超声二维斑点追踪成像技术评价早期肝硬化患者心室纵向收缩功能
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摘要
第一部分
超声二维斑点追踪成像技术评价早期肝硬化患者左室纵向收缩功能
目的:应用超声二维斑点追踪成像技术( two-dimensional speckle tracking imaging ,2D-STI)评价早期肝硬化患者左室局部纵向收缩功能.方法:选取34例早期肝硬化患者作为实验组, 35例健康志愿者作为对照组。常规超声心动图记录左房及左室舒张末期前后径、射血分数(EF)、左室短轴缩短率(FS);心尖长轴切面记录二尖瓣舒张期血流频谱E峰及A峰值,并计算E/A值;记录心尖长轴切面、心尖两腔切面及心尖四腔切面的三个完整心动周期的高帧频二维图像,脱机应用二维应变分析软件测量左室壁各节段收缩期的峰值应变。
结果:肝硬化组左房收缩期前后径(30.49±4.20mm)、左室舒张末期前后径(44.90±4.33mm)与对照组前后径(28.82±3.67mm,43.25±3.21mm)相比差异无统计学意义(P >0.05)。肝硬化组EF(61.15±4.41%)及FS(32.92±3.34%)与对照组(59.74±5.45% ,32.05±3.71%)比较差异不具有统计学意义(P >0.05)。肝硬化组E/A值(1.03±0.29)较对照组(1.31±2.74)减低,差异具有统计学意义(P <0.05)。肝硬化组左室各节段收缩期纵向峰值应变均低于对照组,除左室后壁基底段、下壁基底段、前壁基底段、前间隔基底段及后间隔中间段和基底段外其他各节段间差异均具有统计学意义(P<0.05)。
结论:早期肝硬化患者左室舒张功能及左室局部纵向收缩功能均存在异常,利用2D-STI可以较常规超声检查能更早期敏感地反映肝硬化患者左室局部纵向收缩功能改变。
第二部分
超声二维斑点追踪成像技术评价早期肝硬化患者右室纵向收缩功能
目的:应用超声二维应变技术(Speckle Tracking Echocardiograohy)评价早期肝硬化患者右室纵向收缩功能。
方法:选取34例早期肝硬化患者作为实验组, 35例健康志愿者作为对照组。常规超声心动图心尖四腔切面记录右室及有房舒张末期横径。记录心尖四腔切面的三个完整心动周期的高帧频二维图像,应用二维应变分析软件测量右室游离壁三个节段收缩期的峰值应变(ε),应变率(SRs)及速度(Vs)。测量右室游离壁舒张早期峰值应变率(SRe)和速度(Ve),舒张晚期峰值应变率(SRa)和速度(Va)。
结果:肝硬化组右房舒张期横径较对照组增大,差异具有统计学意义(P<0.05)。肝硬化组右室舒张末期横径较对照组增大,差异不具有统计学意义(P>0.05)。肝硬化组右室游离壁三个节段的收缩期峰值应变及应变率、舒张早期峰值应变率及舒张晚期峰值应变率较对照组明显减低(P<0.05),肝硬化组右室基底段及中间段收缩期峰值及舒张早期峰值速度较对照组减低,差异具有统计学意义(P<0.005),右室心尖段收缩期峰值速度、舒张早期峰值速度及舒张晚期峰值速度较对照组减低,差异不具有统计学意义(P>0.05)。
结论:超声二维应变技术可以快速准确的评价肝硬化患者右心功能,提示临床医生诊断和治疗肝硬化性心肌病以改善肝硬化病人预后情况。
Part 1:
Evaluation of Left Ventricular longitudinal shrinkage Function in Patients with early liver cirrhosis Using two-dimensional speckle tracking imaging
Objective To assess the left ventricular longitudinal shrinkage function in patients with liver cirrhosis with two-dimensional speckle tracking imaging(2D-STI). Methods Echocardiography and Doppler echocardiography were obtained in 34 patients with hepatic cirrhosis and 35 normal persons of corresponding ages underwent .And high frame rate two-dimensional images were recorded from apical long-axis view,four-chamber view and two-chamber view of left ventricle ,then measuring the left ventricular diameter,left atrium diameter,the peak filling velocity of E wave and A wave,E /A ratio ,EF and FS. The peak systolic strain of left ventricular segment were measured using two-dimensional strain software. Results Compared with healthy subjects,left ventricular diameter,left atrium diameter,EF and FS of hepatic cirrhosis patients were not different(P>0.05) ,but the E /A ratio of hepatic cirrhosis was lower (P<0.05),and the peak systolic strain of most left ventricular segment reduced in hepatic cirrhosis were statistically lower (P<0.05), except base segment of each wall and middle segment of back interventricular septum .
Conclusions The heart shape ,systolic and diastole function of hepatic cirrhosis were abnormal. Using the 2D-STI can early and accurately evaluate the systolic function of hepatic cirrhosis.
Part 2:
Evaluation of Right Ventricular longitudinal shrinkage
Function in Patients with early liver cirrhosis Using two-dimensional speckle tracking imaging
Objective To assess the right ventricular longitudinal shrinkage function in patients with liver cirrhosis with Speckle Tracking Echocardiograohy.
Methods Echocardiography was obtained in 34 patients with hepatic cirrhosis and 35 normal persons of corresponding ages underwent . And high frame rate two-dimensional images were recorded from four-chamber view of left ventricle, then measuring the right ventricular and atrium diameter. The peak strain、strain rate and velocity of right ventricular free wall each segment in systolic、early diastole and during atrial contraction were measured using two-dimensional strain software.
Results Compared with healthy subjects,right atrium diameter of hepatic cirrhosis patients was statistically augmentation (P<0.05). Peak systolic strain , strain rate and peak strain rate in early diastole and during atrial contraction of all segments in right ventricular free wall reduced significantly in cirrhosis patients when compared with the contrast people (P<0.05). Peak systolic velocity and velocity in early diastole and during atrial contraction of the middle and base segments in right ventricular were reduced significantly when compared with the contrast people (P<0.05). Although Peak systolic velocity and velocity in early diastole and during atrial contraction of the apex segments in right ventricular were not different (P>0.05).
Conclusions 2D-STI can evaluate the right ventricular function of hepatic cirrhosis patients early and accurately . It can call attention to diagnosis and cure cirrhotic cardiomyopathy then improved the prognosis of hepatic cirrhosis patients.
超声二维斑点追踪成像技术评价早期肝硬化患者左室纵向收缩功能
目的:应用超声二维斑点追踪成像技术( two-dimensional speckle tracking imaging ,2D-STI)评价早期肝硬化患者左室局部纵向收缩功能.方法:选取34例早期肝硬化患者作为实验组, 35例健康志愿者作为对照组。常规超声心动图记录左房及左室舒张末期前后径、射血分数(EF)、左室短轴缩短率(FS);心尖长轴切面记录二尖瓣舒张期血流频谱E峰及A峰值,并计算E/A值;记录心尖长轴切面、心尖两腔切面及心尖四腔切面的三个完整心动周期的高帧频二维图像,脱机应用二维应变分析软件测量左室壁各节段收缩期的峰值应变。
结果:肝硬化组左房收缩期前后径(30.49±4.20mm)、左室舒张末期前后径(44.90±4.33mm)与对照组前后径(28.82±3.67mm,43.25±3.21mm)相比差异无统计学意义(P >0.05)。肝硬化组EF(61.15±4.41%)及FS(32.92±3.34%)与对照组(59.74±5.45% ,32.05±3.71%)比较差异不具有统计学意义(P >0.05)。肝硬化组E/A值(1.03±0.29)较对照组(1.31±2.74)减低,差异具有统计学意义(P <0.05)。肝硬化组左室各节段收缩期纵向峰值应变均低于对照组,除左室后壁基底段、下壁基底段、前壁基底段、前间隔基底段及后间隔中间段和基底段外其他各节段间差异均具有统计学意义(P<0.05)。
结论:早期肝硬化患者左室舒张功能及左室局部纵向收缩功能均存在异常,利用2D-STI可以较常规超声检查能更早期敏感地反映肝硬化患者左室局部纵向收缩功能改变。
第二部分
超声二维斑点追踪成像技术评价早期肝硬化患者右室纵向收缩功能
目的:应用超声二维应变技术(Speckle Tracking Echocardiograohy)评价早期肝硬化患者右室纵向收缩功能。
方法:选取34例早期肝硬化患者作为实验组, 35例健康志愿者作为对照组。常规超声心动图心尖四腔切面记录右室及有房舒张末期横径。记录心尖四腔切面的三个完整心动周期的高帧频二维图像,应用二维应变分析软件测量右室游离壁三个节段收缩期的峰值应变(ε),应变率(SRs)及速度(Vs)。测量右室游离壁舒张早期峰值应变率(SRe)和速度(Ve),舒张晚期峰值应变率(SRa)和速度(Va)。
结果:肝硬化组右房舒张期横径较对照组增大,差异具有统计学意义(P<0.05)。肝硬化组右室舒张末期横径较对照组增大,差异不具有统计学意义(P>0.05)。肝硬化组右室游离壁三个节段的收缩期峰值应变及应变率、舒张早期峰值应变率及舒张晚期峰值应变率较对照组明显减低(P<0.05),肝硬化组右室基底段及中间段收缩期峰值及舒张早期峰值速度较对照组减低,差异具有统计学意义(P<0.005),右室心尖段收缩期峰值速度、舒张早期峰值速度及舒张晚期峰值速度较对照组减低,差异不具有统计学意义(P>0.05)。
结论:超声二维应变技术可以快速准确的评价肝硬化患者右心功能,提示临床医生诊断和治疗肝硬化性心肌病以改善肝硬化病人预后情况。
Part 1:
Evaluation of Left Ventricular longitudinal shrinkage Function in Patients with early liver cirrhosis Using two-dimensional speckle tracking imaging
Objective To assess the left ventricular longitudinal shrinkage function in patients with liver cirrhosis with two-dimensional speckle tracking imaging(2D-STI). Methods Echocardiography and Doppler echocardiography were obtained in 34 patients with hepatic cirrhosis and 35 normal persons of corresponding ages underwent .And high frame rate two-dimensional images were recorded from apical long-axis view,four-chamber view and two-chamber view of left ventricle ,then measuring the left ventricular diameter,left atrium diameter,the peak filling velocity of E wave and A wave,E /A ratio ,EF and FS. The peak systolic strain of left ventricular segment were measured using two-dimensional strain software. Results Compared with healthy subjects,left ventricular diameter,left atrium diameter,EF and FS of hepatic cirrhosis patients were not different(P>0.05) ,but the E /A ratio of hepatic cirrhosis was lower (P<0.05),and the peak systolic strain of most left ventricular segment reduced in hepatic cirrhosis were statistically lower (P<0.05), except base segment of each wall and middle segment of back interventricular septum .
Conclusions The heart shape ,systolic and diastole function of hepatic cirrhosis were abnormal. Using the 2D-STI can early and accurately evaluate the systolic function of hepatic cirrhosis.
Part 2:
Evaluation of Right Ventricular longitudinal shrinkage
Function in Patients with early liver cirrhosis Using two-dimensional speckle tracking imaging
Objective To assess the right ventricular longitudinal shrinkage function in patients with liver cirrhosis with Speckle Tracking Echocardiograohy.
Methods Echocardiography was obtained in 34 patients with hepatic cirrhosis and 35 normal persons of corresponding ages underwent . And high frame rate two-dimensional images were recorded from four-chamber view of left ventricle, then measuring the right ventricular and atrium diameter. The peak strain、strain rate and velocity of right ventricular free wall each segment in systolic、early diastole and during atrial contraction were measured using two-dimensional strain software.
Results Compared with healthy subjects,right atrium diameter of hepatic cirrhosis patients was statistically augmentation (P<0.05). Peak systolic strain , strain rate and peak strain rate in early diastole and during atrial contraction of all segments in right ventricular free wall reduced significantly in cirrhosis patients when compared with the contrast people (P<0.05). Peak systolic velocity and velocity in early diastole and during atrial contraction of the middle and base segments in right ventricular were reduced significantly when compared with the contrast people (P<0.05). Although Peak systolic velocity and velocity in early diastole and during atrial contraction of the apex segments in right ventricular were not different (P>0.05).
Conclusions 2D-STI can evaluate the right ventricular function of hepatic cirrhosis patients early and accurately . It can call attention to diagnosis and cure cirrhotic cardiomyopathy then improved the prognosis of hepatic cirrhosis patients.
引文
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[54]胡望月,孙晓枫,何家春等,肝硬化患者心脏结构和功能的超声改变及其与肝功能的关系,临床消化病杂志,2005,17(6):286-288
[55]张洁,黄灿亮,刘新娟等,高排低阻型血流动力学改变对肝硬化患者的心功能影响,天津医药,2002,9(30):558-559
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[61]王润兰,杨晓英,杨松青等,应用超声心动图Tei指数评价晚期肝硬化患者心功能,吉林大学学报医学版,2006,32(2):350-352