血流向量成像技术评价肥厚型心肌病患者左室功能的初步研究  

Preliminary evaluation of left ventricular function in hypertrophic cardiomyopathy by vector flow mapping

作　　者：杨艳[1] 薛丹[1] 杨一林[1] 王鹏[1] 张宇新[1] 袁丽君[1] 段云友[1] 

机构地区：[1]第四军医大学唐都医院超声诊断科,西安市710038

出　　处：《临床超声医学杂志》2017年第2期85-90,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用血流向量成像(VFM)技术观察肥厚型心肌病(HCM)患者左室收缩期及舒张期能量损耗和循环变化,评价其左室收缩及舒张功能。方法选取26例非梗阻性HCM患者(HCM组)和36例健康志愿者(对照组),分别在标准心尖四腔、三腔及两腔观提取收缩早期、收缩中期、收缩晚期、舒张早期、舒张中期及左房收缩期6个时相的循环参数(涡旋数量、涡旋面积、循环强度)和基底段、中间段、心尖段平均能量损耗(EL)的参数,比较两组上述各参数变化。应用双多普勒同步取样技术获取二尖瓣口舒张早期血流峰值速度(E)、二尖瓣口舒张晚期血流峰值速度(A)、二尖瓣口舒张早期血流速度与室间隔侧二尖瓣环舒张早期运动峰值速度之比(E/e)、Tei指数及心指数,并将其分别与各时相循环和能量损耗参数进行相关性分析。结果 HCM组与对照组在舒张早期心尖段、左房收缩期中间段、收缩早期基底段,以及收缩中、晚期基底段、中间段、心尖段的EL比较,差异均有统计学意义(均P<0.05);两组EL在各个时相从基底段到心尖段依次减低,差异均有统计学意义(均P<0.01)。两组在舒张早期涡旋数量和舒张中期涡旋数量、涡旋面积、循环强度比较,差异均有统计学意义(均P<0.05);两组在收缩早期、收缩中期仅涡旋面积差异有统计学意义(P<0.05)。舒张早期循环强度与E呈正相关(r=0.456,P<0.01);左房收缩期循环强度与A呈正相关(r=0.485,P<0.01);收缩中期基底段EL与心指数呈负相关(r=-0.363,P<0.01);左房收缩期基底段、中间段EL与E/e均呈正相关(r=0.310,P<0.05;r=0.444,P<0.01)。结论 VFM技术能量损耗和循环参数对于早期发现心功能异常更加敏感,可作为评价心脏早期功能变化的新指标。Objective To observe the change of energy loss and circulation of left ventricular systolic and diastolic periods by vector flow mapping,and evaluate the left ventricular systolic and diastolic function in patients with hypertropic cardiomyopathy.Methods Twenty-six non-obstructive hypertropic cardiomyopathy patients（HCM group）and thirty-six healthy volunteers（control group）were enrolled.The quantitative parameters,including average energy loss（EL-base,EL-mid,EL-apex）and circulation（vortex quantity,vortex area,circulation）were measured in the different periods of vector flow mapping imaging mode in an apical four-chamber view,apical three-chamber view and apical two-chamber view,respectively.The difference of parameters were evaluated between two groups during early systole,mid-systole,late-systole,early diastole,mid-diastole and atrial contraction period.The early transmitral valve blood flow velocity E,the late transmitral valve blood flow velocity A,the ratio of early transmitral valve blood flow velocity to the early diastolic mitral valve velocity E/e and Tei index were obtained via dualDoppler imaging technology.Meanwhile,correlationship was analyzed between two groups parameters including average energy loss and circulation and E,A,E/e and Tei index,respectively.Results EL-apex during early diastole,EL-mid during left atrial contraction period,EL-base during early systole and all segments during mid-systole and late-systole were different between two groups（all P〈0.05）.EL decreased gradually from the basal to the apical portion between two groups during six periods that mentioned above（all P〈0.01）.The vortex quantity during early diastole and the vortex quantity,vortex area and circulation during mid-diastole were different between two groups（all P〈0.05）.The vortex area during early systole and mid-systole were different between two groups（P〈0.05）;The circulation had positive correlation with E during early diastole for all subjects（r=0.456,P〈0.01）.The circulati

关 键 词：血流向量成像技术 超声心动描记术 肥厚型心肌病 能量损耗 循环 心室功能 左 

分 类 号：R542.2[医药卫生—心血管疾病] R540.45[医药卫生—内科学]