本文選題：二維斑點追蹤成像 + 心房間不同步�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的運用二維斑點追蹤成像(2D-STI)評價射血分數(shù)保留性心力衰竭(HFPEF)人群中心房間機械收縮延遲(IAMDs),分析IAMDs與左房結(jié)構(gòu)、左房功能及P波間期的相關(guān)性,并探討IAMDs對HFPEF的預(yù)測價值。方法研究納入射血分數(shù)保留性心力衰竭患者34例(HFPEF組),同期射血分數(shù)降低的心力衰竭23例(HFREF組)及左室舒張功能異常者29例(LVDD組),以及22例體檢健康者作為健康對照組。所有受檢者均行常規(guī)超聲檢查,測量并計算二尖瓣口舒張早期血流速度與瓣環(huán)組織運動速度比值(E/e′),實時三維超聲心動圖測量左房容積(LAV_(max)、LAVmin、LAVpre),計算左房射血分數(shù)(LATEF、LAPEF、LAAEF),通過體表面積較正后計算左房最大容積指數(shù)(LAV_(max)I)。2D-STI測量IAMDs及收縮期左房平均峰值應(yīng)變LAm Ss。記錄靜息心電圖,測量P波間期、PR及QRS間期。分析IAMDs與左房容積指數(shù)、左房功能等指標及P波間期的相關(guān)性。繪制IAMDs、E/e′及LAV_(max)I預(yù)測HFPEF的ROC曲線,分析曲線下面積(AUC),探討IAMDs在射血分數(shù)保留性心力衰竭中的預(yù)測價值。結(jié)果與正常對照組及左室舒張功能異常組比較,HFPEF組具有明顯的心房間不同步,IAMDs分別為(28.36±7.09ms VS38.1±14.48 ms VS55.09±13.43ms,P0.05),而HFREF組心房間不同步更加明顯(69.55±10.58ms)。IAMDs與LAm Ss、LAV_(max)、LAV_(max)I、LATEF、E/e′相關(guān)性好(r=-0.67、0.58、0.55、-0.52、0.50,P0.01),而與P波間期無明顯相關(guān)。ROC曲線顯示IAMDs、E/e′及LAV_(max)I的預(yù)測HFPEF的AUC分別為0.856、0.844、0.773;當IAMDs為41.5ms時,其診斷HFPEF的靈敏度為78.1%,特異度為78.0%。結(jié)論2D-STI能夠定量評估心房間不同步,隨著左房擴大、左房功能降低及左室充盈壓升高,心房間不同步更加明顯,且IAMDs預(yù)測射血分數(shù)保留性心力衰竭效能較E/e′及LAV_(max)I更高。
[Abstract]:Objective to evaluate the central room mechanical systolic delay (IAMDS) in patients with ejection fraction reserved heart failure (HFPEF) by two-dimensional speckle tracing imaging (2D STI), and to analyze the correlation between IAMDs and left atrial structure, left atrial function and P wave interval, and to explore the predictive value of IAMDs for HFPEF. Methods Thirty-four patients with retained heart failure with ejection fraction (HFPEF), 23 patients with heart failure with decreased ejection fraction (HFREF), 29 patients with abnormal left ventricular diastolic function (LVDD) and 22 healthy controls were enrolled. All the subjects were examined by conventional ultrasound. The ratio of mitral orifice early diastolic velocity to annular tissue velocity and E / E / E / E ratio were measured and calculated. The left atrial volume was measured by real-time three-dimensional echocardiography. The left atrial ejection fraction (LVEF) and left atrial ejection fraction (LVEF) were calculated. Large volume index (LVI) was used to measure IAMDs and mean peak strain of left atrium (LAm Ss). Resting electrocardiogram was recorded and P wave interval PR and QRS interval were measured. The correlation between IAMDs and left atrial volume index, left atrial function and P wave interval was analyzed. The ROC curves for predicting HFPEF were drawn and the area under the curve was analyzed. The predictive value of IAMDs in ejection fraction reserved heart failure was discussed. Results compared with the normal control group and the abnormal left ventricular diastolic function group, the IAMDs in the HFPEF group were 28.36 鹵14.48ms VS55.09 鹵14.48ms VS55.09 鹵13.43ms VS55.09 鹵13.43ms P0.05, respectively, while in the HFREF group, the atrial asynchrony was more obvious, 69.55 鹵10.58ms).IAMDs, and LAm Sslavi maxLAVVVV / E / E / R = r = -0.670.580.55t -0.520.50m P0.01a, respectively, and the correlation with the P wave interval was higher than that in the HFPEF group (P < 0.05), but it was significantly higher in the HFREF group than in the normal control group and the left ventricular diastolic dysfunction group (HFPEF group). The correlation between IAMDs in the HFPEF group and in the HFREF group was better than that in the control group. No significant correlation. ROC curve showed that the AUC of HFPEF predicted by LAV_(max)I and E / E 'were 0.856 / 0.844 / 0.773.When IAMDs was 41.5ms, The sensitivity and specificity of HFPEF were 78. 1% and 78. 0% respectively. Conclusion 2D-STI can quantitatively evaluate atrial asynchrony. With the enlargement of left atrium, left atrial function decreased and left ventricular filling pressure increased, and atrial asynchrony was more obvious. IAMDs was more effective than E / E 'and LAV_(max)I in predicting ejection fraction reserved heart failure.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.6

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