斑點追蹤及組織同步顯像技術(shù)評價心肌橋noble分級與左心室心肌功能的關(guān)系
發(fā)布時間：2018-11-23 08:01
【摘要】：目的:應(yīng)用斑點追蹤成像技術(shù)(speckle tracking imaging,STI)及組織同步顯像技術(shù)(tissue synchronization imaging,TSI)研究冠狀動脈左前降支單純性心肌橋患者左室局部心肌的應(yīng)變值及左室收縮同步性指標(biāo),以期通過各種定量指標(biāo)評價STI及TSI在定量分析心肌橋患者的左室收縮舒張功能方面的臨床意義,從而為臨床醫(yī)師干預(yù)治療提供準(zhǔn)確依據(jù)。方法:40例正常對照者、30例單純性心肌橋致壁冠狀動脈狹窄Noble I-II級患者、16例單純性心肌橋致壁冠狀動脈狹窄Noble III級患者。三組均接受傳統(tǒng)超聲檢查,并用斑點追蹤技術(shù)獲得左室心尖三腔心切面、左室心尖二腔心切面和左室心尖四腔心切面的圖像,分析左室心肌17節(jié)段縱向收縮期峰值應(yīng)變指標(biāo)。并用組織同步顯像技術(shù)測量上述三切面基底段及中間段的收縮期縱向應(yīng)變達(dá)峰時間(Tssl).獲得左室各壁12節(jié)段達(dá)峰時間標(biāo)準(zhǔn)差(Tssl-SD)及節(jié)段達(dá)峰時間最大差值(Tssl-Dif),以Tssl-SD33 ms作為左室收縮不同步標(biāo)準(zhǔn)。結(jié)果:1比較三組之間的年齡、體重、收縮壓、左房最大前后徑(LA)、舒張末期左室最大內(nèi)徑(LV)、左室射血分?jǐn)?shù)(EF)等指標(biāo),差異無統(tǒng)計學(xué)差異(P0.05)。與正常對照組相比,心肌橋Noble I-II、心肌橋Noble III兩組左室舒張期二尖瓣前向血流頻譜E/A比值減小,差異有統(tǒng)計學(xué)意義(P0.05)。心肌橋Noble I-II、心肌橋Noble III兩組之間比較,左室舒張期二尖瓣前向血流頻譜E/A比值差異無統(tǒng)計學(xué)意義(P0.05)。2與正常對照組比較,心肌橋Noble I-II、心肌橋Noble III兩組前壁中間段及心尖段、前間隔中間段及心尖段Ss明顯降低,差異有統(tǒng)計學(xué)意義(P0.05)?其中,心肌橋Noble I-II組與心肌橋Noble III組相比,差異無統(tǒng)計學(xué)意義(P0.05)。3正常對照組與Noble I-II組的收縮期縱向Tssl-SD及Tssl-diff相比差異無統(tǒng)計學(xué)意義(P0.05);與Noble III組相比,Noble I-II組和對照組相的收縮期縱向Tssl-SD及Tssl-Dif差異有統(tǒng)計學(xué)意義(P0.05)。4以Tssl-SD33 ms作為左室收縮不同步標(biāo)準(zhǔn),Noble I-II組左室收縮不同步率為16.67%(5/30),Noble III組左室收縮不同步率25%(4/16),Noble I-II組與Noble III組間不同步率比較無統(tǒng)計學(xué)差異(P0.05)。5 logistic回歸分析高血壓和壁冠狀動脈Noble III級是左室收縮不同步的兩個主要危險因素。壁冠狀動脈Noble III級組(優(yōu)勢比:8.569,95%CI 2.325-28.48,P0.05),高血壓組(優(yōu)勢比:15.44,95%CI:1.273-146.4,P0.05)。結(jié)論:1 STI技術(shù)可以定量評估單純性心肌橋患者左室心肌的應(yīng)變能力,可為臨床醫(yī)師干預(yù)治療提供可靠依據(jù)。2當(dāng)單純心肌橋組Noble III級時,左室縱向Tssl-SD和Tssr-Dif等指標(biāo)可較敏感的反映出左室壁相應(yīng)節(jié)段收縮不同步。3以Tssl-SD33 ms作為左室收縮不同步標(biāo)準(zhǔn),能比較準(zhǔn)確快速的判斷心肌橋患者的左室收縮不同步。4高血壓和壁冠狀動脈Noble III級更容易導(dǎo)致心肌橋患者的左室收縮不同步的發(fā)生。
[Abstract]:Objective: to study the regional strain and systolic synchronism of left ventricle in patients with left anterior descending coronary artery myocardial bridge by (speckle tracking imaging,STI and (tissue synchronization imaging,TSI. The purpose of this study was to evaluate the clinical significance of quantitative analysis of left ventricular systolic and diastolic function by STI and TSI in patients with myocardial bridge, so as to provide an accurate basis for the intervention of clinicians. Methods: 40 normal controls, 30 patients with Noble I-II grade coronary artery stenosis caused by simple myocardial bridge and 16 patients with Noble III grade coronary artery stenosis caused by simple myocardial bridge were studied. All the three groups were examined by conventional ultrasound. The images of left ventricular apical atrium, left ventricular apical two-chamber and left ventricular apical four-chamber were obtained by dot tracing technique, and the longitudinal peak systolic strain index of 17 segments of left ventricular myocardium was analyzed. Measurement of the peak time of longitudinal strain in the basal and middle segments of the above three sections by using tissue synchronization imaging technique (Tssl). The peak time standard deviation (Tssl-SD) and maximum peak time difference (Tssl-Dif) of 12 segments of left ventricular wall were obtained. Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. Results: 1 there was no significant difference in age, body weight, systolic blood pressure, left atrial maximum anteroposterior diameter (LA), left ventricular end diastolic diameter (LV), left ventricular ejection fraction (EF) between the three groups (P0.05). Compared with normal control group, myocardial bridge Noble I-II and myocardial bridge Noble III decreased the ratio of E / A to E / A in left ventricular diastolic mitral flow spectrum (P 0.05). There was no significant difference in E / A ratio between myocardial bridge Noble I-II and myocardial bridge Noble III in left ventricular diastolic mitral flow spectrum (P0.05). 2 compared with normal control group, myocardial bridge Noble I-II-2, left ventricular diastolic mitral valve forward flow spectrum E / A ratio was not significantly different between the two groups (P0.05). The Ss of anterior wall and apical segment, anterior septal middle segment and apical segment of myocardial bridge Noble III group were significantly lower than that of control group (P0.05). There was no significant difference between myocardial bridge Noble I-II group and myocardial bridge Noble III group (P0.05). 3 there was no significant difference in systolic longitudinal Tssl-SD and Tssl-diff between normal control group and Noble I-II group (P0.05). Compared with Noble III group, the systolic phase longitudinal Tssl-SD and Tssl-Dif in Noble I-II group and control group were significantly different (P0.05). 4 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. The left ventricular systolic unsynchronism rate in Noble I-II group was 16.67% (5 / 30), Noble III group), and the left ventricular systolic non-synchronous rate was 25% (4 / 16) in 5 / 30), Noble III group. There was no significant difference between Noble I-II group and Noble III group (P0.05). 5 logistic regression analysis showed that hypertension and Noble III grade of mural coronary artery were the two main risk factors of left ventricular systolic asynchrony. Mural coronary artery Noble III grade group (odds ratio: 8.569c95 CI 2.325-28.48), hypertension group (odds ratio: 15.44-95CI: 1.273-146.4p0.05). Conclusion: (1) STI technique can quantitatively evaluate the strain-ability of left ventricular myocardium in patients with simple myocardial bridge, and can provide reliable evidence for the intervention of clinicians. (2) when the patients with simple myocardial bridge group have Noble III grade, The indexes of left ventricular longitudinal Tssl-SD and Tssr-Dif were sensitive to reflect that the corresponding segments of left ventricular wall were out of sync. 3 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. High blood pressure and Noble III grade of the mural coronary artery are more likely to cause the left ventricular systolic asynchrony in the patients with myocardial bridge.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.1
本文編號：2350864
[Abstract]:Objective: to study the regional strain and systolic synchronism of left ventricle in patients with left anterior descending coronary artery myocardial bridge by (speckle tracking imaging,STI and (tissue synchronization imaging,TSI. The purpose of this study was to evaluate the clinical significance of quantitative analysis of left ventricular systolic and diastolic function by STI and TSI in patients with myocardial bridge, so as to provide an accurate basis for the intervention of clinicians. Methods: 40 normal controls, 30 patients with Noble I-II grade coronary artery stenosis caused by simple myocardial bridge and 16 patients with Noble III grade coronary artery stenosis caused by simple myocardial bridge were studied. All the three groups were examined by conventional ultrasound. The images of left ventricular apical atrium, left ventricular apical two-chamber and left ventricular apical four-chamber were obtained by dot tracing technique, and the longitudinal peak systolic strain index of 17 segments of left ventricular myocardium was analyzed. Measurement of the peak time of longitudinal strain in the basal and middle segments of the above three sections by using tissue synchronization imaging technique (Tssl). The peak time standard deviation (Tssl-SD) and maximum peak time difference (Tssl-Dif) of 12 segments of left ventricular wall were obtained. Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. Results: 1 there was no significant difference in age, body weight, systolic blood pressure, left atrial maximum anteroposterior diameter (LA), left ventricular end diastolic diameter (LV), left ventricular ejection fraction (EF) between the three groups (P0.05). Compared with normal control group, myocardial bridge Noble I-II and myocardial bridge Noble III decreased the ratio of E / A to E / A in left ventricular diastolic mitral flow spectrum (P 0.05). There was no significant difference in E / A ratio between myocardial bridge Noble I-II and myocardial bridge Noble III in left ventricular diastolic mitral flow spectrum (P0.05). 2 compared with normal control group, myocardial bridge Noble I-II-2, left ventricular diastolic mitral valve forward flow spectrum E / A ratio was not significantly different between the two groups (P0.05). The Ss of anterior wall and apical segment, anterior septal middle segment and apical segment of myocardial bridge Noble III group were significantly lower than that of control group (P0.05). There was no significant difference between myocardial bridge Noble I-II group and myocardial bridge Noble III group (P0.05). 3 there was no significant difference in systolic longitudinal Tssl-SD and Tssl-diff between normal control group and Noble I-II group (P0.05). Compared with Noble III group, the systolic phase longitudinal Tssl-SD and Tssl-Dif in Noble I-II group and control group were significantly different (P0.05). 4 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. The left ventricular systolic unsynchronism rate in Noble I-II group was 16.67% (5 / 30), Noble III group), and the left ventricular systolic non-synchronous rate was 25% (4 / 16) in 5 / 30), Noble III group. There was no significant difference between Noble I-II group and Noble III group (P0.05). 5 logistic regression analysis showed that hypertension and Noble III grade of mural coronary artery were the two main risk factors of left ventricular systolic asynchrony. Mural coronary artery Noble III grade group (odds ratio: 8.569c95 CI 2.325-28.48), hypertension group (odds ratio: 15.44-95CI: 1.273-146.4p0.05). Conclusion: (1) STI technique can quantitatively evaluate the strain-ability of left ventricular myocardium in patients with simple myocardial bridge, and can provide reliable evidence for the intervention of clinicians. (2) when the patients with simple myocardial bridge group have Noble III grade, The indexes of left ventricular longitudinal Tssl-SD and Tssr-Dif were sensitive to reflect that the corresponding segments of left ventricular wall were out of sync. 3 Tssl-SD33 ms was used as the standard of left ventricular systolic asynchrony. High blood pressure and Noble III grade of the mural coronary artery are more likely to cause the left ventricular systolic asynchrony in the patients with myocardial bridge.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前8條
1 魯明軍;王瑋;許玲玲;蘇楠;羅福全;;前降支單純性心肌橋與左心結(jié)構(gòu)及功能關(guān)系研究[J];中國實用醫(yī)藥;2013年19期
2 姚鴻梅;李江波;林建蘭;黃寶濤;黃鶴;;面積應(yīng)變評估正常構(gòu)型高血壓左室收縮功能[J];生物醫(yī)學(xué)工程學(xué)雜志;2013年02期
3 蔡偉;董彥;李學(xué)文;周瑞娟;趙季紅;姜鐵民;;應(yīng)變及應(yīng)變率成像評估心肌橋患者局部心肌缺血的價值[J];中華實用診斷與治療雜志;2012年07期
4 賈妍;郭瑞強;陳金玲;周青;;實時三維超聲心動圖和斑點追蹤顯像技術(shù)評價心肌梗死患者左心室收縮同步性[J];中華超聲影像學(xué)雜志;2011年02期
5 王俊利;尹立雪;郭智宇;李文華;武彤;;應(yīng)變成像評價犬左心室急性心肌缺血邊緣區(qū)跨壁力學(xué)狀態(tài)[J];中華超聲影像學(xué)雜志;2010年01期
6 張峰;錢菊英;吳鴻誼;路艷;葛均波;;血管內(nèi)超聲對心肌橋及其鄰近節(jié)段冠狀動脈結(jié)構(gòu)特點的研究[J];中華超聲影像學(xué)雜志;2008年02期
7 韓艷麗;王營;姜紅菊;左巖霞;朱靖;王健;劉芳;李繼福;陳玉國;;心肌橋與冠狀動脈粥樣硬化關(guān)系的探討[J];中國心血管病研究雜志;2006年03期
8 楊婭;李治安;;冠狀動脈血流顯像分析冠狀動脈左前降支心肌橋血流儲備[J];中華超聲影像學(xué)雜志;2008年10期
，本文編號：2350864
本文鏈接：http://sikaile.net/yixuelunwen/xxg/2350864.html
最近更新
教材專著
