血流向量成像技术评价肥厚型心肌病患者左心室收缩期流体力学变化  

Evaluation on changes of left ventricular systolic fluid in patients with hypertrophic cardiomyopathy by vector flow mapping technology

作　　者：王伟[1] 白晖[1] 周金玲[1] 崔玲妹 杜红惠 王岳恒[1] WANG Wei;BAI Hui;ZHOU Jinling;CUI Lingmei;DU Honghui;WANG Yueheng(Department of Cardiac Ultrasound,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心脏超声科,石家庄市050000 [2]河北省新河县人民医院超声科

出　　处：《临床超声医学杂志》2023年第8期633-638,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的 应用血流向量成像(VFM)技术评价肥厚型心肌病(HCM)患者左心室收缩期血流流场变化规律及机制,探讨能量效率(EE)在评价左心室功能中的临床价值。方法 选取我院25例非梗阻性HCM患者(HCM组)、24例高血压性左心室肥厚患者(H-LVH组)及35例健康志愿者(对照组),应用VFM技术获取各组等容收缩期及射血期平均能量损耗(IVC-EL、Ej-EL)、能量效率(IVC-EE、Ej-EE)、循环值(IVC-cir、Ej-cir)及涡旋面积(IVC-vor-area、Ej-vor-area),并分析各组左心室涡流运动模式;二维斑点追踪技术获取左心室整体纵向应变(GLS)、间隔纵向应变(IVS-LS)及后侧壁纵向应变(PLW-LS);比较各组上述参数的差异。应用多元线性回归分析Ej-EE的独立相关因素;分析Ej-EE与GLS相关性。结果 与对照组比较,HCM组及H-LVH组GLS均减低,IVC-EL、Ej-EL、Ej-EE、SW均增加,HCM组IVC-vor-area、Ej-vor-area、IVS-LS均减低,HCM组IVC-EE及H-LVH组IVC-cir均增加,差异均有统计学意义(均P<0.05);与H-LVH组比较,HCM组Ej-EE增加,SW、IVC-vor-area、Ej-vor-area、IVC-cir、IVS-LS均减低,差异均有统计学意义(均P<0.05)。HCM组22例(88.0%)患者出现“反向涡流”,与对照组和H-LVH组(0、16.7%)比较差异均有统计学意义(均P<0.05)。多元线性回归分析显示,IVC-vor-area和GLS均与Ej-EE独立相关,回归模型方程式:Ej-EL=2.825-0.002×IVC-vor-area+0.057×GLS;相关性分析显示,Ej-EE与GLS呈负相关(r=-0.344,P=0.0013)。结论 VFM技术可直观、定量地显示HCM患者左心室收缩期异常血流动力学变化,EE可作为评估左心室早期功能障碍的可靠指标。Objective To evaluate the changes and mechanism of left ventricular systolic blood flow fluid in hypertrophic cardiomyopathy(HCM)patients by vector flow mapping(VFM)technology,and to explore the clinical value of energy efficiency(EE)in evaluating left ventricular function.MethodsTwenty-five cases of non-obstructive hypertrophic cardiomyopathy patients(HCM group),24 cases of hypertensive left ventricular hypertrophy patients(H-LVH group)and 35cases of healthy volunteers(control group)in our hospital were enrolled.The average energy loss(IVC-EL,Ej-EL),energy efficiency(IVC-EE,Ej-EE),circulation(IVC-cir,Ej-cir)and vortex area(IVC-vor-area,Ej-vor-area)during isovolumic contraction and ejection stages of each group were obtained by VFM technology.The pattern of left ventricular movement in each group were analyzed.The total longitudinal strain(GLS),interventricular septal strai(IVS-LS)and posterior lateral wall strain(PLW-LS)were obtained by two-dimensional speckle tracking imaging.The differences of the above parameters were compared among all groups.The independent correlation factors of Ej-EE were analyzed by multiple Linear regression analysis.The correlation between Ej-EE and GLS was analyzed.ResultsCompared with the control group,GLS was decreased,IVC-EL,EjEL,Ej-EE and SW were increased in HCM group and H-LVH group,and IVC-cir was increased in H-LVH group,while the IVC-vor-area,Ej-vor-area,IVS-LS were decreased and IVC-EE was increased in HCM group,and the differences were statistically significant(all P<0.05).Compared with the H-LVH group,Ej-EE was increased,and SW,IVC-vor-area,Ej-vorarea,IVC-cir,IVS-LS were decreased in HCM group,and the differences were statistically significan(tall P<0.05).The“reverse vortex”was observed in 22 patients(88.0%)in HCM group,and difference were statistically significant compared with control group and H-LVH group(0,16.7%,both P<0.05).There was a negative correlation between Ej-EE and GLS(r=-0.344,P=0.0013).Multiple Linear regression analysis showed that IVC-vor-area and GLS

关 键 词：超声心动描记术 血流向量成像 斑点追踪 二维 肥厚型心肌病 高血压性左心室肥厚 涡旋 能量效率 

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