【摘要】：目的：心腔內(nèi)的血流模式是一個很敏感的指標,在心臟結(jié)構(gòu)和功能發(fā)生改變的同時就會受到即刻影響,從而為心血管生理學(xué)的理解以及發(fā)展超早期診斷工具提供了新視野。血流向量成像技術(shù)在超聲心動圖中的引入使臨床顯像和分析心腔內(nèi)渦流成為了可能,本研究應(yīng)用血流向量成像技術(shù)探討左室舒張功能不全患者的心腔內(nèi)渦流分布與特征。方法：2014年9月至2015年3月在解放軍總醫(yī)院超聲心動圖室經(jīng)常規(guī)超聲檢查確診為左室舒張功能異常的患者93人,分為舒張功能輕度減低組39人(41.9%),中度減低組29人(31.2%),重度減低組25人(26.9%),22位健康成人作為對照組。所有患者行二維超聲心動圖檢查、M型超聲心動圖檢查、多普勒超聲心動圖檢查后收集傳統(tǒng)超聲基線資料,再行血流向量成像技術(shù)檢查并存圖,原始圖像導(dǎo)入東芝DAS-RS1脫機分析系統(tǒng)進行分析,部分患者(23人)行左心導(dǎo)管檢查測量左室舒張末壓。結(jié)果：①在正常組和舒張功能異常組,舒張早、晚期內(nèi)皆有渦流出現(xiàn)。舒張早期渦流持續(xù)時間在重度異常組和中度異常組較輕度異常組和正常組顯著增高(各自P0.05)；而重度異常組較中度異常組也有顯著增高(P0.05)；而舒張晚期渦流持續(xù)時間在各組無明顯差異；舒張早、晚期渦流最大面積在重度減低組較中度、輕度減低組及正常組顯著升高,差異有統(tǒng)計學(xué)意義(各自P0.05)；舒張期平均能量損耗在正常組、輕度異常組、中度異常組和重度異常組逐漸升高(P0.05)。②舒張期平均能量損耗和左室舒張末內(nèi)徑、左室舒張末容積、左房前后徑以及左房容積指數(shù)呈正相關(guān)(r=0.5237,P0.05;r=0.8022,P0.05;r=0.7167, P0.05;r=0.7572, P0.05);舒張期平均能量損耗和二尖瓣舒張早期峰值速度E及E/A呈正相關(guān)(r=0.5237,P0.05；r=0.6487,P0.05),與二尖瓣舒張晚期峰值速度A和舒張早期二尖瓣環(huán)速度e’呈負相關(guān)(r=-0.4673,P0.05；r=-0.6927,P0.05)。③VFM技術(shù)分析獲得的舒張期平均能量損耗與E/e’呈正相關(guān)(r=0.7466,P0.05)。④VFM技術(shù)分析獲得的舒張期平均能量損耗與導(dǎo)管室測得的左室舒張末壓呈正相關(guān)(r=0.8612,P0.05)。結(jié)論：血流向量成像技術(shù)顯像左室舒張功能不全患者的心腔內(nèi)渦流,并可分析其分布與特征。渦流持續(xù)時間是研究渦流產(chǎn)生和演化的重要指標；舒張期平均能量損耗可能是區(qū)分不同程度舒張功能不全和評估左室充盈壓的良好指標。
[Abstract]:Objective: the intracardiac blood flow pattern is a sensitive index, which will be affected immediately when the cardiac structure and function change, thus providing a new vision for understanding cardiovascular physiology and developing ultra-early diagnostic tools. The introduction of flow vector imaging in echocardiography makes it possible for clinical imaging and analysis of intracardiac eddy current. In this study, flow vector imaging was used to study the distribution and characteristics of intraventricular eddy current in patients with left ventricular diastolic dysfunction. Methods: from September 2014 to March 2015, 93 patients with abnormal left ventricular diastolic function were diagnosed by echocardiography in Chinese PLA General Hospital. There were 39 patients (41.9%) in the group of mild diastolic dysfunction, 29 (31.2%) in the moderate group and 25 (26.9%) in the severe group as control group. All patients were examined by two dimensional echocardiography and M-mode echocardiography. After Doppler echocardiography, the baseline data of traditional ultrasound were collected. The original images were analyzed with Toshiba DAS-RS1 offline analysis system. Left ventricular end-diastolic pressure was measured by left ventricular catheterization in some patients (23 patients). Results in normal group and abnormal diastolic function group, eddy current appeared in early diastolic phase and late diastolic phase. The duration of early diastolic eddy current in severe abnormal group and moderate abnormal group was significantly higher than that in mild abnormal group and normal group (P0.05), while that in severe abnormal group was significantly higher than that in moderate abnormal group (P0.05). However, there was no significant difference in the duration of late diastolic eddy current in each group. The maximum area of eddy-current in the group of early diastole and late stage was more moderate than that in the group of severe reduction, while that in the group of mild decrease and normal group was significantly increased (P0.05 respectively). The mean energy loss during diastolic phase increased gradually in normal group, mild abnormal group, moderate abnormal group and severe abnormal group (P0.05). There was a positive correlation between the anterior and posterior diameter of left atrium and the left atrial volume index (r = 0.5237a, P = 0.05, P = 0.8022, P = 0.05, P = 0.7572, P < 0.05), and a positive correlation between the mean energy loss during diastolic period and the peak velocity of early diastolic value of mitral valve E and E / P / A (r = 0.5237, P = 0.05, P < 0.05). There was a negative correlation between the peak velocity of late diastolic mitral valve A and the velocity of mitral annulus in early diastolic period (r = 0.4673, P 0.05). The mean energy loss in diastolic phase was positively correlated with E / E'(r = 0.7466P 0.05) .4VFM technique showed a positive correlation with the left ventricular end-diastolic pressure measured by catheterization (r = 0.8612P 0.05), and the diastolic energy loss obtained by VFM technique was positively correlated with that of E / E (r = 0.7466P 0.05) .4VFM technique showed a positive correlation with the left ventricular end-diastolic pressure measured by catheterization (r = 0.8612P, P < 0.05). Conclusion: the flow vector imaging can analyze the distribution and characteristics of intraventricular eddy current in patients with left ventricular diastolic dysfunction. Eddy current duration is an important index to study the generation and evolution of eddy current, and the average energy loss during diastolic period may be a good index to distinguish different degrees of diastolic insufficiency and to evaluate left ventricular filling pressure.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R540.45;R541.6

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