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.
引文
[1]康素玲,张燕,郭玲等.超声对辦膜置换术后血流动力学改变研究.医药论坛杂志.2007,10:16-17.
[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.
[6]曾施,周启昌,彭清海,等.速度矢量成像检测扩张型心肌病左室长轴功能的探讨.中华超声影像学杂志,2007,16:645-650.
[7]Price DJA,Wallbridge DR,Stewart MJ.Tissue Doppler imaging:current and potential clinical applications.Heart,2000,84:11218
[8]Kiraly P,Kapusta L,Thijssen JM,et al.Left ventricular myocardial function in congenital valvar aortic stenosis assessed by ultrasound tissue - velocity and strain - rate techniques.Ultrasound Med Biol,2003,29:615-20.
[9]Henein MY.Normal long axis function.Heart,1999;81:111-113
[10]G Yip,M Wang,Y Zhang,et al.Left ventricular long axis function in diastolic heart failure is reduced in both diastole and systole:time for a redefinition Heart,2002,87:121-125
[11]Yamada H,Goh PP,Sun JR et al.Prevalence of left ventricular diastolic dysfunction by Doppler echocardiography:clinical application of the Canadian Consensus guidelines.J Am Soc Echocardiogr,2002:10:1238-1244
[12]Rushmer RF,Crystal DK,wagner C.-The functional anatomy of ventricular contraction.Circ Res,1952;1:162-170
[13]Andersen NH,Poulsen SH.Evaluation of longitudinal contraction of the left ventricle in normal subjects by Doppler tissue tracking and strain rate.J Am Soc Echocardiogr,2003,7:716-723
[1]Bendnarz J,Vignon P,Weinert L,et al.Color kinesis:principles of operation and technical guidelines.Echocardiogr,1998,15:21-34.
[2]刘丽文,钱蕴秋,张军,等.彩色室壁运动技术定量评价心肌梗塞患者局部收缩功能[J).中国超声医学杂志,1999,15(10):730-732.
[3]邢艳秋,张运,张梅,等.定量彩色室壁运动技术检验左心室负荷变化准确性的实验研究[J].中华超声影像学杂志,2001,10(3):172-174.
[4]Krahwinkel W,Haltern G,Gulker H.Echocardiographic quantification of regional left ventricular wall motion with color kinesis[J].Am J Cardiol,2000,85(2):245-250.
[5]Hayabuchi Y,Matsuoka S,Kubo M,et al.Usefulness of color kinesis imaging for evaluation of regional right ventricular wall motion in patients with surgically repaired tetralogy of Fallot[J].Am J Cardiol,1998,82(10):1224-1229.
[6]Koch R,Lang RM,Garcia MJ,et al.Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images.JACC,1999,34(2):409-419.
[7]陆凤翔,许迪,顾翔,等.彩色室壁运动技术低剂量多巴酚丁胺负荷超声心动图预测PTCA术后局部收缩功能恢复价值的研究.中华超声影像学杂志,2001,10(3):133-136。
[8]吴雅峰,主编.冠心病超声诊断.第1版,北京:人民卫生出版社,2002,23-67.
[9]卢荔红,林强,林皓平,等.一种新技术--全方向M 型超声心动图的临床应用.中国超声医学杂志,2001,17(8):591-593.
[10]王廉一,李越,温朝阳。任意角度M型超声心动图对心肌梗塞患者的异常室壁分析.中国超声医学杂志,1998,14(1):11-13
[11]徐婷燕,施仲伟,胡厚达,等.解剖M型超声技术评价冠状动脉支架置入术后局部室壁运动变化.中国超声医学杂志,2003,19(10):744-748
[12]李越,王青,林强,等。全方向M型超声检测左室局部舒张功能--一种新的检测方法和指标的研究中国医学影像学杂志,2002,10(3):169-1721
[13]MORAN CM,MCDICKEN N,GROUDSTROEM KWE,et al Potential application of color Doppler imaging of the myocardium in assessing contractility and perfusion[J].Am Heart J,1993,359-374.
[14]Garcia - Femamdez MA,Zamorano J,Azevedo J.Doppler Tissue Imaging Echocardiography.Madrid,McGRAW- HILL,1998:7
[15]Miyatake K,Yamagishi M,Tanaka N,et al.New method for evaluating left ventricular wall motion by color - coded tissue Doppler imaging:in vitro and in vivo studies.J Am Coil Cardiol,1995,25:717
[16]Galiuto L,Ignone G,DeMafia AN.Contraction and relaxation velocities of the normal left ventricle using pulsed - wave tissue Doppler echocardiography.Am J Cardiol,1998,81:609
[17]Witte K K A,Nikitin N P,De Silva R,et al.Exercise capacity and cardiac function assessed by tissue Doppler imaging in chronic heart failure[J].Heart,2004,90(10):1144-1150.
[18]Cem N,Ozan K,Oktay E,et al.Use of tissue Doppler echocardiography in early detection of left ventricular systolic dysfunction in patients with mitral regurgitation[J].The International Journal of Cardiovascular Imaging,2003,19(13):199-209.
[19]Ohte N,Nadta H,Hashimoto T,et al.Evaluation of left ventficular early diastolic performance by color Doppler imaging of the mitral annulus.Am J Cardiol,1998,82:1414
[20]Bach DS,Armastrong WF,Donovan CL,et al.Quantitative Doppler tissue imaging for assessment of regional myocardial velocities during transient ischemia and reperfusion.Am Heart J,1996,132:721
[21]Garot J,Derumeaux GA,Monin JL,et al.Quantitative systolic and diastolic transmyocardial velocity gradient assessed by M - mode colour Doppler tissue imaging as reliable indicators of regional left ventricular function after acute myocardial infarction.Eur Heart J,1999,20:15:2
[22]Severino S,Caso P,Galderisi M,et al.Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic cardiomyopathy.Am J Cardiol,1998,82:1394
[23]李治安,冀瑞平。多普勒组织成像技术及其临床应用。中国医学影像技术,1999,15:2
[24]陈娇,唐红。实时三维超声心动图评价正常人左室射血分数的初步研究实用医院临床杂志,2004 1(2):85-86
[25]Shiota T,McCathy PM,White RD,et al.Initial clinical experience of real-time three-dimensional echocardiography in patients with ischemic and idiopathic dilated cardiom yopathy.Am J Cardio 1,1999,84:1068-1073
[26]Kim WY,Sogaard P,Mortensen PT,et al.Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure.Heart 2001,85(5):514-520.
[27]舒先红,潘翠珍,施月芳等.实时三维超声心动图评价左心室心肌收缩同步性的初步临床研究.中华超声影像学杂志,2005 14(9):645-648.
[28]谢明星,邓斌华,王新房,等。实时三维超声心动图结合声学造影测量犬左室容积。中国医学影像技术,2005,21(2):166-168。
[29]Mor-Aviv,Lang RM.Use of contrast enhancement for the assessment of left ventricular function.Echocardiography,2003,20(7):637-642
[30]Mirsky I,Parmley WW:Assessment of passive elastic stiffness for isolated heart muscle and the intact heart.Circ Res,1973,33:233-243
[31]Heimdal A,Stφylen A,Torp H,et al.Real-time strain rate imaging of the left ventricle by ultrasound.J Am Soc Echocardiogr,1998,11:1013-1019
[32]Voigt J-U,Arnold MF,Karlsson M,et al.Assessment of regional longitudinal myocardial strain rate derived from Doppler myocardial imaging indexes in normal and infarcted myocardium.J Am Soc Echocardiogr,2000,13:588-598
[33]Urheim S,Edvardsen T,Yorp H,et al.Myocardial strain by Doppler echocardiography:validation of a new method to quantify regional myocardial function.Circulation,2000,102:1158-1164
[34]Greenberg NL,Firstenberg MS,Castro PL,et al.Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility.Circulation,2002,105:99-105
[35]Armstrong G,Pasquet A,Fukamachi K,et al.Use of peak systolic strain as an index of regional left ventricular function:comparison with tissue Doppler velocity during dobutamine stress and myocardial ischemia.J Am Soc Echocardiogr,2000,13:731-737
[36]Jamal F,Strotmann J,Weidemann F,et al.Noninvasive quantification of the contractile reserve of stunned myocardium by ultrasonic strain rate and strain.Circulation,2001,104:1059-1065
[37]Yang H,Sun JP,Lever HM,et al.Use of strain imaging in detecting segmental dysfunction in patients with hypertrophic cardiomyopathy[J].J Am Soc Echocardiogr,2003,16(3):233-239.
[38]Weidemann F,EyskensB,Jamal F,et al.Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound based strain rate and strain imaging[ J ]. J Am Soc Echocardiogr, 2002, 15(1) :20-28.
[39] Kukulski T ,Jamal F , Herbots L , et al. Identification of acutely ischemic myocardium using ultrasonic strain measurements : a clinical study in patients undergoing coronary angioplasty [J ]. J Am Coll Cardiol ,2003 ,41 (5) :810-819.
[40] Voigt JU, Arnold MF ,Karlsson M, et al. Assessment of regional longitudinal myocardial strain rate derived from Doppler myocardial imaging indexes in normal and infarcted myocardium[J]. J Am Soc Echocardiogr ,2000 ,13(6) :588-598.
[41] Zhang Y,Chan AKY, Yu CM, et al. Strain rate imaging differentiates transmural from nontransmural myocardial infarction : A validation study using delayed enhancement magnetic resonance imaging[J] . J Am Coll Cardiol ,2005 ,46(5):864-871.
[42] Anderson NH , Poulsen SH. Evaluation of the longitudinal contraction of the left ventricle in normal subjects by Doppler tissue tracking and strain rate. J Am Soc Echocardiogr ,2003 ,16 :716-723
[43] Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 2004, 17:1021-9
[44] Charlotte BI, Hans T, et al. Automated Analysis of Strain Rate and Strain:Feasibility and Clinical Implications. J Am Soc Echocardiogr 2005;18:411-8
[45] 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
[46] Hoskins PR . Ultrasound techniques for measurement of blood flow and tissue motion . Biorheology , 2002 , 39:451-459
[47] Charlotte BI, Hans T, Dr T, et al. Automated Analysis of Strain Rate and Strain: Feasibility and Clinical Implications. J Am Soc Echocardiogr 2005, 18:4118
[48] 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
[49]Bahar P,Marti L,McCulloch,et al.Evaluation of Global and Regional Right Ventricular Systolic Function in Patients With Pulmonary Hypertension Using a Novel Speckle Tracking Method.Am J Cardiol 2006,98:699-704
[50]Rust EM,Albayya FP,Metzger JM.Identification of acontrac tiled deficitin adult cardiac myocytes expressing hypertrophic cardiomyopathy associated mutant troponin T proteins[J].J Clin Invest,1999,103(10):1459-1467.
[51]白江涛,陆凤翔,许迪,等.定量组织速度成像、应变和应变率显像评价肥厚型心肌病与高血压心脏病左室心功能的对比研究[J].中国临床医学影像杂志,2004,15(12):692-695.
[52]Hoffmann R,Ahiok E,Nowak B,et al.Strain rate measurement by Doppler echocardiography allows improved assessment of myocardial viability in patients with depressed left ventricular function[J].J Am Coll Cardiol,2002,39(3):443-449.
[53]Arnold MF,Voigt JU,Kukulski T,et al.Does atrioventricularring motion always distinguish constriction from restriction A Doppler myocardial imaging study[J].J Am Soc Echocardiogr,2001,14(5):391-395.
[54]黄国倩,潘翠珍,舒先红,等.心肌应变率成像--超声定量评价局部心肌功能的新技术[J].中国临床医学,2004,11(5):918-920.
[55]王静,王新房,谢明星,等.曲线M型组织速度图与应变率图评价右心室起搏时心室收缩顺序的对照研究[J].中华超声影像学杂志,2004,13(5):341-344.
[56]黄国倩,潘翠珍,舒先红,等.心肌应变率成像-超声定量评价局部心肌功能的新技术[J]。中国临床医学,2004,11(5):918-920.