血流向量成像技术评价射血分数正常的主动脉瓣狭窄患者左心室功能  

Evaluation of early left ventricular dysfunction in aortic stenosis patients with normal left ventricular ejection fraction by vector flow mapping

作　　者：张计青 谢明星[1] 吕清[1] 刘曼薇 邓文惠 王静[1] Zhang Jiqing;Xie Mingxing;Lyu Qing;Liu Manwei;Deng Wenhui;Wang Jing(Department of Ultrasound,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Province Key Lab of Molecular Imaging,Wuhan 430022,China;Department of Medical Ultrasound,the First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China)

机构地区：[1]华中科技大学同济医学院附属协和医院超声影像科湖北省分子影像重点实验室,武汉430022 [2]山东第一医科大学第一附属医院超声诊疗科,济南250014

出　　处：《中华超声影像学杂志》2020年第9期737-742,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81771851)。

摘　　要：目的探究血流向量成像(VFM)技术在评价左心室射血分数(LVEF)正常的主动脉瓣狭窄(AS)患者左心室功能变化中的应用价值。方法收集2015年10月至2017年2月于华中科技大学同济医学院附属协和医院就诊的LVEF正常(LVEF>50%)的AS患者37例,依据血流动力学改变,分为轻至中度组(AS1组,16例)和重度组(AS2组,21例),同期选取性别、年龄匹配的35例健康志愿者作为对照组。在线测量左心室常规结构及心功能参数,并进行VFM离线分析,根据时间-流量曲线及瓣膜启闭情况划分时相如下:全舒张期(P0)、等容舒张期(P1)、快速充盈期(P2)、减慢充盈期(P3)、心房收缩期(P4)、等容收缩期(P5)、快速射血期(P6)、减慢射血期(P7)、全收缩期(P8),获取相应时相左心室内能量损耗(EL)并进行相关分析。结果左心室EL比较:①三组左心室EL随心动周期均呈规律变化,3个峰值分别出现在P2、P4和P6;全舒张期P0-EL与全收缩期P8-EL接近相等。②与对照组比较,AS1组P0~P8的EL均有所增高,但仅P4、P7、P0差异有统计学意义(P<0.01);与其他两组相比,AS2组P0~P8的EL增高,差异有统计学意义(均P<0.01),其中P2、P4、P6的EL增高显著。相关性分析:①对照组及AS组P0-EL、P8-EL与LVMI呈正相关(r=0.561、0.585,0.635、0.652,P<0.01);②对照组及AS组P2-EL与E和e′呈正相关(r=0.623、0.537,0.576、0.502,P<0.01),P4-EL与A呈正相关(r=0.482、0.555,P<0.01);③对照组及AS组P0-EL、P8-EL与E/e′呈正相关(r=0.480、0.459,0.673、0.590,P<0.01),与LVEF呈负相关(r=-0.537、-0.596,-0.569、-0.625,P<0.01)。结论VFM技术量化左心室EL有望成为早期评价LVEF正常的AS患者左心室功能障碍的新指标。Objective To explore the clinical application value of vector flow mapping(VFM)in assessment of early cardiac dysfunction in aortic stenosis(AS)patients with normal left ventricular ejection fraction(LVEF).Methods The clinical study consisted of 37 patients with various degrees of AS(LVEF>50%)from October 2015 to February 2017 in Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,including 16 mild to moderate ones(AS1 group)and 21 severe ones(AS2 group).A group of 35 age-and gender-matched healthy volunteers were selected as control group.Using Hitachi Aloka Prosound F75 color Doppler ultrasound diagnostic system,general two-dimensional parameters of left ventricular structure and function were measured.Furthermore,standard dynamic apical long axis view color Doppler flow images during 3 completed cardiac cycles were acquired for DAS-RS1 off-line workstation.Based on time-flow curve(T-F curve)of left ventricle,ECG,and the open-close of valves,the diastole period of left ventricle was divided into the isovolumic relaxation phase(P1),rapid filling phase(P2),slow filling phase(P3),atria contract phase(P4),and total diastolic phase(P0);the systole period was divided into isovolumetric contraction phase(P5),rapid ejecting phase(P6),slow ejecting phase(P7),and total systolic phase(P8).The left ventricular energy loss(EL)of three groups were acquired in all phases.Results Left ventricular EL:①Three peaks of EL appeared in P2,P4 and P6 respectively and total diastolic EL was almost equal to systolic.②Compared with control group,the EL values of AS1 group increased in all phases,but only in P4,P7 and P0 with significant differences(P<0.05).③Compared with the other two groups,the EL values in AS2 group increased significantly in all phases of AS2 group(P<0.01).Correlation analysis:①For control group and AS group,there were both significant positive correlations between P0-EL,P8-EL and LVMI(r=0.561,0.585;0.635,0.652 respectively;P<0.01).②There were both significant positive corr

关 键 词：血流向量成像 主动脉瓣狭窄 心室功能 左 能量损耗 

分 类 号：R543.1[医药卫生—心血管疾病]