速度矢量成像技术评价主动脉瓣置换患者心功能的研究
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摘要
目的:应用VVI(velocity vector imaging)技术定量检测主动脉瓣狭窄患者行主动脉瓣置换术前及术后心肌收缩和舒张功能,并与正常人比较,观察其变化特点;观察主动脉瓣置换术后心功能变化的趋势;探讨VVI技术在评价主动脉瓣置换术对主动脉瓣狭窄患者左心室长轴收缩和舒张功能无创估测中的价值。
方法:选取2007年5月～2008年1月在我院心外科行主动脉瓣置换术的主动脉瓣狭窄患者32例,均经冠脉造影检查显示无合并冠状动脉病变、无心律失常、经超声心动图检查无其它瓣膜病变且EF＞55%;按性别、年龄选取与主动脉瓣狭窄患者相匹配的正常人32例。排除既往有冠心病、高血压、先天性心脏病史,经检查有糖尿病、甲状腺疾病、代谢性疾病、结缔组织疾病、营养不良、有严重的肝肾功能损害者、有酗酒、毒物接触史者以及处于围生期者。用VVI技术分别测量16节段心肌长轴上三组指标:Ⅰ—收缩期峰值应变(Ss)、收缩期峰值应变率(SRs);Ⅱ—舒张期峰值应变(Sd)、舒张期峰值应变率(SRd);Ⅲ—应变达峰时间(PTS)、应变率达峰时间(PTSR);每一指标均取一个心动周期。所有计量资料均以均数±标准差表示,多组计量资料间的统计学差别用方差分析比较。配对资料采用配对t检验。
结果:主动脉瓣狭窄术前组各节段心肌长轴方向收缩期和舒张期的S及SR较正常对照组均显著减低,差异有显著意义(p＜0.05),PTS及PTSR在16个节段的一致性也较好,但各节段测值均延长,差异有显著意义(p＜0.05)。术后组各节段心肌收缩期和舒张期的S及SR较术前组增高,但比正常对照组减低,差异均有显著意义(p＜0.05),PTS及PTSR在16个节段的一致性也较好,但各节段测值较正常组延长,差异有显著意义(p＜0.05),与术前组差异无明显意义。
结论:VVI技术的应用能够客观、准确的发现患者长轴方向心肌运动功能应变率的微小变化,为主动脉瓣狭窄患者术前术后准确评估心功能、观察术后心功能恢复情况及随访提供了一种新的无创的、可靠的定量工具,随着对应变率这一参数特性的了解和对VVI技术进一步深入的研究及进一步完善,相信在不久的将来该技术将会广泛运用于临床工作中。
Objective: Practice of quantitative evaluation to myocardial systolic and diastolic function of aortic stenosis patients before and after operation by technique of the Velocity Vector imaging. Data of ordinary person was obtained as a comparison to reveal the heart functional characteristics and the change of the heart function of post aortic valve replacement surgery was observed at the same time. At the end of the study, a brief conclusion about the value of the non-invasive measurement, the VVI technique, and be made, especially in the realm of assessment of the systolic and diastolic heart function of the patient after the aortic valve replacement surgery.
Methods: 32 aortic stenosis patients received the Aortic Valve Replacement surgery (during 2007.5--2008.1 in the 2nd Xiangya Hospital) were observed who have no coronary disease and arrhythmia, no other valve disease(by B-ucg) and EF>55%. Another 32 ordinary people were selected as a contrast group by corresponding sex and age. Those patients who have history of coronary artery disease, hypertension, congenital heart disease and who were proved suffering diabetes, thyroid disease, metabolic disease, connective tissue disease, malnutrition, severe hepatic and renal dysfunction, drug and alcoholic abuse, and in periodical period. Three kind of data on the 16-segment-myocardium were measured by the VVI technique: I -systolic apex strain, systolic apex strain rate(Ss) II -diastolic apex strain (Sd), diastolic apex strain rate (SRd); III - peak time of strain(PTS), peak time of strain rate(PTSR). Each data is taken from single heart cycle.
Results: The systolic and diastolic S and SR of long-axis myocardium of the aortic patients before surgery are significantly lower than the ordinary group(P<0.05). The consistence of PTS and PTSR in the 16 segments is good, but the segments are longer than the ordinary group(P<0.05). The myocardial systolic and diastolic S and SR of post surgery patients are higher than those before surgery while lower than the ordinary group.(P<0.05) The consistence of PTS and PTSR in the 16 segments is good and the length of the segments are longer than the ordinary group (P<0.05)while there is no difference to the data before surgery.
Conclusion: The VVI technique can reveal the small changes of function of the long-axial myocardium objectively and accurately. It is a new kind of non-invasive and credible measurements which can evaluate heart function accurately and the recovery of heart function and the fellow-up. It will be widely used in clinical work with more understanding of its characteristics.
方法:选取2007年5月～2008年1月在我院心外科行主动脉瓣置换术的主动脉瓣狭窄患者32例,均经冠脉造影检查显示无合并冠状动脉病变、无心律失常、经超声心动图检查无其它瓣膜病变且EF＞55%;按性别、年龄选取与主动脉瓣狭窄患者相匹配的正常人32例。排除既往有冠心病、高血压、先天性心脏病史,经检查有糖尿病、甲状腺疾病、代谢性疾病、结缔组织疾病、营养不良、有严重的肝肾功能损害者、有酗酒、毒物接触史者以及处于围生期者。用VVI技术分别测量16节段心肌长轴上三组指标:Ⅰ—收缩期峰值应变(Ss)、收缩期峰值应变率(SRs);Ⅱ—舒张期峰值应变(Sd)、舒张期峰值应变率(SRd);Ⅲ—应变达峰时间(PTS)、应变率达峰时间(PTSR);每一指标均取一个心动周期。所有计量资料均以均数±标准差表示,多组计量资料间的统计学差别用方差分析比较。配对资料采用配对t检验。
结果:主动脉瓣狭窄术前组各节段心肌长轴方向收缩期和舒张期的S及SR较正常对照组均显著减低,差异有显著意义(p＜0.05),PTS及PTSR在16个节段的一致性也较好,但各节段测值均延长,差异有显著意义(p＜0.05)。术后组各节段心肌收缩期和舒张期的S及SR较术前组增高,但比正常对照组减低,差异均有显著意义(p＜0.05),PTS及PTSR在16个节段的一致性也较好,但各节段测值较正常组延长,差异有显著意义(p＜0.05),与术前组差异无明显意义。
结论:VVI技术的应用能够客观、准确的发现患者长轴方向心肌运动功能应变率的微小变化,为主动脉瓣狭窄患者术前术后准确评估心功能、观察术后心功能恢复情况及随访提供了一种新的无创的、可靠的定量工具,随着对应变率这一参数特性的了解和对VVI技术进一步深入的研究及进一步完善,相信在不久的将来该技术将会广泛运用于临床工作中。
Objective: Practice of quantitative evaluation to myocardial systolic and diastolic function of aortic stenosis patients before and after operation by technique of the Velocity Vector imaging. Data of ordinary person was obtained as a comparison to reveal the heart functional characteristics and the change of the heart function of post aortic valve replacement surgery was observed at the same time. At the end of the study, a brief conclusion about the value of the non-invasive measurement, the VVI technique, and be made, especially in the realm of assessment of the systolic and diastolic heart function of the patient after the aortic valve replacement surgery.
Methods: 32 aortic stenosis patients received the Aortic Valve Replacement surgery (during 2007.5--2008.1 in the 2nd Xiangya Hospital) were observed who have no coronary disease and arrhythmia, no other valve disease(by B-ucg) and EF>55%. Another 32 ordinary people were selected as a contrast group by corresponding sex and age. Those patients who have history of coronary artery disease, hypertension, congenital heart disease and who were proved suffering diabetes, thyroid disease, metabolic disease, connective tissue disease, malnutrition, severe hepatic and renal dysfunction, drug and alcoholic abuse, and in periodical period. Three kind of data on the 16-segment-myocardium were measured by the VVI technique: I -systolic apex strain, systolic apex strain rate(Ss) II -diastolic apex strain (Sd), diastolic apex strain rate (SRd); III - peak time of strain(PTS), peak time of strain rate(PTSR). Each data is taken from single heart cycle.
Results: The systolic and diastolic S and SR of long-axis myocardium of the aortic patients before surgery are significantly lower than the ordinary group(P<0.05). The consistence of PTS and PTSR in the 16 segments is good, but the segments are longer than the ordinary group(P<0.05). The myocardial systolic and diastolic S and SR of post surgery patients are higher than those before surgery while lower than the ordinary group.(P<0.05) The consistence of PTS and PTSR in the 16 segments is good and the length of the segments are longer than the ordinary group (P<0.05)while there is no difference to the data before surgery.
Conclusion: The VVI technique can reveal the small changes of function of the long-axial myocardium objectively and accurately. It is a new kind of non-invasive and credible measurements which can evaluate heart function accurately and the recovery of heart function and the fellow-up. It will be widely used in clinical work with more understanding of its characteristics.
引文
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[2]Rusk RA,Li XN,Irvine T,et al.Surface integration of velocity vectors from 3D digital color Doppler:an angle independent method for laminar flow measurements.Eur J Echocardiogr,2002,3:177-184.
[3]Hoskins PR.Ultrasound techniques for measurement of blood flow and tissue motion.Biorheology,2002,39:451-459.
[4]Charlotte BI,Hans T,Dr Tech,et al.Automated Analysis of Strain Rate and Strain:Feasibility and Clinical Implications.J Am Soc Echocardiogr 2005;18:411-8.
[5]Mani AV,Gianni P,Peng Li,et al.Effect of Cardiac Resynchronization Therapy on Longitudinal and Circumferential Left Ventricular Mechanics by Velocity Vector Imaging:Description and Initial Clinical Application of a Novel Method Using High-Frame Rate B-Mode Echocardiographic Images.Echocardiography,2005,22:826-830.
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