二维斑点追踪参数在平板运动负荷超声中的应用研究  

Application of two-dimensional speckle tracking parameters in treadmill exercise stress echocardiograhy

作　　者：张清凤[1] 王胰[1] 张红梅[1] 丁戈琦 郭智宇 尹立雪[1] Zhang Qingfeng;Wang Yi;Zhang Hongmei;Ding Geqi;Guo Zhiyu;Yin Lixue(Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Academy of Medical Science&Sichuan Province People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China;GE Cardiovascular Ultrasound Clinical&Research Department,Chengdu 611731,China)

机构地区：[1]超声心脏电生理与生物力学四川省重点实验室四川省人民医院,成都610072 [2]通用电气心血管超声临床研究所,成都611731

出　　处：《中华医学超声杂志（电子版）》2020年第8期753-758,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的应用二维斑点追踪技术评价平板运动负荷超声心肌力学参数的变化特征。方法收集2017年6月至2018年7月无冠状动脉相关病史、于四川省人民医院行平板运动负荷超声心动图的体检者58例。应用斑点追踪软件分析静息和运动负荷峰值状态常规参数,包括左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室射血分数(LVEF)及二尖瓣前向血流频谱E峰值、A峰值,二尖瓣侧壁瓣环运动曲线e、a、s值,计算E/A,e/a,E/e,并对整体和节段(17个)左心室纵向峰值应变和纵向峰值应变达峰时间进行静息和运动负荷峰值状态比较,计算经心率校正后的静息和运动负荷峰值应变达峰时间比值。结果LVESVI峰值较静息时减小[(6.4±2.1)m^3/m^2 vs(14.7±3.6)m^3/m2],峰值期二尖瓣环s峰值较静息时明显增高[(0.21±0.27)m/s vs(0.12±0.02)m/s],差异均有统计学意义(P均<0.01)。左心室节段除后壁和下壁基底段外,峰值应变在负荷运动峰值期较静息时均明显增加(P均<0.05),静息和运动负荷峰值期的应变绝对值均是心尖部最高[(24.9±3.2)%,(33.9±3.7)%],与基底段和中段相比,差异均有统计学意义(P均<0.01)。运动负荷峰值期各节段达峰时间均较静息期明显缩短(P均<0.01),心尖段峰值期达峰时间最短[(215.9±35.6)ms],基底段峰值期达峰时间最长[(237.8±43.4)ms],二者差异有统计学意义(P<0.01),静息与运动负荷峰值状态经心率校正后的纵向应变达峰时间比值为2.3~3.0。结论负荷状态的应变及达峰时间参数变化特征具有重要的临床应用价值,在负荷前和负荷后均可独立反映心肌功能状态,可为不同心脏病患者的心功能评价提供参考。Objective To evaluate the variation characteristics of myocardial mechanical parameters under treadmill exercise stress echocardiography by two-dimensional speckle tracking technique.Methods A total of 58 healthy volunteers with no history of coronary artery disease who underwent treadmill exercise stress echocardiography at Sichuan Province People's Hospital from June 2017 to July 2018 were collected.Speckle tracking software was used to analyze the general parameters,including left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),left ventricular ejection fraction(LVEF),mitral valve flow spectrum E and A values,lateral mitral annulus movement curve e,a,and s values,and E/A,e/a,and E/e were calculated.The global and segmental(17)left ventricular longitudinal peak strain and time to peak longitudinal strain(TTPS)were compared at rest and peak.The rest to peak ratio of TTPS after heart rate adjustment was calculated.Results The peak value of LVESVI decreased significantly(6.4±2.1 m^3/m^2 vs 14.7±3.6 m^3/m^2)and the peak value of mitral annulus s increased significantly(0.21±0.27 m/s vs 0.12±0.02 m/s)during the peak period compared with resting values(P<0.01).At peak,the strain of left ventricle 17 segment increased significantly except the basal segment of post and inferior wall(P<0.01).The absolute values of strain in both resting and peak periods were highest in the apex[(24.9±3.2)%and(33.9±3.7)%,respectively],and the difference was statistically significant when compared with those of basal and middle segments(P<0.01).The peak value of TTPS was significantly shorter than that at rest(P<0.01),with the value of the apex segment being the shortest(215.9±35.6 ms)and that of the base segment being the longest(237.8±43.4 ms).After adjustment for heart rate,the rest-to-stress ratio of TTPS was about 2.3-3.0.Conclusion The variation characteristics of longitudinal strain and TTPS at peak have important clinical application value,and can independently reflect the

关 键 词：超声心动描记术 压力 平板运动 斑点追踪 

分 类 号：R540.4[医药卫生—心血管疾病]