatively correlated with LVEDV and LVESV(r=-0.305 to -0.625,P<0.05). Conclusion Three-dimensional echocardiography plays an important role in evaluating left ventricular systolic function in elderly patients with coronary heart disease. PAT, PGT, GLS have good correlation with LVEF, LVEDV, and LVESV.
引文
[1]裴莉平,王小丛,张艳丽,等.三维超声斑点追踪技术评价冠心病患者左室扭转运动[J].中国超声医学杂志, 2012, 28(5):417-420.
[2]李嵘娟,孙研,杨娅,等.三维超声斑点追踪成像技术对冠心病患者左心室整体应变的评价[J].心肺血管病杂志, 2014, 33(5):633-636,673.
[3]周红,周微微,王辉山,等.应用实时三维超声心动图评价冠心病三支病变患者冠状动脉旁路移植术前后左室重构及心功能变化[J].中国超声医学杂志, 2012, 28(5):440-442, 474.
[4] MONTALESCOT G, SECHTEM U, ACHENBACH S, et al. 2013ESC guidelines on the management of stable coronary artery disease:the Task Force on the management of stable coronary artery disease of the European Society of Cardiology[J]. Eur Heart J, 2013, 34(38):2949-3003.
[5]王亚非,于春艳,张鲁春,等.二维超声应变对心肌缺血定位的临床应用研究[J].医学影像学杂志, 2013, 23(2):195-199.
[6]潘高云,徐立新,尤利益,等.三维超声心动图应变参数评价左心室整体收缩功能[J].中华医学超声杂志(电子版), 2016, 13(7):510-512.
[7] KIM HK, SOHn DW, LEE SE, et al. Assessment of left ventricular rotation and torsion with two dimensional speckle tracking echocardiography[J]. J Am Soc Echocardiogr, 2007, 20(1):45-53.
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[9]李赵欢,唐红.斑点追踪显像技术对冠心病左心室扭转和解旋运动的研究[J].中国超声影像学杂志, 2010, 19(5):369-373.
[10]许昌庆,史学功,金朝龙,等.二维斑点追踪技术评价冠心病患者左室收缩功能及收缩同步性[J].安徽医科大学学报, 2016, 51(6):855-859.
[11]任焘君,廉伟,李姮,等.碎裂QRS波对急性心肌梗死患者早期左室重构及心功能的影响[J].天津医药, 2018, 46(2):157-161.
[12]叶胜义,吴淑静,姜朝晖,等.经皮冠状动脉介入时机对急性心肌梗死后左室重构及心功能的影响[J].实用临床医药杂志, 2018, 22(3):34-37.
[13]罗娜,辛明志,王淑英,等.实时三维超声心动图评估老年心肌梗死后心力衰竭患者右心功能的价值[J].中国老年学杂志, 2018, 38(12):2838-2840.
[14]范会军.三维斑点追踪评价不同程度冠状动脉狭窄患者的左心室局部收缩功能[D].郑州:郑州大学, 2011.
[15]张慧.基于超声二维斑点追踪技术的二维应变参数评价急性心肌梗死及PCI治疗后心肌三维运动功能的价值及其与NT-proBNP相关性的研究[D].北京:解放军医学院,军医进修学院,解放军总医院, 2010.
[2]李嵘娟,孙研,杨娅,等.三维超声斑点追踪成像技术对冠心病患者左心室整体应变的评价[J].心肺血管病杂志, 2014, 33(5):633-636,673.
[3]周红,周微微,王辉山,等.应用实时三维超声心动图评价冠心病三支病变患者冠状动脉旁路移植术前后左室重构及心功能变化[J].中国超声医学杂志, 2012, 28(5):440-442, 474.
[4] MONTALESCOT G, SECHTEM U, ACHENBACH S, et al. 2013ESC guidelines on the management of stable coronary artery disease:the Task Force on the management of stable coronary artery disease of the European Society of Cardiology[J]. Eur Heart J, 2013, 34(38):2949-3003.
[5]王亚非,于春艳,张鲁春,等.二维超声应变对心肌缺血定位的临床应用研究[J].医学影像学杂志, 2013, 23(2):195-199.
[6]潘高云,徐立新,尤利益,等.三维超声心动图应变参数评价左心室整体收缩功能[J].中华医学超声杂志(电子版), 2016, 13(7):510-512.
[7] KIM HK, SOHn DW, LEE SE, et al. Assessment of left ventricular rotation and torsion with two dimensional speckle tracking echocardiography[J]. J Am Soc Echocardiogr, 2007, 20(1):45-53.
[8]周宣,周鹏,张洪菊.超声斑点追踪技术(二维应变)评价左束支传导阻滞患者左室心内膜下心肌收缩功能的研究[J].中国医疗前沿,2012, 7(10):58-59.
[9]李赵欢,唐红.斑点追踪显像技术对冠心病左心室扭转和解旋运动的研究[J].中国超声影像学杂志, 2010, 19(5):369-373.
[10]许昌庆,史学功,金朝龙,等.二维斑点追踪技术评价冠心病患者左室收缩功能及收缩同步性[J].安徽医科大学学报, 2016, 51(6):855-859.
[11]任焘君,廉伟,李姮,等.碎裂QRS波对急性心肌梗死患者早期左室重构及心功能的影响[J].天津医药, 2018, 46(2):157-161.
[12]叶胜义,吴淑静,姜朝晖,等.经皮冠状动脉介入时机对急性心肌梗死后左室重构及心功能的影响[J].实用临床医药杂志, 2018, 22(3):34-37.
[13]罗娜,辛明志,王淑英,等.实时三维超声心动图评估老年心肌梗死后心力衰竭患者右心功能的价值[J].中国老年学杂志, 2018, 38(12):2838-2840.
[14]范会军.三维斑点追踪评价不同程度冠状动脉狭窄患者的左心室局部收缩功能[D].郑州:郑州大学, 2011.
[15]张慧.基于超声二维斑点追踪技术的二维应变参数评价急性心肌梗死及PCI治疗后心肌三维运动功能的价值及其与NT-proBNP相关性的研究[D].北京:解放军医学院,军医进修学院,解放军总医院, 2010.