速度向量成像技術評價右束支阻滯心室不同步的特點
發(fā)布時間：2019-03-24 21:14
【摘要】：目的:通過速度向量成像技術(VVI)研究右束支阻滯患者心室收縮的不同步性,以指導臨床心臟再同步化治療的優(yōu)化。方法:選取2014年12月至2016年12月期間前來青島大學附屬醫(yī)院的完全性右束支阻滯患者共20人作為試驗組;選取與試驗組年齡、性別等相匹配的健康志愿者20人作為對照組。對實驗對象進行數(shù)據(jù)測量:1)應用常規(guī)超聲測量:左心房內徑、左心室舒張末內徑、左心室舒張末容積、左心室收縮末內徑、左心室收縮末容積、EF值、Sm值(左室側壁基底段)、E/A值、二尖瓣反流,右心房內徑、右心室橫徑、右心室流出道內徑、Sm值(右室側壁基底段)、E/A值、三尖瓣反流。2)應用VVI測量:左室短軸切面16節(jié)段徑向應變達峰時間(Tsr)、周向應變達峰時間(Tsc)、旋轉角度達峰時間(Tra);右室室間隔及游離壁的基底段、中間段、心尖段共6個節(jié)段的應變(收縮)速度達峰時間(Tsl)。分別計算每個實驗對象的各節(jié)段達峰時間標準差(Tsr-SD、Tsc-SD、Tra-SD、Tsl-SD)并進行比較分析。結果:1.CRBBB組與對照組相比較,常規(guī)超聲測得的左室數(shù)據(jù)無差別(無統(tǒng)計學意義,即P0.05),在右室E/A值、三尖瓣反流率上有差別(有統(tǒng)計學意義,即P0.05);2.CRBBB組與對照組相比較,VVI測得的左室Tsc-SD、Tra-SD有統(tǒng)計學意義(即P0.05),Tsr-SD無統(tǒng)計學意義(即P0.05);右室Tsl-SD有統(tǒng)計學意義(即P0.05);3.應用VVI進行數(shù)據(jù)測量,CRBBB組左室Tsc及Tra最早位于后間隔,最晚位于側壁;對照組左室Tsc及Tra最早位于前間隔,最晚位于下后壁。4.CRBBB組右室Tsl最早位于室間隔中間段,最晚位于游離壁基底段;對照組右室Tsl最早位于室間隔基底段,最晚位于游離壁心尖段。5.左室達峰順序:CRBBB組起自后間隔,同時沿順時針和逆時針向兩個方向順序達峰,最后到達側壁;對照組起自前間隔,呈大致順時針方向順序達峰,最后到達下后壁。右室達峰順序:CRBBB組起自室間隔中間段,按室間隔中間段-室間隔基底段-室間隔心尖段-游離壁心尖段-游離壁中間段順序達峰,最終達游離壁基底段;對照組起自室間隔基底段,按室間隔基底段-室間隔心尖段-室間隔中間段-游離壁基底段-游離壁中間段順序達峰,最終達游離壁心尖段。結論:1.CRBBB患者右心室收縮功能正常,舒張功能減低。左心室各節(jié)段周向應變及旋轉角度應變不同步(P0.05),且收縮達峰順序與健康人有差異。2.常規(guī)超聲不能發(fā)現(xiàn)CRBBB患者左室內不同步性,VVI技術可以評價CRBBB心肌運動的同步性。3.CRBBB患者右室內收縮不同步、延遲,且收縮達峰順序與健康人不同。
[Abstract]:Aim: to study the unsynchronism of ventricular contraction in patients with right bundle block by velocity vector imaging (VVI) in order to guide the optimization of cardiac resynchronization therapy. Methods: from December 2014 to December 2016, 20 patients with complete right bundle obstruction were selected as the test group, and 20 healthy volunteers matched with the age and sex of the test group were selected as the control group. The results were as follows: 1) the left atrium diameter, left ventricular end diastolic volume, left ventricular end systolic diameter, left ventricular end systolic volume and EF were measured by routine ultrasound. Sm value (left ventricular lateral wall basal segment), E / A value, mitral regurgitation, right atrial diameter, right ventricular transverse diameter, right ventricular outflow tract diameter, Sm value (right ventricular lateral wall basal segment), E / A value, Tricuspid regurgitation. 2) VVI measurement: peak time of radial strain in 16 segments of left ventricular short axial section (Tsr), peak time of circumferential strain peak time (Tsc), rotation angle peak time (Tra); Peak time of strain (contraction) velocity in 6 segments of right ventricular septum and free wall: basal segment, middle segment and apex segment The peak-to-peak time standard deviation (Tsr-SD,Tsc-SD,Tra-SD,Tsl-SD) of each segment was calculated and analyzed. Results: compared with the control group, there was no difference in left ventricular data measured by conventional ultrasound in 1.CRBBB group (P 0.05). There was significant difference in E / A value and tricuspid regurgitation rate (P 0.05) in right ventricular E / A value and tricuspid valve regurgitation rate (P 0.05). Compared with the control group, the left ventricular Tsc-SD,Tra-SD measured by VVI in 2.CRBBB group was statistically significant (P0.05), but there was no significant difference in Tsr-SD (P0.05); right ventricular Tsl-SD was statistically significant (P0.05); 3. Left ventricular Tsl-SD was statistically significant (P0.05); VVI was used to measure the left ventricular Tsc and Tra in the CRBBB group. The left ventricular Tsc and Tra were located in the posterior septum at the earliest and the lateral wall at the latest. The left ventricular Tsc and Tra in the control group were located in the anterior septum and the inferior posterior wall at the earliest, and the right ventricular Tsl in the 4.CRBBB group was the earliest in the middle segment of the ventricular septum and the last in the basal segment of the free wall. In the control group, the right ventricular Tsl was located at the basal segment of ventricular septum at the earliest, and the apical segment of the free wall at the latest. Left ventricular peak order: CRBBB group from the posterior septum, at the same time along the clockwise and counterclockwise two directions to the peak, finally to the lateral wall; control group from the anterior septum, approximately clockwise order of peak, finally to the lower posterior wall. The peak order of the right ventricle in the CRBBB group was from the middle segment of the interventricular septum, and reached the peak sequence according to the middle segment of the interventricular septum, the basal segment of the ventricular septum, the middle segment of the ventricular septum apex and the free wall, and finally reached the free wall basal segment. The control group began from the basal segment of the ventricular septum and reached the peak according to the order of the basal segment of the ventricular septum, the apical segment of the ventricular septum, the middle segment of the ventricular septum, the basal segment of the free wall and the free wall, and finally reached the apex segment of the free wall. Conclusion: right ventricular systolic function is normal and diastolic function is decreased in 1.CRBBB patients. The circumferential strain and rotational angular strain of each segment of left ventricle were out of sync (P0.05), and the peak order of contraction was different from that of healthy persons. Conventional ultrasound can not find left ventricular synchrony in patients with CRBBB. VVI technique can evaluate the synchrony of CRBBB myocardial motion. 3. The right ventricular contraction in patients with CRBBB is out of sync, delayed, and the order of peak of contraction is different from that of healthy people.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.7
本文編號：2446688
[Abstract]:Aim: to study the unsynchronism of ventricular contraction in patients with right bundle block by velocity vector imaging (VVI) in order to guide the optimization of cardiac resynchronization therapy. Methods: from December 2014 to December 2016, 20 patients with complete right bundle obstruction were selected as the test group, and 20 healthy volunteers matched with the age and sex of the test group were selected as the control group. The results were as follows: 1) the left atrium diameter, left ventricular end diastolic volume, left ventricular end systolic diameter, left ventricular end systolic volume and EF were measured by routine ultrasound. Sm value (left ventricular lateral wall basal segment), E / A value, mitral regurgitation, right atrial diameter, right ventricular transverse diameter, right ventricular outflow tract diameter, Sm value (right ventricular lateral wall basal segment), E / A value, Tricuspid regurgitation. 2) VVI measurement: peak time of radial strain in 16 segments of left ventricular short axial section (Tsr), peak time of circumferential strain peak time (Tsc), rotation angle peak time (Tra); Peak time of strain (contraction) velocity in 6 segments of right ventricular septum and free wall: basal segment, middle segment and apex segment The peak-to-peak time standard deviation (Tsr-SD,Tsc-SD,Tra-SD,Tsl-SD) of each segment was calculated and analyzed. Results: compared with the control group, there was no difference in left ventricular data measured by conventional ultrasound in 1.CRBBB group (P 0.05). There was significant difference in E / A value and tricuspid regurgitation rate (P 0.05) in right ventricular E / A value and tricuspid valve regurgitation rate (P 0.05). Compared with the control group, the left ventricular Tsc-SD,Tra-SD measured by VVI in 2.CRBBB group was statistically significant (P0.05), but there was no significant difference in Tsr-SD (P0.05); right ventricular Tsl-SD was statistically significant (P0.05); 3. Left ventricular Tsl-SD was statistically significant (P0.05); VVI was used to measure the left ventricular Tsc and Tra in the CRBBB group. The left ventricular Tsc and Tra were located in the posterior septum at the earliest and the lateral wall at the latest. The left ventricular Tsc and Tra in the control group were located in the anterior septum and the inferior posterior wall at the earliest, and the right ventricular Tsl in the 4.CRBBB group was the earliest in the middle segment of the ventricular septum and the last in the basal segment of the free wall. In the control group, the right ventricular Tsl was located at the basal segment of ventricular septum at the earliest, and the apical segment of the free wall at the latest. Left ventricular peak order: CRBBB group from the posterior septum, at the same time along the clockwise and counterclockwise two directions to the peak, finally to the lateral wall; control group from the anterior septum, approximately clockwise order of peak, finally to the lower posterior wall. The peak order of the right ventricle in the CRBBB group was from the middle segment of the interventricular septum, and reached the peak sequence according to the middle segment of the interventricular septum, the basal segment of the ventricular septum, the middle segment of the ventricular septum apex and the free wall, and finally reached the free wall basal segment. The control group began from the basal segment of the ventricular septum and reached the peak according to the order of the basal segment of the ventricular septum, the apical segment of the ventricular septum, the middle segment of the ventricular septum, the basal segment of the free wall and the free wall, and finally reached the apex segment of the free wall. Conclusion: right ventricular systolic function is normal and diastolic function is decreased in 1.CRBBB patients. The circumferential strain and rotational angular strain of each segment of left ventricle were out of sync (P0.05), and the peak order of contraction was different from that of healthy persons. Conventional ultrasound can not find left ventricular synchrony in patients with CRBBB. VVI technique can evaluate the synchrony of CRBBB myocardial motion. 3. The right ventricular contraction in patients with CRBBB is out of sync, delayed, and the order of peak of contraction is different from that of healthy people.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.7
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