速度向量成像技术评价正常人与房颤患者左房心肌运动的初步研究
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摘要
目的运用速度向量成像技术初步研究正常人的左心房心肌运动特性;并探讨其评价心房颤动左心房功能的价值。
方法对38例正常人与27例持续性房颤患者进行常规超声心动图学,并记录相关指标;进行速度向量成像检查,并测定左房侧壁和房间隔上段、中段与下段的应变值(ε)。
结果与正常组比较,房颤组患者左心房前后径明显大于正常组(43.3±8.8 vs 32.9±3.6,P<0.01),肺静脉血流频谱PVs及PVd小于正常组(0.50±0.09 vs 0.70±0.05, 0.38±0.11 vs 0.53±0.05,P<0.01)。在正常组中左心房侧壁和房间隔在同一水平上的峰值应变值差异均无统计学意义。而正常组左心房侧壁及房间隔自身不同节段之间的峰值应变存在差异:心房上段的峰值应变大于中段(侧壁101.1±9.1 vs 59.2±9.5,P<0.01;房间隔92.0±10.1 vs 54.5±7.6,P<0.05),中段的峰值应变大于下段(侧壁59.2±9.5 vs 39.9±2.2, P<0.01;房间隔54.5±7.6 vs 31.9±1.6, P<0.01)。房颤患者左房上段峰值应变小于正常组相应测值(侧壁:72.3±8.5 vs 101.1±9.1,P<0.01;房间隔:61.1±10.5 vs 92.0±10.1, P<0.01)。
结论速度向量成像技术可以无创地分析正常人和房颤患者的左房心肌运动。
Objective To assess the movement of left atrial cardiomyocyte in control group and to assess the feasibility of velocity vector imaging in assessing left atrial function in atrial fibrillation patients.
Methods Conventional echocardiography and velocity vector imaging was performed in 38 controls and 27 patients with atrial fibrillation. The peak strain (ε) at the different segments of left atrium lateral wall and atrial septum were measured. The Conventional echocardiography measures were also measured.
Results Compared with the control group, LAD of patients with atrial fibrillation was larger(43.3±8.8 vs 32.9±3.6,P<0.01), but PVs and PVd was lower(0.50±0.09 vs 0.70±0.05, 0.38±0.11 vs 0.53±0.05,P<0.01). In control group, there was no significantly different betweenεat left atrium and atrial septum on the same level.εof upper segment was higher than that of mid segment (lateral wall of left atrium 101.1±9.1 vs 59.2±9.5,P<0.01;atrial septum 92.0±10.1 vs 54.5±7.6,P<0.05), andεof mid segment was higher than that of lower segment(lateral wall of left atrium 59.2±9.5 vs 39.9±2.2, P<0.01;atrial septum 54.5±7.6 vs 31.9±1.6, P<0.01). In atrial fibrillation patients,εat the upper segment was lower than that of control group.
Conclusion Velocity vector imaging may provide a noninvasive tool to evaluate the movement of atrial cardiomyocyte. Andεis a parameter to assess the movement.
方法对38例正常人与27例持续性房颤患者进行常规超声心动图学,并记录相关指标;进行速度向量成像检查,并测定左房侧壁和房间隔上段、中段与下段的应变值(ε)。
结果与正常组比较,房颤组患者左心房前后径明显大于正常组(43.3±8.8 vs 32.9±3.6,P<0.01),肺静脉血流频谱PVs及PVd小于正常组(0.50±0.09 vs 0.70±0.05, 0.38±0.11 vs 0.53±0.05,P<0.01)。在正常组中左心房侧壁和房间隔在同一水平上的峰值应变值差异均无统计学意义。而正常组左心房侧壁及房间隔自身不同节段之间的峰值应变存在差异:心房上段的峰值应变大于中段(侧壁101.1±9.1 vs 59.2±9.5,P<0.01;房间隔92.0±10.1 vs 54.5±7.6,P<0.05),中段的峰值应变大于下段(侧壁59.2±9.5 vs 39.9±2.2, P<0.01;房间隔54.5±7.6 vs 31.9±1.6, P<0.01)。房颤患者左房上段峰值应变小于正常组相应测值(侧壁:72.3±8.5 vs 101.1±9.1,P<0.01;房间隔:61.1±10.5 vs 92.0±10.1, P<0.01)。
结论速度向量成像技术可以无创地分析正常人和房颤患者的左房心肌运动。
Objective To assess the movement of left atrial cardiomyocyte in control group and to assess the feasibility of velocity vector imaging in assessing left atrial function in atrial fibrillation patients.
Methods Conventional echocardiography and velocity vector imaging was performed in 38 controls and 27 patients with atrial fibrillation. The peak strain (ε) at the different segments of left atrium lateral wall and atrial septum were measured. The Conventional echocardiography measures were also measured.
Results Compared with the control group, LAD of patients with atrial fibrillation was larger(43.3±8.8 vs 32.9±3.6,P<0.01), but PVs and PVd was lower(0.50±0.09 vs 0.70±0.05, 0.38±0.11 vs 0.53±0.05,P<0.01). In control group, there was no significantly different betweenεat left atrium and atrial septum on the same level.εof upper segment was higher than that of mid segment (lateral wall of left atrium 101.1±9.1 vs 59.2±9.5,P<0.01;atrial septum 92.0±10.1 vs 54.5±7.6,P<0.05), andεof mid segment was higher than that of lower segment(lateral wall of left atrium 59.2±9.5 vs 39.9±2.2, P<0.01;atrial septum 54.5±7.6 vs 31.9±1.6, P<0.01). In atrial fibrillation patients,εat the upper segment was lower than that of control group.
Conclusion Velocity vector imaging may provide a noninvasive tool to evaluate the movement of atrial cardiomyocyte. Andεis a parameter to assess the movement.
引文
[1]Sanlos A, Ledesma-Carbayo MJ, Malpiea N,et al. Accuracy of heart strain rate calculation derived from Doppler tissue velocity data. SPIE, 2001, 4325:546-555.
[2]姚豪华,舒先红,黄国倩,等。应变成像技术评价心房颤动患者左心房功能。中华超声影像学杂志,2008,17(1):27-29.
[3]Wang T, Wang M, Fung JW, et al. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: a combined transthoracic tissue Doppler and transoesophageal imaing study. Int J Cardio, 2007, 114:202-209.
[4]周自强,胡大一,陈捷,等.中国心房颤动现状流行病学研究.中华内科杂志,2004,43:491-494.
[5]Wang K, Ho SY, Gibson DG, et al. Architecture of atrial musculature in humans. Br Heart J, 1995, 73: 559-565.
[6]Ausma J, Wiffels M, van Eys G, et al. Dedifferentiation of atrial cardiomyocytes as result of chronic atrial fibrillation. Am J Pathol, 1997, 151: 985-997.
[7]Li D, Fare S, Leung TK. Promotion of atrial fibrillation by heart failure in dogs atrial remodeling of a different sort. Circulation, 1999, 100: 87-95.
[1]阎国辉,智光,徐勇.速度向量成像技术对正常人左室扭转运动特征的分析.中国超声医学杂志, 2006, 22 (12): 911-913.
[2]Zhao W, Li P, Vannan M, et al. Decreased reversal of left ventricular apical rotation is the basis of abnormal left ventricular filling in patients with hypertensive left ventricular hypertrophy and preserved ejection fraction: Evaluation of left ventricular torsional dynamics using velocity vector imaging. J Am Soc Echocardiogr, 2007, 20 (5): 571.
[3]Yu CM, Lin H, Zhang Q, et al. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration [J]. Heart, 2003, 89(1): 54-60.
[4]Pasquent A, Armstrong G, Beachler L, et al. Use of segmental tissue Doppler velocity ofquantitate exercise echocardiography [J]. J Am Soc Echocadiogr, 1999, 12(11):901-912.
[5]王璎瑛,许迪,雍永宏,等.速度向量成像技术评价正常人心肌运动协调性.南京医科大学学报(自然科学版),2007,27(4):303-306.
[6]吴晓霞,智光,孙琪,等.正常成人心肌应变及应变率的速度向量成像定量分析.临床超声医学杂志,2007, 9(2): 76-78.
[7]王璎瑛,许迪,陆凤翔,等.速度向量成像技术评价正常人心室节段功能.中华超声影像学杂志,2007,16(5):369-372.
[8]田雪,林艳,张海滨,等.速度向量成像技术对冠心病缺血心肌的初步评价.心脏杂志,2006,18(6):691-693.
[9]陈红军,曹铁生,段云友,等.速度向量成像技术评价扩张型心肌病室壁局部收缩功能.中国医学影像技术,2006,22(12):1831-1833.
[10]江鸿,智光,阎国辉,等.肥厚型心肌病患者左室心肌收缩期应变率的速度向量成像定量分析.第二军医大学学报,2008,29(4):390-394.
[11]Price DJA, Wallbridge DR, Stewart MJ. Tissue Doppler imaging: current and potential clinical applications. Heart, 2000, 84(Suppl 2): 11-18.
[12]Onose Y, Oki T, Mishiro Y, et a1. Influence of aging on systolic left ventricular wall motion velocities along the long and short axis in clinically normal patients determined by pulse tissue Doppler imaging. J Am Soc Echocardiogr, 1999, 12: 921-926.
[13]吴晓霞,智光,孙琪,等.速度向量成像评价早期左心室收缩功能不全.中华超声影像学杂志,2007,16(10):832-835.
[14]Knebel F, Reibis RK, Bondke HJ, et al. Tissue Doppler echocardiography and inventricular pacing in heart failure: patient selection, procedural guidance, follow-up, quantification of success. Cardiovasc Ultrasound, 2004, 2: 17.
[15]方凌云,谢明星,王新房,等.速度向量成像评价室性心律失常的研究.中华超声影像学杂志,2007,16(3):185-188.
[16]王静,谢明星,王新房,等.速度向量成像评价显性预激综合征患者左心室收缩不同步特征的初步临床研究.中华超声影像学杂志, 2007, 16(2):93-96.
[17]谢明星,张静,王静,等.速度向量成像评价左束支传导阻滞患者左心室收缩同步性.中华超声影像学杂志,2007,16(7):553-557.
[18]Vannan MA, Pedrizzetii G, Li P, et a1. Efect of cardiac resynchronization therapy onlongitudinal 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 [J]. Echocardiography, 2005, 22(10): 826-830.
[19]赵博文,姜卫香,杨园,等.速度向量成像在胎儿超声心动图中的初步应用研究.中国超声医学杂志,2008,24(4):355-358.
[20]王鸿,耿丹明,李慧忠,等.应变与应变率成像在胎儿心律失常应用的初步探讨.中国超声医学杂志,2008,24(2):168-171.
[21]汪奇,钱蕴秋,刘丽文,等.速度向量成像技术评价脑梗死患者颈总动脉管壁运动的初步研究.中国超声医学杂志,2007,23(1):32-35.
[1]周自强,胡大一,陈捷等.中国心房颤动现状流行病学研究.中华内科杂志,2004,43:491-494.
[2]Blondheim DS, Osipov A, M eisel SR, et al. Relation of left atrial size to function as determined by transesophageal echocardiography[J]Am J Cardiol, 2005, 96:457-463.
[3]Bollmann A, Binias KH, Grothues F, et al. Left atrial appendage function and pulmonary venous flow in patients with monrheumatic atrial fibrillation and their relation to spontaneous echo contrast. Echocardiography, 2002, 19(1):37-43.
[4]朱彩霞,李莹,张代富等.超声技术评价不同的消融术式对阵发性心房颤动患者左心房功能的长期影响,临床心血管杂志. 2007, 23(1):45-48.
[5]刘永太,田庄,方理刚等.经食管超声心动图组织多普勒评价左心耳功能,中国超声医学杂志.2007,23(5):352-355.
[6]Donal E, Grimm RA, Yamada H, et al. Usefulness of Doppler assessment of pulmonary vein and left atrial appendage floe following pulmonary vein isolation of chronic atrial fibrillation in predicting recovery of left atrial function. Am J Cardiol, 2005,95:941-947.
[7]Verma A, Marrouche NF, Yamada H, et al. Usefulness of intracardiac Doppler assessment of left atrial function immediately post-pulmonary vein antrum isolation to predict short-term recurrence of atrial fibrillation. Am J Cardiol, 2004, 94: 951-954.
[8]Spencer KT, Mor-Avi V, Gorcsan J 3rd,et al. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart, 2001, 85:272-277.
[9]Matsuda Y, Toma Y, Ogawa H, et al. Importance of left atrial function in patients with myocardial infraction. Circulation, 1983,67(3):566-571.
[10]马骁,张薇,杨贵荣等.心房颤动犬心房功能改变特点及机制的研究.中华超声影像学杂志, 2007,16:257-260.
[11]李春梅,尹立雪,罗安果等.组织多普勒成像评价正常人心房心肌运动特性.中华医学超声杂志(电子版),2006,3(2):84-87.
[12]姚豪华,舒先红,黄国倩等.应变成像技术评价心房颤动患者左心房功能.中华超声影像学杂志,2008,17:27-29.
[13] Inaba Y, Yuda S, Kobayashi N, et al. Strain rate imaging for moninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibeillation. J Am Soc Echocardiography, 2005, 18: 729-736.
[14] Rodrigues AC ,d’Avila A ,Hough taling C ,et al. Intrapericardial Echocardiography :A Novel Catheter-based Approach to Cardiac Imaging. Journal of the American Society of Echocardiography ,2004,17(3):269-274.
[15]Yin LX, Cai L, Li CM, et al. Cardiac comductive system excitation maps using intracardiac ultrasound catheter with tissue Doppler imaging. Circulation, 2000(supll), 1027-1029.
[16]Joseph B ,Prashanthan S ,Paul B ,et al .Atrial Flutter and Comparison With Multiplane Transesophageal Echocardiography .Am J Csrdio ,2002 ,90:741-746.
[2]姚豪华,舒先红,黄国倩,等。应变成像技术评价心房颤动患者左心房功能。中华超声影像学杂志,2008,17(1):27-29.
[3]Wang T, Wang M, Fung JW, et al. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: a combined transthoracic tissue Doppler and transoesophageal imaing study. Int J Cardio, 2007, 114:202-209.
[4]周自强,胡大一,陈捷,等.中国心房颤动现状流行病学研究.中华内科杂志,2004,43:491-494.
[5]Wang K, Ho SY, Gibson DG, et al. Architecture of atrial musculature in humans. Br Heart J, 1995, 73: 559-565.
[6]Ausma J, Wiffels M, van Eys G, et al. Dedifferentiation of atrial cardiomyocytes as result of chronic atrial fibrillation. Am J Pathol, 1997, 151: 985-997.
[7]Li D, Fare S, Leung TK. Promotion of atrial fibrillation by heart failure in dogs atrial remodeling of a different sort. Circulation, 1999, 100: 87-95.
[1]阎国辉,智光,徐勇.速度向量成像技术对正常人左室扭转运动特征的分析.中国超声医学杂志, 2006, 22 (12): 911-913.
[2]Zhao W, Li P, Vannan M, et al. Decreased reversal of left ventricular apical rotation is the basis of abnormal left ventricular filling in patients with hypertensive left ventricular hypertrophy and preserved ejection fraction: Evaluation of left ventricular torsional dynamics using velocity vector imaging. J Am Soc Echocardiogr, 2007, 20 (5): 571.
[3]Yu CM, Lin H, Zhang Q, et al. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration [J]. Heart, 2003, 89(1): 54-60.
[4]Pasquent A, Armstrong G, Beachler L, et al. Use of segmental tissue Doppler velocity ofquantitate exercise echocardiography [J]. J Am Soc Echocadiogr, 1999, 12(11):901-912.
[5]王璎瑛,许迪,雍永宏,等.速度向量成像技术评价正常人心肌运动协调性.南京医科大学学报(自然科学版),2007,27(4):303-306.
[6]吴晓霞,智光,孙琪,等.正常成人心肌应变及应变率的速度向量成像定量分析.临床超声医学杂志,2007, 9(2): 76-78.
[7]王璎瑛,许迪,陆凤翔,等.速度向量成像技术评价正常人心室节段功能.中华超声影像学杂志,2007,16(5):369-372.
[8]田雪,林艳,张海滨,等.速度向量成像技术对冠心病缺血心肌的初步评价.心脏杂志,2006,18(6):691-693.
[9]陈红军,曹铁生,段云友,等.速度向量成像技术评价扩张型心肌病室壁局部收缩功能.中国医学影像技术,2006,22(12):1831-1833.
[10]江鸿,智光,阎国辉,等.肥厚型心肌病患者左室心肌收缩期应变率的速度向量成像定量分析.第二军医大学学报,2008,29(4):390-394.
[11]Price DJA, Wallbridge DR, Stewart MJ. Tissue Doppler imaging: current and potential clinical applications. Heart, 2000, 84(Suppl 2): 11-18.
[12]Onose Y, Oki T, Mishiro Y, et a1. Influence of aging on systolic left ventricular wall motion velocities along the long and short axis in clinically normal patients determined by pulse tissue Doppler imaging. J Am Soc Echocardiogr, 1999, 12: 921-926.
[13]吴晓霞,智光,孙琪,等.速度向量成像评价早期左心室收缩功能不全.中华超声影像学杂志,2007,16(10):832-835.
[14]Knebel F, Reibis RK, Bondke HJ, et al. Tissue Doppler echocardiography and inventricular pacing in heart failure: patient selection, procedural guidance, follow-up, quantification of success. Cardiovasc Ultrasound, 2004, 2: 17.
[15]方凌云,谢明星,王新房,等.速度向量成像评价室性心律失常的研究.中华超声影像学杂志,2007,16(3):185-188.
[16]王静,谢明星,王新房,等.速度向量成像评价显性预激综合征患者左心室收缩不同步特征的初步临床研究.中华超声影像学杂志, 2007, 16(2):93-96.
[17]谢明星,张静,王静,等.速度向量成像评价左束支传导阻滞患者左心室收缩同步性.中华超声影像学杂志,2007,16(7):553-557.
[18]Vannan MA, Pedrizzetii G, Li P, et a1. Efect of cardiac resynchronization therapy onlongitudinal 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 [J]. Echocardiography, 2005, 22(10): 826-830.
[19]赵博文,姜卫香,杨园,等.速度向量成像在胎儿超声心动图中的初步应用研究.中国超声医学杂志,2008,24(4):355-358.
[20]王鸿,耿丹明,李慧忠,等.应变与应变率成像在胎儿心律失常应用的初步探讨.中国超声医学杂志,2008,24(2):168-171.
[21]汪奇,钱蕴秋,刘丽文,等.速度向量成像技术评价脑梗死患者颈总动脉管壁运动的初步研究.中国超声医学杂志,2007,23(1):32-35.
[1]周自强,胡大一,陈捷等.中国心房颤动现状流行病学研究.中华内科杂志,2004,43:491-494.
[2]Blondheim DS, Osipov A, M eisel SR, et al. Relation of left atrial size to function as determined by transesophageal echocardiography[J]Am J Cardiol, 2005, 96:457-463.
[3]Bollmann A, Binias KH, Grothues F, et al. Left atrial appendage function and pulmonary venous flow in patients with monrheumatic atrial fibrillation and their relation to spontaneous echo contrast. Echocardiography, 2002, 19(1):37-43.
[4]朱彩霞,李莹,张代富等.超声技术评价不同的消融术式对阵发性心房颤动患者左心房功能的长期影响,临床心血管杂志. 2007, 23(1):45-48.
[5]刘永太,田庄,方理刚等.经食管超声心动图组织多普勒评价左心耳功能,中国超声医学杂志.2007,23(5):352-355.
[6]Donal E, Grimm RA, Yamada H, et al. Usefulness of Doppler assessment of pulmonary vein and left atrial appendage floe following pulmonary vein isolation of chronic atrial fibrillation in predicting recovery of left atrial function. Am J Cardiol, 2005,95:941-947.
[7]Verma A, Marrouche NF, Yamada H, et al. Usefulness of intracardiac Doppler assessment of left atrial function immediately post-pulmonary vein antrum isolation to predict short-term recurrence of atrial fibrillation. Am J Cardiol, 2004, 94: 951-954.
[8]Spencer KT, Mor-Avi V, Gorcsan J 3rd,et al. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart, 2001, 85:272-277.
[9]Matsuda Y, Toma Y, Ogawa H, et al. Importance of left atrial function in patients with myocardial infraction. Circulation, 1983,67(3):566-571.
[10]马骁,张薇,杨贵荣等.心房颤动犬心房功能改变特点及机制的研究.中华超声影像学杂志, 2007,16:257-260.
[11]李春梅,尹立雪,罗安果等.组织多普勒成像评价正常人心房心肌运动特性.中华医学超声杂志(电子版),2006,3(2):84-87.
[12]姚豪华,舒先红,黄国倩等.应变成像技术评价心房颤动患者左心房功能.中华超声影像学杂志,2008,17:27-29.
[13] Inaba Y, Yuda S, Kobayashi N, et al. Strain rate imaging for moninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibeillation. J Am Soc Echocardiography, 2005, 18: 729-736.
[14] Rodrigues AC ,d’Avila A ,Hough taling C ,et al. Intrapericardial Echocardiography :A Novel Catheter-based Approach to Cardiac Imaging. Journal of the American Society of Echocardiography ,2004,17(3):269-274.
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