摘要
第一部分超声斑点追踪技术评价正常妊娠妇女左室整体旋转与扭转运动
目的应用二维斑点追踪成像(Speckle Tracking Imaging,STI)技术评价正常妊娠妇女不同孕期左室心肌整体旋转与扭转运动变化特征。
方法选取不同妊娠期妇女84例、健康未孕女性为对照组28例,分别采集左室心底水平(MV)、心尖水平(AP)短轴二维图像,运用STI软件进行脱机分析,记录左室整体扭转角度峰值(Peak twist, Ptw)、心底水平旋转角度峰值(Peak rotation-MV, Prot-MV)、达峰绝对时间(Peak time-MV, Pti-MV)、达峰时间百分比(Percent of Peak time-MV, Perc-Pti-MV)、心尖水平旋转角度峰值(Peak rotation-AP, Prot-AP)、达峰绝对时间(Peak time-AP, Pti-AP)及达峰时间百分比(Percent of Peak time-AP, Perc-Pti-AP)。
结果①妊娠组与对照组比较:左室心肌扭转运动随心动周期变化的曲线呈规律性变化,且形态基本一致。②分别与对照组比较,早、中妊娠组Ptw、Prot-AP测值增大,晚期妊娠组Ptw、Prot-AP测值减小,差异有统计学意义(P<0.05);与早期妊娠组比较,中期妊娠组Ptw、Prot-AP测值增大,晚期妊娠组Ptw、Prot-AP测值减低,差异有统计学意义(P<0.05)。晚期妊娠组与中期妊娠组比较Ptw、Prot-AP测值减小,差异有统计学意义(P<0.05);各组间Prot-MV比较差异无统计学意义(P>0.05)。③分别与对照组比较,早、中、晚期妊娠组Perc-Pti-AP及晚期妊娠组Perc-Pti-MV测值增大,差异均有统计学意义(P<0.05);与早期、中期妊娠组比较,晚期妊娠组Perc-Pti-MV增大,差异有统计学意义(P<0.05)。④Ptw与BSA、Prot-AP有相关性,与HR、身高、Prot-MV、LVEDV、LVEF无相关性。
结论随着孕周数增加,妊娠期妇女左室收缩功能正常时,左室扭转与旋转运动已出现变化,且变化趋势不同。
第二部分超声斑点追踪技术评价妊娠妇女左心室各节段室壁旋转运动
目的应用STI技术评价正常妊娠期妇女左室心底、心尖各室壁节段旋转运动特征。
方法研究对象、图像采集均同第一部分。
结果①对照组内,左室心底各节段旋转角度测值比较显示:下壁、后壁测值最大,后间隔、侧壁次之,前壁、前间隔最小;前壁、前间隔与下壁、后壁比较,差异有统计学意义(P<0.05)。心尖各节段旋转角度差异无统计学意义(P>0.05)。②同一妊娠期,心底平面各节段旋转峰值差异有统计学意义(P<0.05);不同妊娠期,心底平面各节段旋转角度峰值比较,差异有统计学意义(P<0.05)。③同一妊娠期,心尖平面各节段旋转角度峰值差异无统计学意义(P>0.05);不同妊娠期,心尖平面各节段旋转角度峰值比较,各节段峰值之间差异有统计学意义(P<0.05),且随着孕周增加,出现妊娠早、中期增加,晚期减低的趋势。
结论左室心底水平整体扭转随孕周无差异,心肌各节段室壁旋转角度随孕周的增加呈不同的变化趋势。左室心尖水平整体扭转随孕周增加,而心肌各节段室壁旋转角度变化一致。
Part 1: Evaluation of left ventricular global rotation and twist in normal pregnant women by ultrasound speckle tracking imaging
Objectives To evaluate left ventricular global rotation and twist in normal pregnant women by ultrasound speckle tracking imaging.
Methods Eighty-four pregnant women and 28 normal women volunteers were collected in the study. Pregnant women were divided into three groups by gestational weeks: early pregnancy group (EP group), middle pregnancy group (MP group) and late pregnancy group (LP group). Basal and apical short-axis images of left ventricle were acquired to analysis left ventricular rotation(LVrot) and twist(LVtw). Ptw, Prot, Pti and Pre-Pti were measured respectively in the two short-axis imagings and the values of the above parameters were compared. Left ventricular torsion angle peak(Peak twist, Ptw), Basal levels of rotation peak(Peak rotation-MV, Prot-MV), peak absolute time(Peak time-MV, Pti-MV), peak time percentage(Percent of Peak time-MV, Perc-Pti-MV), apical levels of rotation peak level(Peak rotation-AP, Prot-AP), peak absolute time(Peak time-AP, Pti-AP)and time to peak percentage(Percent of Peak time-AP, Perc-Pti-AP) were recorded. The correlation between left ventricular rotation parameters and height, weight, heart rate, ejection fraction, LVEDV were compared.
Results①The curve shapes of the LVrot and LVtw of the pregnant women were same with the one in normal.②Compared with control group, Ptw, Prot-AP increased significantly (P<0.05) in EP and MP groups and decreased significantly in LP (P<0.05). Compared with EP group, Ptw, Prot-AP increased significantly in MP group(P<0.05) and dereased significantly in LP group(P<0.05). Compared with LP and MP groups, Ptw、Prot-AP decreased significantly in LP group(P<0.05).③Compared with control group, Perc-Pti-AP increased significantly(P<0.05) in EP and MP groups, while Perc-Pti-MV and Perc-Pti-AP increased significantly(P<0.05) in LP groups. Compared with EP and MP groups, Perc-Pti-MV increased significantly (P<0.05) in LP group.
Conclusions The left ventricular systolic torsion and twist had already changed in normal pregnancy when left ventricular systolic function maintained mormal. And with pregnancy progressing, it had showed different trends.
Part 2. Evaluation of left ventricular regional rotation in normal pregnant women by ultrasound speckle tracking imaging
Objectives To evaluate left ventricular regional rotation in normal pregnant women in pregnancy progress by ultrasound speckle tracking imaging.
Methods Object of study, image acquisition were the same with the first part . Segmental and global LV rotation were recorded at both apical and basal short-axis views.
Results:①Basal segmental rotation showed significant different heterogeneity in the control group(P<0.05). Segmental rotation in left ventricular short-axis at the apical level was similar(P>0.05).②In the same pregnant group, segmental rotation of apical level had no significant difference(P>0.05); in different pregnant groups, segmental rotation of apical level had statistically significant difference(P<0.05).③In the same pregnant group, regional rotation of basal level had significant difference(P<0.05), And in different pregnant group, basal level rotation had no statistically significant difference(P>0.05).
Conclusions With the increase of gestational weeks, the basal and apical segmental totation showed different trends.
引文
1 Carlin A, Alfirevic Z. Physiological changes of pregnancy and monitoring. Best Pract Res Clin Obstet Gynaecl. 2008, 22: 801-823.
2 Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Physiol. Heart Circ.Physiol. 2002, 283: H 1627-1633.
3 Kametas NA, Mcauliffe F, Cook B, et al. Maternal left ventricular transverse and long-axis systolic function during pregnancy. Ultrasound Obstet Gynecol. 2001, 18: 467-474.
4 Schannwell CM, Zimmermann T, Schneppenheim M, et al. Left ventricular hypertrophy and diastolic dysfunction in healthy pregnant women. Cardilology. 2002, 97: 73-78.
5张丽,谢明星,王新房等.超声斑点追踪显像技术评价不同年龄正常人左心室扭转运动的初步研究.中华超声影像学杂志. 2007, 16: 746-750.
6 Nakai H, Takeuchi M, Nishikage T, et al. Effect of aging on twist-displacement lopp by 2-dimensional speckle tracking imaging. J Am Soc Echocardiogr. 2006, 19: 880-885.
7王士雯.妇女心脏病学(第一版).北京.人民军医出版社, 2008. 127-128.
8 Carlin A, Alfirevic Z. Physiological changes of pregnancy and monitoring. Best Pract Res Clin Obstet Gynaecol. 2008, 22: 801-823.
9 Schneider NS, Shimayoshi T, Amano A, et al. Mechanism of the Frank-Starling law—a simulation study with a novel cardiac muscle contraction model that includes titin and troponinⅠ. J Mol Cell Cardiol. 2006, 41: 522-536.
10 Smulyan H, Asmar RG, Rudnicki A, et al. Comparative effects of aging in men and women on the properties of the arterial tree. J Am Coll Cardiol. 2001, 37: 1374-1380.
11 Bombardini T. Myocardial contractility in the echo lab: molecular, cellular and pathophysiological basis. Cardiovasc Ultrasound. 2005 ,8: 3-27.
12 George J, Sarah S, Michael H, et al. Changes in hemodynamics, ventricular remodeling and ventricular contractility during normal pregnancy, A longitudial study. Obstet Gynecol. 1997, 89: 957-962.
13 Zentner D, du Plessis M, Brennecke S, et al. Deterioration in cardiac systolic and diastolic function late in normal human pregnancy. Clin Sci. 2009, 116: 59-606.
14 Yarbrough WM, Spinale FG. Large animal models of heart failure. Nucl Cardiol. 2003, 10: 77-86.
15 Wong CY, O’Moore ST, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation. 2004, 110: 3081-3087.
16 Taber LA, Yang M, Podszus WW. Mechanics of ventricular torsion. J Biombch. 1996, 29: 745-752.
17 Buckberg GD, Coghlan HC, Torrent-Guasp F. The structure and function of the helical heart and its buttress wrapping. V. Anatomic and physiologic considerations in the healthy and failing heart. Semin Thorac Cardiovasc Surg. 2001, 13: 358-85.
18 Opdahl A, Helle-Valle T, Remme EW, et al. Apical rotation by speckle tracking echocardiogaphy: a simplified beside index of left ventricular twist. J Am Socechocardiogr. 2008, 10: 1121-1128.
19 Torrent-Guasp F, Kocica M, Corno A, et al. Towards new understanding of the heart structure and function. Eur J Cardiothrac Surg. 2005, 1: 191-201.
20 Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation. 1978, 58: 434-441.
21 Capsa VB, Fouron JC, Comte B, et al. Structural, functional and metabolic remodeling of rat left ventricular myocytes in normal and in sodium-supplemented pregnancy. cardiovascular Research. 2006, 69: 423-431.
1 Bamfo JE., Kametas NA, Nicolaides KH, et al. Reference ranges for tissue Dopple measures of maternal systolic and diastolic left ventricular function.Ultrasound Obstet Gynecol. 2007, 29; 414-420.
2 Gustafsson U, Lindqvist P, M?rner S, et al. Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function: an echocardiographic speckle-tracking study in healthy individuals. Eur J Echocardiogr. 2009; 10: 56-61.
3 Hui L, Pemberton, Pemberton J, Hiickey E, et al. The contribution of left ventricular muscle bands to left ventricular rotation:assessment by a 2-dimensional speckle tracking method.J Am Soc Echocardiogr. 2007, 486-491.
4罗安果,尹立雪,李春梅,等.超声斑点跟踪显像技术对左心室收缩期旋转角度的初步研究.中华超声影像学杂志. 2006; 15: 641-645.
5 Hui L, Pemberton, Pemberton J, Hiickey E, et al. The contribution of left ventricular muscle bands to left ventricular rotation: assessment by a 2-dimensional speckle tracking method. J Am Soc Echocardiogr. 2007, 486-491.
6 Taber LA, Yang M, Podszus WW. Mechanics of ventricular torsion. J Biomech. 1996; 29:745–752.
7王士雯.妇女心脏病学.第一版.北京.人民军医出版社, 2008: 127-128.
8 Starling EH:Linacre lectrue on the law of the heart(1915) London.Longmans;1918.
9 V.Bassien-Capsa, J-C.Fouron, B.Comte, A.Chorvatova. Structural,functional and metabolic remodeling of rat left ventricular myocytes in normal and in sodium-supplemented pregnancy.cardiovascular Research. 2006, 69: 423-431.
10 Torrent-Guasp F, Buckberg GD, Clemente C, et al. The structure and function of the helical heart and its buttress wrapping.I.The normal macroscopic structure of the heart. Semin Thorac Cardiovasc Surg. 2001; 13: 301-319.
11 Stevens C, Remme E, LeGrice I, et al. Ventricular mechanics in disastole : materialparameter sensitivity. J Biomech. 2003, 36: 737-748.
12滕银成,汤希伟.妊娠期妇女心血管结构和功能变化的研究进展.国外医学妇产科科学分册. 2001, 28: 137-139.
1 Meunier J, Bertrand M. Ultrasonic texture motion analysis: theory and simulation. IEEE Trans Med Imaging. 1995, 14: 293-300.
2 Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional Strain- a novel software for real-time quantitative echocardiograpic assessment of myocardial function. J Am Soc Echocardiogr. 2004, 17: 1021-1029.
3 Azhari H, Buchalter M, Sideman S, et al. A conical model to describe the nonuniformity of the left ventricular twisting motion. Ann Biomed Eng. 1992, 20: 149–165.
4 Kim HK, Sohn DW, Lee SE, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr. 2007, 20: 45-53.
5张丽、谢明星、王新房等.超声斑点追踪显像技术评价不同年龄正常人左心室扭转运动的初步研究.中华超声影像学杂志. 2007,16: 746-750.
6 Hell-Valle T, Crosby J, Edvardsen T, et al. New nonivasive method for essessment of left ventricular rotation: speckle tracking echocardiography. Circulation. 2005, 112:3149-3156.
7 Buchalter MB, Weiss JL, Rogers WJ, et al. Noninvasive quantification of left ventricular rotation deformation in normal humans using magnetic resonance imaging myocardial tagging. Circulation. 1990, 81: 1236-1244.
8 Taber LA, Yang M, Podszus WW. Mechanics of ventricular torsion. J Biombch. 1996, 29: 745-752.
9 Opdahl A, Helle-Valle T, Remme EW, et al. Apical rotation by speckle tracking echocardiogaphy: a simplified beside index of left ventricular twist. J Am Socechocardiogr. 2008, 10: 1121-1128.
10 Hui L, Pemberton, Pemberton J, Hiickey E, et al. The contribution of left ventricular muscle bands to left ventricular rotation: assessment by a2-dimensional speckle tracking method. J Am Soc Echocardiogr. 2007, 486-491.
11 Buchalter MB, Rademakers FE, Weiss JL, et al. Rotaional deformation of the canine left ventricle measured by magnetic resonnce tagging:effects of catecholamines, ischaemia and pacing. Cardiovasc Res. 1994, 28:500-507.
12 Rüssel IK, G?tte MJ, Bronzwaer JG, et al. Left ventricular torsion: an expanding role in the analysis of myocardial dysfunction. JACC Cardiovasc Imaging. 2009, 2: 648-55.
13韩伟,谢明星,王新房等.斑点追踪显像评价左室前壁心肌梗死血运重建术前后左室整体和局部扭转运动特征.中华超声影像学杂志. 2008, 17: 107-111.
14 Taeuehi M, Nishikage T, Nakai H, et a1. The assessment of left ventrieular twist in anterior wall myocardial infarction using two-dimensional speckle tracking imaging. J Am Soc Echocardiogr. 2007, 20: 36-44.
15 Zornoff LA, PAIVA SA, Duarte DR,et al. Ventricular remodeling after myocardial infarction:concepts and clinical implications. Arq Bras Cardiol. 2009; 92: 150-164.
16 Ma H, Xie MX, Wang J, et al. Ultrasound speckle tracking imaging contributes to early diagnosis of impaired left ventricular systolic function in patients with type 2 diabetes mellitus. J Huazhong Univ Sci Technol. 2008, 28: 719-723.
17 Henson RE, Song SK, Pastorek JS, et al. Left ventricular torsion is equalin mice and humans. Am J Physiol Heart Circ Physiol. 2009, 278: 1117-1123.
18 Shivu GN, Abozguia K, Phan TT, et al. Increased left ventricular torsion in uncomplicationed type 1 diabetic patients: the role of coronary microvascular function. Diabetes Care. 2009, 32: 1710-1712.
19 Stuber M, Scheidegger MB,Fischer SE, et al. Alteration in the local myocardial motion pattern in patients suffering from pressure overload due to aortic stenosis. Circulation. 1999, 100: 361-368.
20 Tibayan FA, Lai DT, Timek TA, et al. Alteration in left ventricular torsion intachycardia-induced dilated cardiomyopathy. J Thorac Cardiovasc Surg. 2002, 124: 43-49.
21 Popescu BA, Beladan CC, Calin A, et al. Left ventricular remodelling and torsional dynamics in dilated cardiomyopathy: reversed apical rotation as a marker of disease severity. Eur J Heart Fail. 2009, 11: 945-951.
22张伶俐,谢明星,王新房等.应用超声二维斑点追踪成像技术评价扩张性心脏病患者左室扭转的初步研究.中国医学影像技术. 2007, 23: 1313-1316.
23 Meluzin J, Spinarova L, Hude P, et al. Left ventricular mechanics in idiopathic dilated cardiomypathy:systolic-diastolic coupling and torsion. J Am Soc Echocardiogr. 2009, 22:486-493.
24 Chandrashekhar Y. Role of apoptosis in ventricular remodeling. Curr Heart Fail Rep. 2005, 2: 18-22.
25谢明星,李朝军,王新房等.超声斑点追踪成像评价心功能不全患者收缩期心肌扭转的初步研究.中华超声影像学杂志. 2009, 18: 381-384.
26 Frederic AT, David TM, Tomasz AT, et al. Alterations in left ventricular torsion in tachycardia-induced dilated cardiomyopathy. J Thorac Cardiovasc Surg. 2002. 124: 43-49.
27 Chai PJ, Williamson JA, Lodge AJ, et al. Effects of ischemia on pulmonary dysfunction after cardiopulmonary bypass.Ann Thorac Surg. 1999, 67: 731-735.
28 Shivalkar B, Flameng W, Szilard M, et al. Repeated stunning precedes myocardial hibernation in progressive multiple coronary artery obstruction. J Am Coll Cardiol. 1999, 34: 2126-2136.
29 Brown PM Jr, Kim VB, Boyer BJ, et al. Regional left ventricular systolic function in humans during off-pump coronary bypass surgery. Circulation. 1999, 100: 125-127.
30 Esch BT, Scott JM, Warburton DE, et al. Left ventricular torsion and untwisting during exercise in heart transplant recipients. J Physiol. 2009, 1587: 2375-2386.
31潘翠珍,陈昊,舒先红等.斑点追踪显像评价心脏移植左心室收缩及扭转功能.中华超声影像学杂志. 2008, 17: 268-230.
32 Mirro MJ, Rogers EW, Weyman AE, et al. Angular displacement of the papillary muscles during cardiac cycle. Circulation. 2008, 60: 328-333.
33 Dong L, Zhang F, Shu X, et al. Left ventricular torsion in patients with secundum atrial septal defect. Circ J. 2009, 73: 1308-1314.
34 Ramani GV, Bazaz R, Edelman K, et al. Pulmonary Hypertension Affects Left Ventricular Basal Twist: A Novel Use for Speckle-Tracking Imaging. Echocardiography. 2009; 26: 44-51.
35宋家琳,黎春雷,童春等.斑点追踪显像对房间隔缺损患者左心旋转和扭转运动的初步研究.中华超声影像学杂志. 2008, 14: 277-280.