血流向量成像对非梗阻型肥厚性心肌病患者左室血流模式的分析  

Vector flow mapping analysis of left ventricle flow pattern in NHCM patients

作　　者：程颖颖[1] 包凌云[1] 黄安茜[1] 

机构地区：[1]浙江省杭州市第一人民医院超声科,浙江杭州310000

出　　处：《医学影像学杂志》2017年第3期446-448,453,共4页Journal of Medical Imaging

摘　　要：目的探讨利用血流向量成像评价非梗阻型肥厚性心肌病患者左室血流模式变化情况。方法收集非梗阻型肥厚性心肌病患者16例,常规经胸超声检查并获取心尖位左室长轴观、两腔观和四腔观的血流图,记录左室流出道处的室间隔厚度及流出道宽度、左室流出道血流压力阶差和左室质量。利用VFM观测左室内涡流及主动脉瓣环、瓣下1cm、瓣下2cm处收缩期最大血流向量及二尖瓣口、瓣下1cm、瓣下2cm处舒张期最大血流向量,与性别年龄体重等匹配的正常对照比较,探索其血流模式变化。结果非梗阻型肥厚性心肌病患者与对照组相比,在室间隔厚度、左房大小、左室质量、左室流出道内径、左室流出道速度及压差均有显著性差异。其左室流出道可见明显加速过程,主动脉瓣下2cm、1cm、主动脉瓣环处收缩期最大向量存在明显差异,即因左室流出道存在梗阻,导致加速过程(P<0.01)。正常对照无类似现象。正常对照主动脉瓣下2cm、1cm、主动脉瓣环处收缩期最大向量存在明显差异,即存在减速过程。非梗阻型肥厚性心肌病患者组各个水平收缩期最大向量均明显大于正常对照组(P<0.01)。舒张期正常对照及患者均存在先减速后加速过程。肥厚性心肌病组二尖瓣各水平速度向量均小于正常对照组。结论非梗阻型肥厚性心肌病患者左室流出道存在显著加速过程,二尖瓣回心血流向量较对照组明显减慢。Objective To study the flow pattern of the left ventricle in HCM patients, by VFM flow vector analysis. Methods We record the images with the consensus of 16 HCM patients,get the routine LV parameters such as LVmass, LVOT diameter in a regular TEE, and record images in VFM mode. Then, off-line analysis is used to determine the vortex in LV and the maximum vector in the systolic phase at the level of aotic valve and 1 cm, 2 cm below the valve, as well as the maximum vector in the dias- tolic phase at the level of mitral valve and 1 cm, 2 cm below the valve. We compare all the parameters with age and gender matched normal contrast, to illustrate the changes in LV flow pattern in HCM patients. Results HCM patients show sibnigficant- ly different compared to normal contrast in IVS diameters and LA, LVMass, LVOT, PG and Vmax of LVOT. HCM patients pres- ent a process of acceleration in LVOT, there is significant increase among 2 cm to 1 cm below the valve to the aortic valve. While in the normal contrast, there is a a process of deceleration in LVOT, there is significant decrease among 2 cm to 1 cm＇ below the valve to the aortic valve. HCM patients and normal contrast all present a a process of first acceleration then deceleration in LV in- flow. And HCM patients present a significantly smallerr vector in all levels of of inflow compared with the normal. Conclusion HCM patients present different pattern in LV LVOT outflow and Transmittal inflow, especially significantly smallerr vector in all levels of of inflow compared with the normal.

关 键 词：血流向量成像 超声心动图 肥厚性心肌病 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]