UCG和ECG診斷高血壓左室肥厚一致性及STI技術(shù)評(píng)價(jià)左室功能的研究
發(fā)布時(shí)間：2018-11-26 14:32
【摘要】：目的:研究超聲心動(dòng)圖(Echocardiography,UCG)和心電圖(Electrocardiogram,ECG)在診斷左室肥厚(Left Ventricular Hypertrophy,LVH)上是否一致,探索兩者在篩查L(zhǎng)VH以及預(yù)測(cè)心血管疾病上的優(yōu)點(diǎn)。運(yùn)用二維斑點(diǎn)追蹤成像技術(shù)(Two-dimensional Speckle Tracking Imaging,2D-STI)對(duì)高血壓LVH伴有心電圖表現(xiàn)出T波改變患者的左心室功能進(jìn)行早期判斷,旨在為臨床提供有效的診斷價(jià)值,幫助臨床最大限度地降低心血管事件的發(fā)生率和死亡率。方法:采用前瞻性研究方法,通過超聲心動(dòng)圖左室質(zhì)量指數(shù)(Left ventricular mass index,LVMI)和/或心電圖Sv1+Rv5為指標(biāo)收集原發(fā)性高血壓左室肥厚患者74例,分析兩種診斷方法在診斷LVH上是否一致及其相關(guān)性。采用2D-STI技術(shù)評(píng)價(jià)各個(gè)節(jié)段心肌收縮功能,觀察高血壓T波改變組和T波正常組之間應(yīng)變值是否存在差異,以及心電圖Sv1+Rv5值與超聲心動(dòng)圖收縮、舒張功能值、STI應(yīng)變值之間的相關(guān)性。結(jié)果:1.高血壓各組的IVSTd、LVPWTd、LVMI、RWT、Rv5、Sv1+Rv5均比正常對(duì)照組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);其中高血壓T波改變組的LVMI、Sv1、Rv5、Sv1+Rv5高于T波正常組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.高血壓T波改變組的LVEF、FS比T波正常組稍高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.高血壓各組的E/A比值明顯低于正常對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但在高血壓T波正常和T波改變組比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。高血壓各組的Ea/Aa比值明顯低于正常對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);高血壓T波改變組的E/Ea比正常對(duì)照組和高血壓T波正常組高,與兩者的差異有統(tǒng)計(jì)學(xué)意義(P0.05);高血壓各組的左房容積指數(shù)比正常對(duì)照組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.高血壓各組縱向應(yīng)變(Longitudinal strain,LS)峰值變化規(guī)律:為形態(tài)紊亂的負(fù)向峰值曲線,并于收縮末期達(dá)負(fù)向峰值;四腔心、兩腔心、心尖長(zhǎng)軸切面的LS峰值及整體縱向應(yīng)變值(Global longitudinal strain,GLS)在三組中呈遞減趨勢(shì),高血壓兩組與正常對(duì)照組之間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),但高血壓兩組之間差異無(wú)統(tǒng)計(jì)學(xué)意義(PP0.05)。5.高血壓各組圓周應(yīng)變(Circumferential strain,CS)峰值變化規(guī)律:為形態(tài)紊亂的負(fù)向峰值曲線,并于收縮末期達(dá)負(fù)向峰值;高血壓各組基底段、中間段、心尖段CS峰值及整體圓周應(yīng)變值(Global circumferential strain,GCS)均比正常對(duì)照組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其中高血壓T波改變組的心尖段CS峰值及GCS值進(jìn)一步減低,與高血壓T波正常組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。6.高血壓各組徑向應(yīng)變(Radial strain,RS)峰值變化規(guī)律:為形態(tài)紊亂的正向峰值曲線,并于收縮末期達(dá)正向峰值;高血壓各組在各個(gè)節(jié)段、基底段、中間段、心尖段RS峰值及整體徑向應(yīng)變值變(Global radial strain,GRS)均比正常組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但高血壓兩組間比較差異不具統(tǒng)計(jì)學(xué)意義(P0.05)。7.超聲心動(dòng)圖和心電圖均能同時(shí)診斷出LVH占24.32%,超聲心動(dòng)圖能診斷LVH而心電圖不能診斷的占75.68%;LVMI與Sv1+Rv5呈正相關(guān)關(guān)系(r=0.623,P0.05)。8.心電圖電壓Sv1+Rv5與GLS、GCS、GRS值呈負(fù)相關(guān)關(guān)系(r=-0.264,-0.352,-0.202,P均0.05)。結(jié)論:1.二維斑點(diǎn)追蹤成像技術(shù)可用于評(píng)價(jià)高血壓患者左室整體及局部收縮功能。2.組織多普勒成像(Tissue Doppler imaging,TDI)及E/Ea比值能客觀反映左室舒張功能。3.高血壓T波改變組GCS比高血壓T波正常組明顯減低。4.采用左室質(zhì)量指數(shù)為診斷左室肥厚的標(biāo)準(zhǔn),超聲心動(dòng)圖診斷高血壓左室肥厚患者中,相當(dāng)大一部分未能同時(shí)作出一致的診斷;超聲心動(dòng)圖LVMI與心電圖Sv1+Rv5呈中度正相關(guān)關(guān)系。5.心電圖Sv1+Rv5值與GLS、GCS及GRS呈負(fù)相關(guān)關(guān)系。
[Abstract]:Objective: To study whether the echocardiogram (UCG) and the electrocardiogram (ECG) were consistent in the diagnosis of left ventricular hypertrophy (LVH) and to explore the advantages of the two methods in the screening of LVH and the prediction of cardiovascular diseases. Two-dimensional speckle tracking imaging (2D-STI) was used to evaluate the left ventricular function of patients with high blood pressure LVH with ECG, and the aim of this study was to provide effective diagnostic value for clinical application. help to minimize the incidence and mortality of cardiovascular events. Methods: 74 patients with essential hypertension left ventricular hypertrophy were collected by the left ventricular mass index (LVMI) and/ or the electrocardiogram (Sv1 + Rv5) by a prospective study. The myocardial contractility of each segment was evaluated by the 2D-STI technique. It was observed that there was a difference in the strain value between the T-wave changing group and the T-wave normal group, and the correlation between the electrocardiogram Sv1 + Rv5 value and the echocardiogram, the diastolic function value and the STI strain value. Results: 1. The IVSTd, LVPWTd, LVMI, RWT, Rv5 and Sv1 + Rv5 in the essential hypertension group were higher than those in the normal control group (P <0.05). The LVMI, Sv1, Rv5, Sv1 + Rv5 of the group were higher than that of the normal control group (P0.05). The LVEF and FS of the T-wave-change group were slightly higher than that in the T-wave group, but the difference was not significant (P0.05). The ratio of E/ A in each group was significantly lower than that in the control group (P0.05). The ratio of Ea/ Aa in the hypertension group was significantly lower than that in the control group (P <0.05). The E/ Ea ratio of the T-wave changing group in the hypertension group was higher than that of the normal control group and the normal group of the hypertension, and the difference between the two groups was statistically significant (P0.05). The left atrial volume index in each group was higher than that in the normal control group (P0.05). The peak value of longitudinal strain (LS) in each group of high blood pressure was: the negative peak curve of the form disorder, and the negative peak at the end of the contraction; the LS peak value and the whole longitudinal strain value (GLS) of the four-chamber heart, the two-cavity heart and the apical long-axis section showed a decreasing trend in the three groups, The difference between the two groups was statistically significant (P0.05), but there was no significant difference between the two groups (PP0. 05). The peak value of the circumferential strain (CS) of the hypertension group was: the negative peak curve of the form disorder and the negative peak value at the end of the contraction; the basal segment, the middle segment, the apical segment CS peak value and the total circumferential strain value (GCS) of the hypertension group were lower than that of the normal control group, The difference was significant (P0.05), in which the peak value of CS and the value of GCS in the apical segment of the T-wave changing group were further reduced, and the difference of CS peak and GCS in the normal group of T-wave of hypertension was statistically significant (P0.05). The peak value of radial strain (RS) in each group of hypertension was: the positive peak curve of the form disorder and the forward peak at the end of systole; and the peak and the overall radial strain value of the hypertension group at each segment, the basal segment, the middle segment, the apical segment RS and the overall radial strain value (Global radial strain, The difference of GRS was lower than that in the normal group (P0.05), but the difference between the two groups was not statistically significant (P0.05). Both echocardiography and electrocardiogram were able to diagnose the LVH at 24. 32% at the same time. The diagnosis of LVH by echocardiography was 75. 68%, and the LVMI was positively correlated with Sv1 + Rv5 (r = 0.623, P0.05). There was a negative correlation between the ECG voltage (Sv1 + Rv5) and the GLS, GCS, and GRS (r =-0.264,-0.352,-0.202, P 0.05). Conclusion: 1. the two-dimensional spot-tracking imaging technique can be used to evaluate the whole and local contraction of the left chamber of a hypertensive patient. Tissue Doppler imaging (TDI) and E/ Ea ratio can objectively reflect the left ventricular diastolic function. The normal group GCS of the T wave of hypertension was significantly lower than that in the normal group of the hypertension T wave. The left ventricular mass index was used as the standard for the diagnosis of left ventricular hypertrophy. In the patients with left ventricular hypertrophy, a significant proportion of the patients with left ventricular hypertrophy failed to make a consistent diagnosis at the same time, and the LVMI of the echocardiogram was in a moderate positive correlation with the electrocardiogram Sv1 + Rv5. The values of the ECG Sv1 + Rv5 were negatively correlated with the GLS, GCS and GRS.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.3;R540.4
本文編號(hào)：2358825
[Abstract]:Objective: To study whether the echocardiogram (UCG) and the electrocardiogram (ECG) were consistent in the diagnosis of left ventricular hypertrophy (LVH) and to explore the advantages of the two methods in the screening of LVH and the prediction of cardiovascular diseases. Two-dimensional speckle tracking imaging (2D-STI) was used to evaluate the left ventricular function of patients with high blood pressure LVH with ECG, and the aim of this study was to provide effective diagnostic value for clinical application. help to minimize the incidence and mortality of cardiovascular events. Methods: 74 patients with essential hypertension left ventricular hypertrophy were collected by the left ventricular mass index (LVMI) and/ or the electrocardiogram (Sv1 + Rv5) by a prospective study. The myocardial contractility of each segment was evaluated by the 2D-STI technique. It was observed that there was a difference in the strain value between the T-wave changing group and the T-wave normal group, and the correlation between the electrocardiogram Sv1 + Rv5 value and the echocardiogram, the diastolic function value and the STI strain value. Results: 1. The IVSTd, LVPWTd, LVMI, RWT, Rv5 and Sv1 + Rv5 in the essential hypertension group were higher than those in the normal control group (P <0.05). The LVMI, Sv1, Rv5, Sv1 + Rv5 of the group were higher than that of the normal control group (P0.05). The LVEF and FS of the T-wave-change group were slightly higher than that in the T-wave group, but the difference was not significant (P0.05). The ratio of E/ A in each group was significantly lower than that in the control group (P0.05). The ratio of Ea/ Aa in the hypertension group was significantly lower than that in the control group (P <0.05). The E/ Ea ratio of the T-wave changing group in the hypertension group was higher than that of the normal control group and the normal group of the hypertension, and the difference between the two groups was statistically significant (P0.05). The left atrial volume index in each group was higher than that in the normal control group (P0.05). The peak value of longitudinal strain (LS) in each group of high blood pressure was: the negative peak curve of the form disorder, and the negative peak at the end of the contraction; the LS peak value and the whole longitudinal strain value (GLS) of the four-chamber heart, the two-cavity heart and the apical long-axis section showed a decreasing trend in the three groups, The difference between the two groups was statistically significant (P0.05), but there was no significant difference between the two groups (PP0. 05). The peak value of the circumferential strain (CS) of the hypertension group was: the negative peak curve of the form disorder and the negative peak value at the end of the contraction; the basal segment, the middle segment, the apical segment CS peak value and the total circumferential strain value (GCS) of the hypertension group were lower than that of the normal control group, The difference was significant (P0.05), in which the peak value of CS and the value of GCS in the apical segment of the T-wave changing group were further reduced, and the difference of CS peak and GCS in the normal group of T-wave of hypertension was statistically significant (P0.05). The peak value of radial strain (RS) in each group of hypertension was: the positive peak curve of the form disorder and the forward peak at the end of systole; and the peak and the overall radial strain value of the hypertension group at each segment, the basal segment, the middle segment, the apical segment RS and the overall radial strain value (Global radial strain, The difference of GRS was lower than that in the normal group (P0.05), but the difference between the two groups was not statistically significant (P0.05). Both echocardiography and electrocardiogram were able to diagnose the LVH at 24. 32% at the same time. The diagnosis of LVH by echocardiography was 75. 68%, and the LVMI was positively correlated with Sv1 + Rv5 (r = 0.623, P0.05). There was a negative correlation between the ECG voltage (Sv1 + Rv5) and the GLS, GCS, and GRS (r =-0.264,-0.352,-0.202, P 0.05). Conclusion: 1. the two-dimensional spot-tracking imaging technique can be used to evaluate the whole and local contraction of the left chamber of a hypertensive patient. Tissue Doppler imaging (TDI) and E/ Ea ratio can objectively reflect the left ventricular diastolic function. The normal group GCS of the T wave of hypertension was significantly lower than that in the normal group of the hypertension T wave. The left ventricular mass index was used as the standard for the diagnosis of left ventricular hypertrophy. In the patients with left ventricular hypertrophy, a significant proportion of the patients with left ventricular hypertrophy failed to make a consistent diagnosis at the same time, and the LVMI of the echocardiogram was in a moderate positive correlation with the electrocardiogram Sv1 + Rv5. The values of the ECG Sv1 + Rv5 were negatively correlated with the GLS, GCS and GRS.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.3;R540.4
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