本文選題：房顫 + 心衰　； 參考：《鄭州大學》2017年碩士論文

【摘要】：目的心房顫動是臨床上最常見的心律失常之一,影響患者生存質(zhì)量,可使患者的卒中和心衰發(fā)生率明顯增加,是我國最主要的致殘和致死疾病之一[1]。房顫發(fā)作時心房失去有效的收縮射血功能,加之快速而不規(guī)則的心室率,使左室收縮功能和順應性受損[2],從而進一步影響左室局部及整體功能。關(guān)于左室心肌局部和整體功能的定量評價,已經(jīng)受到影像診斷的廣泛關(guān)注,而目前卻較少對左室心肌功能的分層分析進行深入研究。本文以房顫患者為研究對象,利用2D-STI評價房顫患者左室心肌分層應變,初步探討房顫患者左室分層應變變化規(guī)律。方法48例房顫無心衰組,32例房顫合并心衰組,40例正常對照組。常規(guī)測量,采集動態(tài)圖像后,應用Echo PAC113軟件分析二維動態(tài)圖像,獲得左室18個節(jié)段心內(nèi)膜、中層心肌和心外膜各層的收縮期峰值縱向應變及心內(nèi)膜、中層心肌和心外膜整體收縮期峰值縱向應變。常規(guī)超聲測量指標:Simpson法測量左室射血分數(shù)(LVEF),左房內(nèi)徑(LAD)、左室舒張末內(nèi)徑(LVEDD)、左室收縮末內(nèi)徑(LVESD)以及舒張早期二尖瓣口血流速度(E)和室間隔處二尖瓣環(huán)運動速度(e')的比值E/e'。節(jié)段分層應變指標:十八節(jié)段心內(nèi)膜收縮期峰值縱向應變(PLSEndo)、中層心肌收縮期峰值縱向應變(PLSMid)、心外膜收縮期峰值縱向應變(PLSEpi)。整體分層應變指標:心內(nèi)膜整體收縮期峰值縱向應變(GPLSEndo)、中層心肌整體收縮期峰值縱向應變(GPLSMid)、心外膜整體收縮期峰值縱向應變(GPLSEpi)及全層心肌整體收縮期峰值縱向應變(GPLS)。結(jié)果1、常規(guī)超聲心動圖測量參數(shù)比較:與對照組相比,房顫無心衰組左室舒張末內(nèi)徑、左室收縮末內(nèi)徑、左室射血分數(shù)均無統(tǒng)計學差異,但左房內(nèi)徑、舒張早期二尖瓣口血流速度(E)和室間隔處二尖瓣環(huán)運動速度(e')的比值E/e'有差異(P0.05)。房顫合并心衰組與對照組相比左房內(nèi)徑、左室舒張末內(nèi)徑、左室收縮末內(nèi)徑、左室射血分數(shù)以及舒張早期二尖瓣口血流速度(E)和室間隔處二尖瓣環(huán)運動速度(e')的比值E/e'均有顯著統(tǒng)計學差異(P0.01)。2、節(jié)段分層應變的比較:與對照組比較,房顫無心衰組及房顫合并心衰組基底段、中間段、心尖段心內(nèi)膜收縮期峰值縱向應變(PLSEndo)、中層心肌收縮期峰值縱向應變(PLSMid)、心外膜收縮期峰值縱向應變(PLSEpi)均減低,差異均有統(tǒng)計學意義(P0.05)。房顫合并心衰組與房顫無心衰組相比,基底段、中間段、心尖段心內(nèi)膜收縮期峰值縱向應變(PLSEndo)、中層心肌收縮期峰值縱向應變(PLSMid)、心外膜收縮期峰值縱向應變(PLSEpi)均減低,差異均有統(tǒng)計學意義(P0.05)。3、整體分層應變的比較:與對照組比較,房顫無心衰組及房顫合并心衰組的心內(nèi)膜、中層心肌、心外膜整體收縮期峰值縱向應變(GPLSendo、GPLSMid、GPLSepi)及左室整體全層收縮期峰值縱向應變(GPLS)明顯減低,差異有統(tǒng)計學意義(P0.05)。房顫合并心衰組與房顫無心衰組相比,心內(nèi)膜、中層心肌、心外膜整體收縮期峰值縱向應變(GPLSendo、GPLSMid、GPLSepi)及左室整體的全層收縮期峰值縱向應變(GPLS)明顯減低,差異有統(tǒng)計學意義(P0.05)。對照組所有入選者左室自內(nèi)層到外層心肌的GPLS均依次減低。4.ROC曲線分析左室全層整體縱向應變對房顫患者左室心肌的檢測左室全層整體縱向應變檢測房顫患者左室心肌的曲線下面積為84.9%,當截斷點為-21.38%時,靈敏度77.7%,特異度72.5%。結(jié)論分層應變技術(shù)可定量分層評價房顫患者左室心肌的整體及局部功能,具有一定的臨床應用價值。
[Abstract]:Objective atrial fibrillation is one of the most common arrhythmia in clinic. It affects the quality of life of the patients. It can increase the incidence of stroke and heart failure in patients. It is one of the most important deformity and fatal diseases in China, one of the most fatal diseases in China, [1]. atrial fibrillation, the atrial loss of effective systolic ejection function, coupled with the rapid and irregular ventricular rate, make the left ventricular contraction. Function and compliance damage [2], which further affects the local and overall function of the left ventricle. The quantitative assessment of the local and overall function of the left ventricular myocardium has received extensive attention from the imaging diagnosis. At present, there is less in-depth study of the stratified analysis of left ventricular myocardial function. This article uses 2D-STI to evaluate the patients with atrial fibrillation. Stratified strain of left ventricular myocardium in patients with atrial fibrillation was preliminarily investigated. Methods 48 cases of atrial fibrillation, 32 cases of atrial fibrillation, heart failure, 40 cases of normal control. After routine measurement, dynamic images were collected, and two dimensional dynamic images were analyzed with Echo PAC113 software to obtain 18 segments of the left ventricular endocardium and middle layer. Peak systolic peak longitudinal strain and endocardium, middle myocardial and epicardial systolic peak longitudinal strain. Conventional ultrasonic measurement index: Simpson method to measure left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and early diastolic mitral valve flow The ratio of velocity (E) and mitral annulus velocity (E') at ventricular septum E/e'. segment stratified strain index: Eighteen segment endocardial systolic peak longitudinal strain (PLSEndo), middle myocardial systolic peak longitudinal strain (PLSMid), epicardial systolic peak longitudinal strain (PLSEpi). Overall stratified strain index: the peak systolic peak value of endocardium Longitudinal strain (GPLSEndo), median myocardial total systolic peak longitudinal strain (GPLSMid), epicardial systolic peak longitudinal strain (GPLSEpi) and total systolic peak longitudinal strain (GPLS). Results 1, conventional echocardiographic measurements were compared: compared with the control group, the left ventricular end diastolic diameter, left ventricle, and left ventricle were compared with the control group. There was no statistical difference between the end systolic diameter and the left ventricular ejection fraction, but the left atrial diameter, the early diastolic flow velocity of mitral valve mouth (E) and the ratio of the mitral annulus velocity (E') in the interventricular septum were different (P0.05). The left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter and left ventricular ejection fraction were compared with the control group (P0.05) in the early diastolic diameter of the left atrium (E). The ratio of mitral valve flow velocity (E) and mitral annulus velocity (E') at the ventricular septum in the early diastolic phase and the ratio E/e' of the mitral annulus velocity (E') in the interventricular septum had significant statistical difference (P0.01).2, compared with the control group, and compared with the control group, the basal segment of atrial fibrillation and atrial fibrillation combined with heart failure group, the middle segment, and the peak longitudinal strain of the endocardium systolic phase of the apical segment (PLSEnd) O), the peak systolic peak longitudinal strain (PLSMid), the peak systolic peak longitudinal strain (PLSEpi) of the epicardium all decreased, and the difference was statistically significant (P0.05). The atrial fibrillation combined with the heart failure group was compared with the heart failure group of the atrial fibrillation, the basal segment, the middle segment, the peak longitudinal strain of the endocardium systolic peak in the apical segment (PLSEndo), and the peak systolic peak length of the middle myocardium. Strain (PLSMid), epicardial peak systolic peak longitudinal strain (PLSEpi) decreased, and the difference was statistically significant (P0.05).3, the overall stratified strain comparison: compared with the control group, the endocardium, the middle myocardium, the epicardial systolic peak longitudinal strain (GPLSendo, GPLSMid, GPLSepi) and the left ventricle were compared with the control group. The overall total systolic peak longitudinal strain (GPLS) was significantly reduced, and the difference was statistically significant (P0.05). The endocardium, the middle myocardium, the peak systolic peak longitudinal strain (GPLSendo, GPLSMid, GPLSepi) and the total systolic peak longitudinal strain (GPLS) in the left ventricular whole of the heart failure group and the atrial fibrillation group were significantly lower than those of the heart failure group of atrial fibrillation. The difference was statistically significant (P0.05). The GPLS in all the left ventricular from the left ventricular to the outer layer of the left ventricular myocardium in all the controls was reduced by.4.ROC curve. The left ventricular myocardium in the left ventricular myocardium in patients with atrial fibrillation was detected by the overall longitudinal strain of the left ventricle. The area of the left ventricular myocardium in the left ventricular myocardium of the patients with atrial fibrillation was 84.9%, and the truncated point was -21.. At 38%, the sensitivity of 77.7%, specificity 72.5%. conclusion stratified strain technique can be used to quantitatively evaluate the overall and local function of left ventricular myocardium in patients with atrial fibrillation, which has certain clinical value.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R540.45;R541.75

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