实时三维超声心动图评价主动脉瓣狭窄患者左心室功能及同步性
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摘要
目的探析实时三维超声心动图对主动脉瓣狭窄患者左心室功能及同步性的评价结果。方法选取2014年3月至2017年9月我院确诊的主动脉瓣狭窄患者90例,按狭窄程度分为轻度组、中度组及重度组各30例,同时选取健康体检者30名为健康组,4组患者均进行实时三维超声心动图检查,记录4组患者的左心室17节段容积-时间曲线、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)及左心室射血分数(LVEF),分别测得左心室16、12、6个节段达到收缩末期最小容积的时间标准差(Tmsv-SD)及时间最大差值(Tmsv-Dif),并用心率校正后以百分比表示,评价患者左心室收缩功能及同步性。结果健康组受检者左心室17节段容积-时间曲线形态一致,各节段收缩末期最小容积随心动周期同步变化,主动脉瓣狭窄者形态紊乱,各节段达到收缩末期最小容积时间离散;随主动脉瓣狭窄程度加重,受检者LVEDV及LVESV均逐渐增高,差异有统计学意义(P<0.05);而LVEF呈下降趋势,除健康组与轻度组间比较差异无统计学意义(P>0.05),其余组组间比较差异均有统计学意义(P<0.05);16、12、6个节段Tmsv-SD%及Tmsv-Dif%水平呈上升趋势,差异有统计学意义(P<0.05)。结论实时三维超声心动图对主动脉瓣狭窄患者左心室功能及同步化水平的诊断具有重要的临床价值。
Objective To evaluate the left ventricular function and synchrony in patients with aortic stenosis with real-time three-dimensional echocardiography. Methods A total of 90 patients with aortic stenosis diagnosed in the hospital from March 2014 to September 2017 were selected. According to the degree of stenosis,they were divided into mild,moderate and severe three groups,30 patients in each group. Thirty healthy subjects were selected as the healthy group. All subjects underwent real-time three-dimensional echocardiography,and the left ventricular 17-segment volumetime curves,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction(LVEF)of 4 groups were recorded. The time standard deviation(Tmsv-SD)and the maximum time difference(Tmsv-Dif) of the minimum volume of the left ventricular 16,12 and 6 segments reaching the end of systole were measured,respectively. They were corrected by heart rate and expressed by percentages. The left ventricular systolic function and synchrony were evaluated. Results The volume-time curve of the left ventricle 17 segments in the healthy group was consistent. The minimum volume at the end of systole of each segment changed synchronously with the cardiac cycle. The aortic stenosis was disordered,and the minimum volume of each segment reaching the end of systole was discrete. With the severity of aortic stenosis,LVEDV and LVESV were gradually increased(P<0.05),while LVEF showed a downward trend. There was no significant difference between the healthy group and the mild group(P>0.05),but the differences between the other groups were statistically significant(P<0.05). The levels of Tmsv-SD% and TmsvDif% of 16,12 and 6 segments showed an upward trend(P<0.05). Conclusion Real-time three-dimensional echocardiography is of great value in the diagnosis of left ventricular function and synchrony in patients with aortic stenosis.
Objective To evaluate the left ventricular function and synchrony in patients with aortic stenosis with real-time three-dimensional echocardiography. Methods A total of 90 patients with aortic stenosis diagnosed in the hospital from March 2014 to September 2017 were selected. According to the degree of stenosis,they were divided into mild,moderate and severe three groups,30 patients in each group. Thirty healthy subjects were selected as the healthy group. All subjects underwent real-time three-dimensional echocardiography,and the left ventricular 17-segment volumetime curves,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction(LVEF)of 4 groups were recorded. The time standard deviation(Tmsv-SD)and the maximum time difference(Tmsv-Dif) of the minimum volume of the left ventricular 16,12 and 6 segments reaching the end of systole were measured,respectively. They were corrected by heart rate and expressed by percentages. The left ventricular systolic function and synchrony were evaluated. Results The volume-time curve of the left ventricle 17 segments in the healthy group was consistent. The minimum volume at the end of systole of each segment changed synchronously with the cardiac cycle. The aortic stenosis was disordered,and the minimum volume of each segment reaching the end of systole was discrete. With the severity of aortic stenosis,LVEDV and LVESV were gradually increased(P<0.05),while LVEF showed a downward trend. There was no significant difference between the healthy group and the mild group(P>0.05),but the differences between the other groups were statistically significant(P<0.05). The levels of Tmsv-SD% and TmsvDif% of 16,12 and 6 segments showed an upward trend(P<0.05). Conclusion Real-time three-dimensional echocardiography is of great value in the diagnosis of left ventricular function and synchrony in patients with aortic stenosis.
引文
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[2]伍婷,白文娟,饶莉,等.超声三维斑点追踪技术评估主动脉瓣狭窄患者左室功能[J].西部医学,2015,27(9):1391-1396.
[3]蔚俊丽,张全斌,高瑞锋,等.单心动周期实时三维超声心动图评价健康成人右心室容积和射血分数[J].中华超声影像学杂志,2015,24(9):747-752.
[4]刘文旭,薛超,赵映,等.实时三维结合二维超声心动图对先天性主动脉瓣下膜性狭窄的诊断价值[J].心肺血管病杂志,2015,34(5):394-397.
[5]田海燕,郭建东,张小杉.斑点追踪技术评价主动脉瓣狭窄瓣膜置换术前后左心室扭转功能[J].心血管康复医学杂志,2016,25(3):321-323.
[6]Nishimura RA,Otto CM,Bonow RO,et al.2017 AHA/ACCFocused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease:a report of the american college of cardiology/american heart association task force on clinical practice guidelines[J].JACC,2017,63(22):252-289.
[7]李绍军,姜宏宁,黄学菁,等.磁共振评价冠状动脉狭窄程度与左心室结构和功能的相关性研究[J].临床放射学杂志,2014,33(2):208-212.
[8]毕涛,赵映,刘家礻韦,等.多排CT、实时三维超声心动图和MRI对左心房功能评估的对比研究[J].医学影像学杂志,2015,25(5):792-796.
[9]闫晓妮,陈瑛,汪越君,等.三维斑点追踪技术对主动脉瓣狭窄患者亚临床左心室收缩功能受损的评价[J].中国医师杂志,2016,18(5):692-694.