本文選題：斑點(diǎn)追蹤成像 + 二維應(yīng)變��； 參考：《第二軍醫(yī)大學(xué)》2014年碩士論文

【摘要】：第一部分二維斑點(diǎn)追蹤成像技術(shù)評(píng)價(jià)正常人左心房功能的研究 目的：運(yùn)用斑點(diǎn)追蹤成像技術(shù)（speckle tracking imaging, STI）評(píng)價(jià)不同年齡段正常人左心房的功能，總結(jié)代表左心房儲(chǔ)存功能、管道功能及輔助泵功能的應(yīng)變及應(yīng)變率參數(shù)的變化趨勢(shì)，為進(jìn)一步研究病理狀態(tài)下左心房功能變化提供基礎(chǔ)資料。 方法：選取2012年3月～2013年3月期間在長海醫(yī)院超聲科行心臟超聲檢查的90例健康體檢者，男53例，女37例；年齡23～81歲，平均54.7±11.82歲；按其年齡分為三組：青年組30例：年齡≤45歲，平均33.5±7.91（23～45）歲，中年組30例：45＜年齡≤65歲，平均54.9±8.15（46～65）歲；老年組30例：年齡＞65歲，72.3±5.83（66～81）歲。常規(guī)行超聲心動(dòng)圖檢查，記錄左心房及左心室相應(yīng)測(cè)量數(shù)據(jù)，采集相應(yīng)時(shí)相及切面的左心房二維超聲動(dòng)態(tài)圖像并存盤，運(yùn)用STI技術(shù)對(duì)三組受檢查者的二維超聲動(dòng)態(tài)圖像進(jìn)行脫機(jī)分析處理并建立相應(yīng)數(shù)據(jù)庫，比較分析各個(gè)年齡段左心房常規(guī)超聲測(cè)量指標(biāo)及應(yīng)變和應(yīng)變率參數(shù)測(cè)量指標(biāo)的差異，總結(jié)其變化趨勢(shì)。 結(jié)果：1.青年組、中年組及老年組間在性別、心率、收縮壓、舒張壓等方面差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；老年組二維超聲心動(dòng)圖測(cè)得的左心室舒張末期內(nèi)徑（LVIDd）、左心室收縮末期內(nèi)徑（LVIDs）值均大于青、中年組，左心室射血分?jǐn)?shù)（LVEF）值小于青、中年組，但無顯著性差異（P＞0.05）；老年組左房內(nèi)徑（LAD）及左心房最大容積（LAVmax）、左心房最小容積（LAVmin）值均較青年組及中年組高，且左心房總射血分?jǐn)?shù)（TLAEF）、左心房被動(dòng)射血分?jǐn)?shù)（PLAEF）值均有不同程度降低，以左心房被動(dòng)射血分?jǐn)?shù)（PLAEF）降低明顯，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；老年組左心房收縮前容積（LAVpreA）、左心房主動(dòng)射血分?jǐn)?shù)（ALAEF）較青、中年組高（P＜0.05）；老年組E峰、A峰值與青年組及中年組比較無顯著性差異（P＞0.05），但E/A比值明顯降低、E峰減速時(shí)間（DT）顯著延長（P＜0.05）。 2.三組受檢者左心房側(cè)壁的應(yīng)變率值（SR）最高，房間隔最低（P＜0.05），前壁和后壁之間差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；左心房各壁基底段的應(yīng)變率最高（P＜0.05），中間段和上段差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；老年組收縮期及舒張?jiān)缙趹?yīng)變率（SRs、SRe）均較青、中年組低，且以側(cè)壁和前壁的基底段下降明顯，舒張晚期的應(yīng)變率（SRa）較青、中年組高（P＜0.05）。 3.老年組基底段達(dá)峰時(shí)間較青年組和中年組長（P＜0.05），中年組大于青年組，但差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；老年組與中年組中間段達(dá)峰時(shí)間較青年組長，而中年組與老年組間無顯著差異（P＞0.05）； 4.左心房整體的應(yīng)變率SRs與TLAEF、SRe與PLAEF、SRa與ALAEF良好的相關(guān)性。 結(jié)論：STI技術(shù)能夠準(zhǔn)確評(píng)價(jià)左心房的功能，并得出各年齡段左心房正常的應(yīng)變及應(yīng)變率參考值；且隨著年齡的增長，，左心房功能逐漸下降，左心房下壁及側(cè)壁的應(yīng)變參數(shù)是其功能早期改變的敏感預(yù)測(cè)指標(biāo)。 第二部分二維斑點(diǎn)追蹤成像技術(shù)評(píng)價(jià)心房顫動(dòng)患者在射頻消融術(shù)前后左心房功能的變化 目的：運(yùn)用STI技術(shù)評(píng)價(jià)心房顫動(dòng)患者在經(jīng)導(dǎo)管射頻消融術(shù)前及術(shù)后不同階段左心房功能的變化情況，檢測(cè)左心房壁各節(jié)段應(yīng)變參數(shù)的變化趨勢(shì)和規(guī)律，總結(jié)經(jīng)導(dǎo)管射頻消融術(shù)后左心房功能變化的敏感指標(biāo)，確定判斷房顫復(fù)發(fā)可能性的預(yù)測(cè)指標(biāo)，為其療效的判定、后期治療及預(yù)后提供影像學(xué)依據(jù)。 方法：選取2012年1月～2013年12月期間在長海醫(yī)院心內(nèi)科行導(dǎo)管射頻消融術(shù)治療的心房顫動(dòng)患者48例，其中陣發(fā)性房顫33例，年齡49～76歲，平均65.8±12.41歲，男18例，女15例，持續(xù)性房顫15例，年齡55～81歲，平均68.6±11.48歲，男9例，女6例；記錄其相應(yīng)臨床資料；分別于術(shù)前1天、術(shù)后3天、3個(gè)月、6個(gè)月行超聲心動(dòng)圖檢查，記錄左心房及左心室相應(yīng)測(cè)量數(shù)據(jù)，采集相應(yīng)時(shí)相及切面的左心房二維超聲動(dòng)態(tài)圖像并存盤，運(yùn)用STI技術(shù)對(duì)受檢查者的二維超聲動(dòng)態(tài)圖像進(jìn)行脫機(jī)分析處理并建立相應(yīng)數(shù)據(jù)庫。對(duì)比分析其常規(guī)超聲心動(dòng)圖參數(shù)、二維應(yīng)變參數(shù)的變化情況。 結(jié)果：所有的房顫患者在射頻消融術(shù)后即時(shí)均成功轉(zhuǎn)復(fù)為竇性心律，在術(shù)后的6個(gè)月隨訪中，33例陣發(fā)性房顫患者中有4例患者出現(xiàn)房顫復(fù)發(fā)，余29例均維持竇性心律；15例持續(xù)性房顫患者中6例在術(shù)后維持竇性心律，余9例患者均出現(xiàn)房顫復(fù)發(fā)。 1.持續(xù)性房顫組、陣發(fā)性房顫組在性別、收縮壓、舒張壓等方面與正常對(duì)照組之間的差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；持續(xù)性房顫組的心率較正常對(duì)照組快（P＜0.05），陣發(fā)性房顫組與正常對(duì)照組無顯著性差異（P＞0.05）。 2.陣發(fā)性房顫組、持續(xù)性房顫術(shù)前及術(shù)后的3天、3月、6月隨訪中在LVIDd、LVIDs、LVEF等方面與正常對(duì)照組比較，差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05）； 3.陣發(fā)性房顫組術(shù)前LAD較正常對(duì)照組大，E/A比值降低，且DT時(shí)間延長（P＜0.05）；術(shù)后3月E/A值增加，DT時(shí)間縮短，但與術(shù)前相較差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；術(shù)后6月E/A值較術(shù)前增加明顯，DT也明顯減少，但均低于正常對(duì)照組水平（P＜0.05）； 4.持續(xù)性房顫組在術(shù)前左心房各壁的應(yīng)變率值均較正常對(duì)照組低（P＜0.05），陣發(fā)性房顫組則與正常對(duì)照組無顯著性差異（P＞0.05）； 5.術(shù)后3天，陣發(fā)性房顫組、持續(xù)性房顫組左心房各壁的上段應(yīng)變率值均較術(shù)前降低，術(shù)后3月，其上段應(yīng)變率值有不同程度升高，但均低于正常對(duì)照組（P＜0.05）； 6.術(shù)后6月維持竇性心律的患者，其左心房各壁的應(yīng)變率值較術(shù)前增高，而復(fù)發(fā)房顫的患者，其應(yīng)變率值進(jìn)一步下降（P＜0.05）。 結(jié)論：房顫患者較同齡正常人左心房功能降低，尤其是持續(xù)性房顫的患者；在導(dǎo)管消融術(shù)后，左心房上段心肌形變能力減低；STI技術(shù)能夠評(píng)估房顫患者左心房功能，并且可以作為房顫復(fù)發(fā)的預(yù)測(cè)指標(biāo)。
[Abstract]:Part two evaluation of left atrial function in normal subjects by two-dimensional speckle tracking imaging
Objective: To evaluate the function of left atrium in normal people of different ages by speckle tracking imaging (STI), and to summarize the change trend of strain and strain rate parameters representing the left atrium storage function, the function of the pipe and the function of auxiliary pump, so as to provide the basic data for the further study of the changes of left atrium function under the pathological condition.
Methods: from March 2012 to March 2013, 90 healthy subjects, 53 males and 37 females, were enrolled in the ultrasound department of Changhai Hospital. The age was 23~81 years old and the average was 54.7 + 11.82 years old. According to their age, there were three groups: the young group was 30 cases, the average age was 33.5 + 7.91 (23~45) years, and the middle-aged group was less than equal. The average 54.9 + 8.15 (46~65) years old and 30 aged group: age > 65 years and 72.3 + 5.83 (66~81) years. Routine echocardiography was performed to record the left atrium and left ventricle of the left atrium. The two-dimensional ultrasound dynamic images of the left atrium and the left atrium were collected and the STI technique was applied to the two-dimensional ultrasound dynamic map of the three groups. The difference between the conventional ultrasonic measurement indexes of the left atrium and the parameters of the strain rate and strain rate parameters of the left atrium in all ages was compared, and the trend of the change was summarized.
Results: there was no significant difference in gender, heart rate, systolic pressure and diastolic pressure between the middle age group and the elderly group (P > 0.05). The left ventricular end diastolic diameter (LVIDd) and the left ventricular end diameter (LVIDs) value of the elderly group were greater than those of the old group, and the left ventricular end systolic diameter (LVIDs) values were all larger than those of the old group, and the middle age group and the left ventricular ejection fraction (LVEF) were less than those in the old group. In the middle-aged group, there was no significant difference (P > 0.05). The left atrium diameter (LAD) and the left atrial maximum volume (LAVmax) and the left atrial minimum volume (LAVmin) were higher in the elderly group than in the young group and the middle age group, and the left atrium total ejection fraction (TLAEF), the left atrial passive ejection fraction (PLAEF) decreased in varying degrees, and the left atrial passive ejection fraction (P). LAEF) decreased significantly (P < 0.05), the volume of left atrial pre systolic volume (LAVpreA) and left atrial active ejection fraction (ALAEF) were higher in the elderly group than in the middle age group (P < 0.05); the peak of E in the elderly group had no significant difference between the young group and the middle age group (P > 0.05), but the E/A ratio decreased significantly, and the E peak deceleration time (DT) was significantly extended. Long (P < 0.05).
2. the left atrial lateral wall strain rate (SR) was the highest (P < 0.05), and there was no significant difference between the anterior and posterior walls (P > 0.05). The strain rate of the basal segments of the left atrium was the highest (P < 0.05), and the difference between the middle and upper segments was not statistically significant (P > 0.05), and the systolic and early diastolic strain rates (SRs, SR) in the elderly group (SRs, SR). E) were lower than those in the young and middle-aged group, and the basal segments of the lateral and anterior wall decreased significantly. The strain rate (SRa) of late diastolic phase was higher than that of the green group and the middle age group was higher (P < 0.05).
3. the peak time of the basal segment of the aged group was more than that of the young group and the middle age group (P < 0.05), the middle age group was larger than the young group, but the difference was not statistically significant (P > 0.05); the middle period of the elderly group and the middle age group was longer than the young group, but there was no significant difference between the middle age group and the elderly group (P > 0.05).
4. there is a good correlation between the strain rate SRs of left atrium and TLAEF, SRe and PLAEF, SRa and ALAEF.
Conclusion: STI technique can accurately evaluate the function of left atrium and draw a reference value for the normal strain and strain rate of left atrium in all ages. With the increase of age, the function of left atrium gradually decreases, and the strain parameters of the lower and lateral walls of the left atrium are sensitive predictors of early functional changes of the left atrium.
The second part two dimensional speckle tracking imaging is used to evaluate the changes of left atrial function before and after radiofrequency ablation in patients with atrial fibrillation.
Objective: To evaluate the changes of left atrial function in patients with atrial fibrillation before and after transcatheter radiofrequency ablation by STI technique, to detect the change trend and regularity of the strain parameters of each segment of the left atrial wall, and to sum up the sensitive index of the changes of left atrial function after catheter radiofrequency ablation, and to determine the possibility of recurrence of atrial fibrillation. The predictive indexes provide the imaging evidence for the judgement of the curative effect, the later treatment and the prognosis.
Methods: from January 2012 to December 2013, 48 patients with atrial fibrillation treated by catheter radiofrequency ablation in Department of Cardiology, Changhai Hospital, including 33 cases of paroxysmal atrial fibrillation, age 49~76 years old, average 65.8 + 12.41 years, 18 men, 15 women, 15 cases of persistent atrial fibrillation, average age 55~81 years, average 68.6 + 11.48 years, male 9, female 6, were recorded. The corresponding clinical data were performed 1 days before the operation, 3 days after the operation, 3 months and 6 months after the operation, and the left atrium and left atrium were recorded by the echocardiography. The two-dimensional ultrasound dynamic images of the left atrium and the left atrium were collected and the STI technique was used to analyze and process the two-dimensional ultrasonic dynamic images of the examiners. Establish a corresponding database, and compare the changes of conventional echocardiographic parameters and two-dimensional strain parameters.
Results: all patients with atrial fibrillation were successfully converted to sinus rhythm after radiofrequency ablation. During the 6 month follow-up, 4 of 33 patients with paroxysmal atrial fibrillation had recurrent atrial fibrillation, 29 remained sinus rhythm, 6 of 15 patients with persistent atrial fibrillation maintained sinus rhythm after operation and 9 patients had atrial fibrillation. Relapse.
1. in the group of persistent atrial fibrillation, there was no significant difference in sex, systolic pressure and diastolic pressure in paroxysmal atrial fibrillation group (P > 0.05), and the heart rate of persistent atrial fibrillation group was faster than that of normal control group (P < 0.05), and there was no significant difference between paroxysmal atrial fibrillation group and normal control group (P > 0.05).
2. paroxysmal atrial fibrillation group, 3 days before and after the operation of persistent atrial fibrillation, in March, June, in the LVIDd, LVIDs, LVEF and other aspects compared with the normal control group, the difference was not statistically significant (P > 0.05).
The preoperative LAD of 3. paroxysmal atrial fibrillation group was larger than that of the normal control group, the ratio of E/A decreased and the time of DT prolonged (P < 0.05). The E/A value increased in March and the time of DT shortened, but there was no statistical difference between the preoperative and preoperative (P > 0.05). The value of E/A in June after the operation was significantly higher than that before the operation, and the DT also decreased, but all were lower than the normal control group (P < 0.05).
4. the strain rate of all the left atrial walls in the continuous atrial fibrillation group was lower than that in the normal control group (P < 0.05), but there was no significant difference between the paroxysmal atrial fibrillation group and the normal control group (P > 0.05).
5. after 3 days, the strain rate of the left atrium in the paroxysmal atrial fibrillation group was lower than that before the operation. In March after the operation, the strain rate of the upper segment increased in different degrees, but all were lower than that of the normal control group (P < 0.05).
The strain rate of each wall in the left atrium was higher than that before operation in the patients who maintained the sinus rhythm in June after 6., and the strain rate of the patients with recurrent atrial fibrillation was further decreased (P < 0.05).
Conclusion: Patients with atrial fibrillation have lower left atrial function than normal people of the same age, especially in patients with persistent atrial fibrillation. After catheter ablation, the deformation ability of the left atrium in the left atrium is reduced; STI technique can evaluate the left atrial function in patients with atrial fibrillation and can be used as a predictor of atrial fibrillation recurrence.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R541.75;R540.45

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