應(yīng)用三維斑點追蹤技術(shù)評價冠心病患者左室扭轉(zhuǎn)運動及位移的初步研究
發(fā)布時間：2018-07-27 11:45
【摘要】：目的：應(yīng)用超聲三維斑點追蹤技術(shù)對冠心病(Coronary Artery Disease，CAD)患者左室扭轉(zhuǎn)運動特征及位移參數(shù)進(jìn)行評價，并探討兩者的相關(guān)性。 方法：選取我院2012年9月至2013年3月行冠狀動脈造影檢查確診為冠心病的患者120例，男75例，女45例，年齡36-81歲，平均（57.36土12.96）歲，依冠狀動脈狹窄部位分為左前降支組(LAD組,n=47)、左旋支組（LCX組，n=25)、右冠狀動脈組(RCA組，n=23)、多支病變組(n=25)，左主干病變歸入多支組。選取40例健康志愿者作為正常對照組，其中男25例，女15例，年齡22～76歲，平均(49.14土12.57)歲，根據(jù)病史及體檢、心電圖、常規(guī)超聲心動圖等相關(guān)檢查排除器質(zhì)性心臟疾患。 采用TOSHIBA ARTIDA彩色多普勒超聲診斷儀，同步記錄胸導(dǎo)聯(lián)心電圖，待患者平靜呼吸后，采用PST-30SBT二維探頭經(jīng)胸采集常規(guī)超聲參數(shù)，切換至PST-25SX三維探頭，獲取并存儲左室三維全容積動態(tài)圖像，隨后運用三維斑點追蹤軟件對存儲的圖像進(jìn)行脫機分析，儀器自動獲得左室整體、基底段、中間段、心尖段扭轉(zhuǎn)角度峰值（PGT、 PBT、PMT、PAT）及相應(yīng)節(jié)段的達(dá)峰時間（Time-PGT、Time-PBT、Time-PMT、Time-PAT），左室射血分?jǐn)?shù)（LVEF）、左室整體及各節(jié)段三維位移(three-dimensional displacement，P3DD)等指標(biāo)。將CAD各組和對照組的上述指標(biāo)進(jìn)行對比研究，并分析左室扭轉(zhuǎn)角度峰值與位移參數(shù)、LVEF的相關(guān)性。 結(jié)果：1.一般臨床資料比較：兩組患者的年齡、身高、體重、心率、收縮壓、舒張壓相比，無明顯差異（P0.05）。2.常規(guī)超聲心動圖參數(shù)比較：與對照組患者比較：CAD各組LVEF減低，差異均有統(tǒng)計學(xué)意義（P0.05）；LAD組、多支組LA、LVIDd、LVIDs增大，LVESV、LVEDV明顯增加，LVEF減少,差異均有統(tǒng)計學(xué)意義（P0.05或0.01）。3.CAD組與對照組左室各節(jié)段收縮期扭轉(zhuǎn)角度峰值及達(dá)峰時間的比較：與對照組比較：（1）CAD組PGT、PAT均減低，差異有統(tǒng)計學(xué)意義（P0.05或0.01）；（2）LCX組、RCA組心尖、心底水平左室收縮期扭轉(zhuǎn)趨勢與正常對照組一致，PBT、PMT有減低趨勢，但差異無統(tǒng)計學(xué)意義；Time-PBT較對照組明顯延遲，差異有統(tǒng)計學(xué)意義（P0.05），Time-PMT雖較對照組延遲，但差異無統(tǒng)計學(xué)意義（P0.05）；（3）LAD組PBT較對照組減低，差異有統(tǒng)計學(xué)意義（P0.05）；PMT較對照組減低，差異無統(tǒng)計學(xué)意義（P0.05），Time-PMT較對照組明顯延遲，差異有統(tǒng)計學(xué)意義（P0.05）；（4）多支組PBT、PMT較對照組明顯減低，差異均有統(tǒng)計學(xué)意義(P0.01)，各節(jié)段扭轉(zhuǎn)角度達(dá)峰時間均較對照組減低，差異有統(tǒng)計學(xué)意義。4.CAD組與對照組左室各節(jié)段及整體三維位移比較：CAD組患者左室整體三維位移明顯減低(P0.05)；與對照組相比，LAD組前壁各段、前側(cè)壁基底段及中間段、側(cè)壁心尖段、心尖部P3DD明顯減低，差異有統(tǒng)計學(xué)意義（P0.05或0.01）；LCX組下間隔基底段及中間段、前間隔基底段及中間段、間隔心尖段P3DD明顯減低，差異有統(tǒng)計學(xué)意義（P0.05或0.01），RCA組下側(cè)壁基底段及中間段、下壁各段P3DD明顯減低，差異有統(tǒng)計學(xué)意義（P0.05或0.01），多支病變組左室壁各節(jié)段收縮期峰值三維位移顯著下降。5.參數(shù)相關(guān)性分析：CAD組PGT、PAT、PBT均與LVEF、P3DD呈正相關(guān)，PAT與LVEF、P3DD相關(guān)性好（r1=0.53，，P10.05；r2=0.44，P20.05），PGT與LVEF、P3DD相關(guān)性弱（r1=0.017，P10.05；r2=0.009，P20.05）。 結(jié)論：3D-STI可以在三維空間內(nèi)實時研究左室位移及扭轉(zhuǎn)運動，從而敏感的檢測CAD患者的左室收縮功能減低，為CAD的診斷提供重要線索，具有廣闊的應(yīng)用前景。
[Abstract]:Objective: To evaluate the left ventricular torsion and displacement parameters in patients with Coronary Artery Disease (CAD) by ultrasonic three-dimensional speckle tracking technique, and to explore the correlation between them.
Methods: 120 cases of coronary heart disease diagnosed by coronary angiography from September 2012 to March 2013 were selected, 75 men, 45 women, 36-81 years old, and the average (57.36 soil 12.96) years old. They were divided into left anterior descending group (group LAD, n=47), left circumflex group (group LCX, n=25), right coronary artery group (RCA group, n=23), multiple branch lesions. Group (n=25), left main artery disease was classified into multiple groups. 40 healthy volunteers were selected as normal control group, including 25 male, 15 female, 22~76 years old and average (49.14 soil 12.57) years old. The medical history and physical examination, electrocardiogram, routine echocardiography and other related examinations were used to exclude qualitative heart disease.
The TOSHIBA ARTIDA color Doppler ultrasound diagnostic instrument is used to synchronize the chest lead electrocardiogram. After the patient's calm breathing, the PST-30SBT two-dimensional probe is used to collect the conventional ultrasonic parameters through the chest, and switch to the PST-25SX three-dimensional probe to obtain and store the three-dimensional full volume dynamic image of the left ventricle, and then use the 3D speckle tracking software for the stored image. By off-line analysis, the instrument automatically obtained the left ventricular whole, the basal segment, the middle segment, the peak of the torsional angle of the apical segment (PGT, PBT, PMT, PAT) and the peak time of the corresponding segments (Time-PGT, Time-PBT, Time-PMT, Time-PAT), the left ventricular ejection fraction (LVEF), the left ventricular body and the three dimensional displacement of each segment (three-dimensional displacement, P3DD) and other indicators. The above indexes were compared in each group and the control group, and the correlation between the peak value of left ventricular twist and the displacement parameters and LVEF was analyzed.
Results: 1. comparison of general clinical data: compared with the age, height, weight, heart rate, systolic pressure and diastolic pressure in the two groups, there was no significant difference (P0.05).2. routine echocardiographic parameters: compared with the control group, LVEF decreased in each group of CAD, the difference was statistically significant (P0.05); LAD, LA, LVIDd, LVIDs, LVESV, LVED in group LAD V significantly increased, LVEF decreased, the difference was statistically significant (P0.05 or 0.01).3.CAD and the control group of the left ventricular systolic twist angle peak and peak time: (1) CAD group PGT, PAT decreased, the difference was statistically significant (P0.05 or 0.01); (2) LCX group, RCA group apex, left ventricular systolic twist The trend was in accordance with the normal control group, PBT, PMT had a decreasing trend, but the difference was not statistically significant; Time-PBT was significantly delayed in comparison with the control group (P0.05). Although Time-PMT was delayed in comparison with the control group, there was no significant difference (P0.05); (3) the PBT in the LAD group was lower than the control group (P0.05); PMT was compared with the control group. The difference was not statistically significant (P0.05), and Time-PMT was significantly delayed in comparison with the control group (P0.05). (4) multiple groups of PBT and PMT were significantly lower than those in the control group (P0.01), and the peak time of each segment was lower than that in the control group, and the difference was statistically significant between the.4.CAD group and the control group left ventricular segments. In group CAD, the three-dimensional displacement of the left ventricle decreased significantly (P0.05). Compared with the control group, the anterior wall of the LAD group, the basal and middle segment of the anterior wall, the apical segment of the lateral wall and the apical P3DD decreased significantly (P0.05 or 0.01), and the basal segment and the middle segment of the lower interval of group LCX, the basal segment of the anterior septum, and the basal segment of the anterior septum. In the middle segment, the apical P3DD was significantly reduced, the difference was statistically significant (P0.05 or 0.01). The lower lateral wall and the middle segment of the lower wall of the RCA group decreased significantly (P0.05 or 0.01). The three-dimensional displacement of the systolic peak value of the left ventricular wall in the left ventricular wall decreased significantly by the.5. parameter correlation analysis: CAD group PGT, P AT, PBT are positively related to LVEF, P3DD, PAT and LVEF, P3DD is good (r1=0.53, P10.05; r2=0.44, P20.05).
Conclusion: 3D-STI can be used to study the left ventricular displacement and torsional movement in three dimensional space, so as to detect the left ventricular systolic function of CAD patients sensitive and provide an important clue for the diagnosis of CAD, and it has a broad application prospect.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R541.4;R445.1
本文編號：2147718
[Abstract]:Objective: To evaluate the left ventricular torsion and displacement parameters in patients with Coronary Artery Disease (CAD) by ultrasonic three-dimensional speckle tracking technique, and to explore the correlation between them.
Methods: 120 cases of coronary heart disease diagnosed by coronary angiography from September 2012 to March 2013 were selected, 75 men, 45 women, 36-81 years old, and the average (57.36 soil 12.96) years old. They were divided into left anterior descending group (group LAD, n=47), left circumflex group (group LCX, n=25), right coronary artery group (RCA group, n=23), multiple branch lesions. Group (n=25), left main artery disease was classified into multiple groups. 40 healthy volunteers were selected as normal control group, including 25 male, 15 female, 22~76 years old and average (49.14 soil 12.57) years old. The medical history and physical examination, electrocardiogram, routine echocardiography and other related examinations were used to exclude qualitative heart disease.
The TOSHIBA ARTIDA color Doppler ultrasound diagnostic instrument is used to synchronize the chest lead electrocardiogram. After the patient's calm breathing, the PST-30SBT two-dimensional probe is used to collect the conventional ultrasonic parameters through the chest, and switch to the PST-25SX three-dimensional probe to obtain and store the three-dimensional full volume dynamic image of the left ventricle, and then use the 3D speckle tracking software for the stored image. By off-line analysis, the instrument automatically obtained the left ventricular whole, the basal segment, the middle segment, the peak of the torsional angle of the apical segment (PGT, PBT, PMT, PAT) and the peak time of the corresponding segments (Time-PGT, Time-PBT, Time-PMT, Time-PAT), the left ventricular ejection fraction (LVEF), the left ventricular body and the three dimensional displacement of each segment (three-dimensional displacement, P3DD) and other indicators. The above indexes were compared in each group and the control group, and the correlation between the peak value of left ventricular twist and the displacement parameters and LVEF was analyzed.
Results: 1. comparison of general clinical data: compared with the age, height, weight, heart rate, systolic pressure and diastolic pressure in the two groups, there was no significant difference (P0.05).2. routine echocardiographic parameters: compared with the control group, LVEF decreased in each group of CAD, the difference was statistically significant (P0.05); LAD, LA, LVIDd, LVIDs, LVESV, LVED in group LAD V significantly increased, LVEF decreased, the difference was statistically significant (P0.05 or 0.01).3.CAD and the control group of the left ventricular systolic twist angle peak and peak time: (1) CAD group PGT, PAT decreased, the difference was statistically significant (P0.05 or 0.01); (2) LCX group, RCA group apex, left ventricular systolic twist The trend was in accordance with the normal control group, PBT, PMT had a decreasing trend, but the difference was not statistically significant; Time-PBT was significantly delayed in comparison with the control group (P0.05). Although Time-PMT was delayed in comparison with the control group, there was no significant difference (P0.05); (3) the PBT in the LAD group was lower than the control group (P0.05); PMT was compared with the control group. The difference was not statistically significant (P0.05), and Time-PMT was significantly delayed in comparison with the control group (P0.05). (4) multiple groups of PBT and PMT were significantly lower than those in the control group (P0.01), and the peak time of each segment was lower than that in the control group, and the difference was statistically significant between the.4.CAD group and the control group left ventricular segments. In group CAD, the three-dimensional displacement of the left ventricle decreased significantly (P0.05). Compared with the control group, the anterior wall of the LAD group, the basal and middle segment of the anterior wall, the apical segment of the lateral wall and the apical P3DD decreased significantly (P0.05 or 0.01), and the basal segment and the middle segment of the lower interval of group LCX, the basal segment of the anterior septum, and the basal segment of the anterior septum. In the middle segment, the apical P3DD was significantly reduced, the difference was statistically significant (P0.05 or 0.01). The lower lateral wall and the middle segment of the lower wall of the RCA group decreased significantly (P0.05 or 0.01). The three-dimensional displacement of the systolic peak value of the left ventricular wall in the left ventricular wall decreased significantly by the.5. parameter correlation analysis: CAD group PGT, P AT, PBT are positively related to LVEF, P3DD, PAT and LVEF, P3DD is good (r1=0.53, P10.05; r2=0.44, P20.05).
Conclusion: 3D-STI can be used to study the left ventricular displacement and torsional movement in three dimensional space, so as to detect the left ventricular systolic function of CAD patients sensitive and provide an important clue for the diagnosis of CAD, and it has a broad application prospect.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R541.4;R445.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 楊雨;秦石成;張瑞芳;程安玲;;應(yīng)用三維斑點追蹤成像技術(shù)評價心臟再同步化治療的短期療效[J];中國臨床醫(yī)學(xué)影像雜志;2012年04期
2 李婭姣;李晨;李春梅;張立;白文娟;張曉玲;唐紅;饒莉;;超聲三維斑點追蹤及面積應(yīng)變技術(shù)在冠心病室壁運動異常檢測中的價值[J];四川大學(xué)學(xué)報(醫(yī)學(xué)版);2013年04期
3 李翠玲;林紅;范瑞;姚鳳娟;陸X;;斑點追蹤成像技術(shù)評價冠狀動脈不同狹窄程度患者的左室扭轉(zhuǎn)運動[J];臨床超聲醫(yī)學(xué)雜志;2012年01期
4 王君;周長鈺;鄭成環(huán);富華穎;索婭;;二維斑點追蹤技術(shù)對急性心肌梗死左室扭轉(zhuǎn)與解旋運動的研究[J];天津醫(yī)藥;2010年05期
5 張娜;王東平;陳金國;何艷;袁野;楊體霞;張軍;周利民;;斑點追蹤技術(shù)對心肌缺血者乳頭肌水平室壁運動的研究[J];中華全科醫(yī)學(xué);2014年01期
6 Simona Sitia;Livio Tomasoni;Maurizio Turiel;;Speckle tracking echocardiography:A new approach to myocardial function[J];World Journal of Cardiology;2010年01期
7 劉芷寧;李玉宏;;斑點追蹤顯像對冠心病患者左心室扭轉(zhuǎn)運動的研究[J];中國醫(yī)科大學(xué)學(xué)報;2011年12期
8 秦川;穆玉明;;超聲二維應(yīng)變新技術(shù)在冠心病診斷中的應(yīng)用[J];中華醫(yī)學(xué)超聲雜志(電子版);2010年02期
9 魏鳳;李玉宏;;斑點追蹤技術(shù)觀察心肌缺血患者左心室心肌力學(xué)改變[J];中國醫(yī)學(xué)影像技術(shù);2011年01期
10 郭亞軍;楊軍;白洋;喻曉娜;王欣;韓舒;;斑點追蹤顯像評價犬心尖缺血對左心功能的影響[J];中國醫(yī)學(xué)影像技術(shù);2011年03期
相關(guān)博士學(xué)位論文 前1條
1 馬春梅;斑點追蹤技術(shù)評價左室扭轉(zhuǎn)和解旋運動的研究[D];中國人民解放軍軍醫(yī)進(jìn)修學(xué)院;2009年
本文編號：2147718
本文鏈接：http://sikaile.net/yixuelunwen/fangshe/2147718.html
最近更新
教材專著
