斑点追踪显像对慢性心力衰竭患者心脏再同步化治疗短期疗效的评价

目的 探讨超声斑点追踪显像(STI)技术对慢性心力衰竭患者心脏再同步化治疗(CRT)短期疗效的评价价值.方法 16例慢性心力衰竭患者,获取心尖长轴观测量各节段收缩期纵向应变达峰时间、径向应变达峰时间,胸骨旁短轴观测环向应变达峰时间,计算CRT术后1个月、术后3个月18节段纵向、径向、环向应变达峰时间标准差(LS-SD18、RS-SD18、CS-SD18),左室各节段收缩期纵向、径向、环向应变达峰时间最大差值(LS-dif、RS-dif、CS-dif)作为应变非同步指标.将术后3个月、1个月18节段纵向、径向、环向应变达峰时间标准差与术前的差值(△LS-SD18、△RS-SD18、ACS-SD18)与术后3个月、1个月左室收缩末容积减少百分比(△ESV%)进行相关性分析.结果 CRT后1个月、术后3个月LS-SD18、RS-SD18、CS-SD18及RS-dif较术前显著减少,差异有统计学意义(P<0.05);术后3个月△RS-SD18与术后3个月△ESV%具有明显的相关性(r=0.694).结论 应变非同步指标对评价短期CRT后机械非同步性具有重要意义.     

斑点追踪显像对慢性心力衰竭患者心脏再同步化治疗短期疗效的评价

Objective To assess the short-term effect of cardiac resynchronization therapy (CRT) by speckle tracking strain imaging(STI). Methods Sixteen chronic heart failure patients(CHF) with CRT were enrolled. The time to peak systolic longitudinal strain and the time to peak systolic radial strain were derived from the LV apical views, and the time to peak systolic circumferential strain was derived from the parasternal short axis. The standard deviation for time to peak longitudinal, radial and circumferential strain in the 18 segments (LS-SD18, RS-SD18, CS-SD18) and the maximal temporal difference of any two segments(LS-dif, RS-dif, CS-dif) were calculated as a strain-derived dyssynchrony index. The difference of LS-SDIS, RS-SD18, CS-SD18 between 1 month,3 months after CRT and baseline (△LS-SD18, △RS-SD18, △CS-SD18) was calculated. The correlation between △LS-SD18,ARS-SD18,△CS-SD18 and the reduction of end-systolic volume at follow-up(△ESV%) were analyzed. Results The LS-SD18, RS-SD18,CS-SD18 and RS-dif were decreased significantly 1 month,3 months after CRT.△RS-SD18 was correlated with △ESV% 3 months after CRT(r = 0. 694). Conclusions The strain-derived dyssynchrony index is great significient for short-term effect of CRT.     

斑点追踪显像技术评价心肌扭转与心肌梗死范围相关性的实验研究

目的 应用斑点追踪显像技术评价急性心肌梗死(AMI)再灌注前、后左室心肌扭转,借以比较多个常规扭转指标与梗死范围的相关性,找出最能反映梗死范围的扭转指标.方法 小型猪15只,结扎左前降支120 min,分别检测结扎前、结扎后120 min、解除结扎后30 min、60 min、90 min、12 h各时间点常规超声指标以及扭转数据并进行比较.氯化硝基四氮唑蓝染色后计算心肌梗死范围.结果 AMI后心尖及左室各旋转/扭转角度指标均显著下降,再灌注12 h无明显改善.AMI即刻,左室整体扭转角度峰值及心尖整体旋转角度峰值与梗死范围的相关性明显优于同期其他扭转指标,相关系数分别为-0.81和-0.69(P均＜0.01);再灌注12 h相关性依然较好.结论 在AMI即刻及再灌注12 h内,左室整体扭转角度峰值及心尖整体旋转角度峰值是反映心肌梗死范围最敏感的扭转指标.

Abstract：

Objective To investigate the most sensitive markers of left ventricular(LV) torsion which can reflect infarct size by assessing the relationship between routine markers of LV torsion and infarct size using speckle tracking imaging (STI).Methods Fifteen open-chest pigs underwent 120 minutes of left anterior descending (LAD) ligation followed by 12 hours of reperfusion.Rotation and torsion of LV were obtained by STI before LAD occlusion,LAD occlusion immediately,and 30,60,90 minutes and 12 hours after reperfusion.Infarct size was measured by nitrotetrazolium blue chloride staining.Results LAD ligation resulted in a dramatic decrease in both subepicardial and subendocardial peak apical rotation or peak LV torsion.Twelve hours after reperfusion,all of the peak rotation and torsion remained significantly reduced (P ＜ 0.01 versus AMI).At AMI,peak bulk LV torsion and peak bulk apical rotation inversely correlated with infarct size (r = - 0.81,P ＜0.01; r = - 0.69,P ＜0.01).There existed the good relationship at 12-hour follow-up after reperfusion.The relationship was superior to that of other torsion markers.Conclusions Peak bulk LV torsion and peak bulk apical rotation are the most sensitive markers of LV torsion which can reflect infarct size.     

斑点追踪成像评估心力衰竭兔左心室扭转和解旋

目的 应用斑点追踪显像(STI)技术评价舒张性心力衰竭(DHF)和收缩性心力衰竭(SHF)兔模型的左室扭转及解旋运动的特点.方法 33只雄性新西兰兔分为三组:分别为DHF模型组(12只)、SHF模型组(11只)及对照组(10只).应用STI技术评估左室扭转,并行左室导管及心肌病理学检查.结果 与对照组相比,DHF组左室峰值扭转角度(Ptw)无显著变化(P＞0.05),SHF组Ptw减低,两组的解旋均延迟,等容解旋率减低,DHF组的左室解旋峰速(PUTV)增加,SHF组的PUTV减低(P＜0.05).两组的Ptw均与左室收缩功能指标呈正相关.SHF组的PUTV与左室导管舒张功能指标呈正相关.结论 STI可有效评价SHF和DHF兔左室扭转和解旋运动.

Abstract：

Objective To assess left ventricular twist and untwist in rabbit models with diastolic heart failure(DHF) and systolic heart failure(SHF) by speckle tracking imaging(STI).Methods Thirtythree male New Zealand rabbits were divided into three groups:one group was used to establish DHF model by suprarenal abdominal aortic constriction(n = 12) and the other was used to establish SHF model by abdominal aortic constriction subdiaphragmly above celiac artery origin(n = 11),another was control group established by sham operation(n = 10).After two weeks,left ventricular twist-related parameters were measured.by STE.Finallly,left ventricular catheterization and myocardial pathological examination were performed.Results Compared with control group,peak twist angle (Ptw) and peak twisting velocity(PTV)remained unchanged in DHF group (P ＞ 0.05) and decreased in SHF group (P ＜ 0.05).Isovolumic untwisting rate (IUR) decreased,untwisting half-time(UHT) was prolonged,time to peak twist (tPtw) and peak untwisting velocity (tPUTV) were delayed in SHF and DHF groups.In additon,Peak untwisting velocity(PUTV) decreased in SHF group,but increased in DHF group (P ＜0.05).Ptw correlated correlated positively with LVEF,+ dp/dtmax significantly in both groups (DHF group:r = 0.897,P =0.002; r = 0.719,P = 0.044;SHF group:r = 0.727,P = 0.041; r = 0.780,P = 0.022).A significantly positive correlation was observed between PUTV and - dp/dtmax Tau,LVEDP(r = 0.801,P = 0.017; r =0.814,P = 0.014; r = 0.875,P = 0.004) in SHF group.Conclusions STI is useful in evaluating left ventricular twist and untwist in rabbit model of DHF and SHF.     

斑点追踪成像技术评价慢性心力衰竭患者心脏再同步化治疗后的左心室扭转运动

目的应用斑点追踪成像技术评价慢性心力衰竭（CHF）患者心脏再同步化治疗（CRT）后左心室扭转及其与左心室收缩功能之间的关系。方法获取18例慢性心力衰竭患者左心室的标准短轴基底部、心尖部的图像,应用斑点追踪成像技术测量心底部旋转角度（Rot—B）及心尖部旋转角度（Rot—A）,比较慢性心力衰竭患者CRT术后3个月与术前左心室心底部旋转角度差值（ARot—B）、心尖部旋转角度差值（ARot—A）、扭转差值（ALVtor）与左心室射血分数差值（△EF）之间的关系。结果CRT术后3个月左心室心尖部旋转角度较术前明显增加,左心室扭转角度明显增加。△LVtor、△Rot—A与△EF（r=0．619,r=0．592）呈正相关。结论左心室扭转为评价CRT后患者左心室收缩功能提供了有价值的信息。     

斑点追踪显像技术评价心肌扭转与心肌梗死范围相关性的实验研究

Objective To investigate the most sensitive markers of left ventricular(LV) torsion which can reflect infarct size by assessing the relationship between routine markers of LV torsion and infarct size using speckle tracking imaging (STI).Methods Fifteen open-chest pigs underwent 120 minutes of left anterior descending (LAD) ligation followed by 12 hours of reperfusion.Rotation and torsion of LV were obtained by STI before LAD occlusion,LAD occlusion immediately,and 30,60,90 minutes and 12 hours after reperfusion.Infarct size was measured by nitrotetrazolium blue chloride staining.Results LAD ligation resulted in a dramatic decrease in both subepicardial and subendocardial peak apical rotation or peak LV torsion.Twelve hours after reperfusion,all of the peak rotation and torsion remained significantly reduced (P ＜ 0.01 versus AMI).At AMI,peak bulk LV torsion and peak bulk apical rotation inversely correlated with infarct size (r = - 0.81,P ＜0.01; r = - 0.69,P ＜0.01).There existed the good relationship at 12-hour follow-up after reperfusion.The relationship was superior to that of other torsion markers.Conclusions Peak bulk LV torsion and peak bulk apical rotation are the most sensitive markers of LV torsion which can reflect infarct size.     

斑点追踪成像评估心力衰竭兔左心室扭转和解旋

Objective To assess left ventricular twist and untwist in rabbit models with diastolic heart failure(DHF) and systolic heart failure(SHF) by speckle tracking imaging(STI).Methods Thirtythree male New Zealand rabbits were divided into three groups:one group was used to establish DHF model by suprarenal abdominal aortic constriction(n = 12) and the other was used to establish SHF model by abdominal aortic constriction subdiaphragmly above celiac artery origin(n = 11),another was control group established by sham operation(n = 10).After two weeks,left ventricular twist-related parameters were measured.by STE.Finallly,left ventricular catheterization and myocardial pathological examination were performed.Results Compared with control group,peak twist angle (Ptw) and peak twisting velocity(PTV)remained unchanged in DHF group (P ＞ 0.05) and decreased in SHF group (P ＜ 0.05).Isovolumic untwisting rate (IUR) decreased,untwisting half-time(UHT) was prolonged,time to peak twist (tPtw) and peak untwisting velocity (tPUTV) were delayed in SHF and DHF groups.In additon,Peak untwisting velocity(PUTV) decreased in SHF group,but increased in DHF group (P ＜0.05).Ptw correlated correlated positively with LVEF,+ dp/dtmax significantly in both groups (DHF group:r = 0.897,P =0.002; r = 0.719,P = 0.044;SHF group:r = 0.727,P = 0.041; r = 0.780,P = 0.022).A significantly positive correlation was observed between PUTV and - dp/dtmax Tau,LVEDP(r = 0.801,P = 0.017; r =0.814,P = 0.014; r = 0.875,P = 0.004) in SHF group.Conclusions STI is useful in evaluating left ventricular twist and untwist in rabbit model of DHF and SHF.     

斑点追踪显像评价原发性高血压患者左心室旋转和扭转

目的 探讨斑点追踪显像(STI)评价原发性高血压(EH)患者左心室旋转和扭转运动早期改变的价值.方法 对65例左心室正常构型(LVN)的EH患者和45名正常人,经胸采集左心室短轴心尖水平和心底水平的二维图像,计算心底水平旋转角度峰值(MV-Prot)、心尖水平旋转角度峰值(AP-Prot)、扭转角度峰值(Ptw)、收缩期末扭转角度(AVCtw)、等容舒张期末扭转角度(MVOtw)、解扭转率(Untw R)和解扭转减半时间(HTU).结果 在NLAE组和LAE组中,MV-Prot和AP-Prot间差异无统计学意义.与正常组相比,NLAE组和LAE组MV-Prot、AP-Prot、Ptw、AVCtw和MVOtw增大,Untw R减低、HTU延长.结论 EH患者早期左心室旋转及扭转运动功能改变的特征是心尖部相对心底部旋转优势消失、旋转和扭转增高、解扭转降低.     

斑点追踪显像技术评价心肌缺血再灌注对心肌扭转影响的实验研究

目的 应用斑点追踪显像技术测定心肌缺血及再灌注后不同时刻的心肌扭转.方法 14只小型猪,随机分为两组:A组结扎前降支1 min,B组结扎前降支15 min.分别测定结扎前、解除结扎前及解除结扎后第1、5、30、60、90 min、1周各时间点常规心脏超声指标以及扭转数据,并进行比较.结果 缺血时A组心尖部及左室心内膜下扭转角度峰值再灌注后第1 min即恢复至基线水平;而B组相同扭转指标再灌注后30min出现一过性改善,相对于解除结扎前分别为(6.5±0.8).对(3.4±1.2).和(7.8±1.0)°对(6.1±1.1).(P均＜0.01),完全恢复则在再灌注后1周.B组心外膜下扭转角度峰值再灌注后呈逐渐上升趋势.结论 心肌缺血时间不同,再灌注前后心内、外膜下心肌扭转角度改变不尽相同.应用斑点追踪显像技术测定再灌注后心肌扭转恢复情况可以反映心肌缺血程度,从而为评价心肌缺血提供更长时间的观察窗.     

斑点追踪显像技术对冠心病左心室扭转和解旋运动的研究

目的 应用斑点追踪显像技术评价冠心病患者左室扭转和解旋运动的特征.方法 48例拟诊为冠心病,拟行冠状动脉造影、冠状动脉螺旋CT成像或心肌核素显像检查确诊,或行冠状动脉介入手术或冠状动脉搭桥手术治疗的患者.采集心尖左室长轴观、胸骨旁左室二尖瓣水平和心尖水平二维图像,应用二维应变分析软件分别获得左室二尖瓣水平和心尖水平短轴观整体的旋转角度一时间曲线,计算左室整体扭转角度峰值(Ptor)、扭转角度达峰时间(Tp-tor)、收缩末扭转角度(AVCtor)、等容舒张末扭转角度(MVOtor)和等容舒张解旋率(Untw-R).根据临床最终诊断结果,将所有研究对象分为三组:心肌梗死组19例,心肌缺血组19例,冠脉正常组10例.结果 心肌缺血组基底段旋转角度峰值(Prot)和收缩末旋转角度(AVCrot)均明显小于心尖段,差异有统计学意义.心肌梗死组的Untw-R小于冠脉正常组,差异有统计学意义.Ptor与左心室舒张末期内径及射血分数之间存在直线相关关系.基底段的Prot与射血分数之间存在负的直线相关关系.Untw-R与射血分数和Ptor之间存在正的直线相关关系.结论 心肌缺血患者左室心尖段旋转角度明显大于基底段,使心肌缺血患者左室整体表现为更为明显的逆时针扭转.心肌梗死组左室的舒张功能严重受损.Untw-R是反映心肌舒张功能的定量指标.     

二维斑点追踪技术评价移植心脏左心室扭转

目的 探讨左室扭转评价移植心脏左心室功能的价值.方法 30例心脏移植受者,17例正常人,应用二维应变软件测量左室基底部和心尖部旋转角度、整体扭转角度及达峰时间,计算解旋率,比较两组间差异,并分析其与舒张末期、收缩末期容积及射血分数之间的关系.结果 移植组心尖部旋转角度及整体扭转角度均小于对照组.扭转角度与收缩末容积呈负相关,与射血分数呈正相关.两组间解旋率无明显差异.结论 二维斑点追踪技术可以准确反映左室扭转运动,为移植心脏左室收缩功能的整体判断提供重要的依据.     

二维斑点追踪技术评价慢性心力衰竭患者左心室收缩同步性

目的 利用二维斑点追踪显像(2D-STI)技术评价慢性心力衰竭患者左室机械运动同步性.方法 37例慢性心力衰竭患者,依据左室射血分数(LVEF)分为两组:A组,LVEF≤35％;B组,35％＜LVEF＜50％.35例正常人为对照组(C组).采集受试者心尖两腔观、三腔观、四腔观及胸骨旁左室短轴观二尖瓣水平、乳头肌水平的清晰图像,用Qlab软件测量各切面二尖瓣水平和乳头肌水平各节段自QRS起点至收缩期峰值应变、应变率的时间,推算左室12节段纵向、径向及圆周应变、应变率不同步参数:达收缩期峰值时间标准差(Tsb12SD、Ts1r-12SD、Tsr-12SD、Tsrr-12SD、Tsc-12SD、Tscr-12SD)和最大时间差(Ts1-12Dif、Ts1r-12 Dif、Tsr-12Dif、Tsrr-12Dif、Tsc-12 Dif、Tscr-12 Dif),比较三组参数.分析LVEF与各参数的相关关系.根据统计学原理,推算C组各参数的不同步界限,计算A、B组各参数的不同步检出率,组内比较各个率值.结果 与C组比较,A组各项不同步参数均显著增大(P＜0.05),B组TsI-12SD、Ts1-12Dif、Ts1r-12SD、Ts1r-12 Dif及Tsr-12SD显著增大(P＜0.05).病例组各项不同步参数均与LVEF呈显著线性负相关(P＜0.05).A、B两组内各项参数检出率差异均有统计学意义(均P＜0.05),均以TsI-12SD的检出率最高.结论 2D-STI技术能定量评价慢性心力衰竭患者左室收缩同步性,纵向参数较径向、圆周参数检出不同步的能力更强.     

超声斑点追踪成像评价心功能不全患者收缩期心肌扭转的初步研究

目的 应用超声斑点追踪成像技术评价心功能不全患者收缩期左室心肌旋转及扭转运动变化.方法 32例正常对照者和24例心功能不全患者,显示左室标准短轴观图像,分别测量并比较两组患者各短轴观图像在标化时间点处的左室旋转及扭转角度、收缩期左室旋转及扭转峰值与相应达峰时间,观察左室旋转值及扭转值随时间变化的关系.结果 心功能不全患者左室各短轴观收缩期左室旋转及扭转峰值均显著低于对照组(P<0.05);与对照组比较,心功能不全组左室扭转达峰时间明显延长(P<0.05),达峰点出现在舒张期,左室心尖水平顺时针旋转达峰时间长于对照组(P<0.05),延长至射血期.结论 心功能不全患者左室扭转运动减低,左室心底、心尖相对旋转不同步,旋转角度减低.     

二维斑点追踪应变成像对冠心病患者左心室同步性的定量研究

目的 探讨二维斑点追踪应变成像技术评价冠心病患者左室同步性的临床价值.方法 42例急性心肌梗死患者、39例冠心病心肌缺血患者和32例对照者接受二维超声检查,用二维应变软件分析心尖长轴观、心尖两腔观和四腔观以及左室短轴观基底水平、乳头肌水平、心尖水平的图像,测量自心电图QRS波起点至左室在心尖长轴观上的收缩期纵向应变达峰时间(Tssl)及胸骨旁短轴观上的收缩期径向和环向应变达峰时间( Tssr,Tssc).计算左室各节段达峰时间标准差(Tssl-SD,Tssr-SD,Tssc-SD)及节段达峰时间最大差值(Tssl-Dif,Tssr-Dif,Tssc-Dif),以左室短轴观乳头肌水平前室间隔和后壁的径向应变的达峰时间之差(TAS-POST)≥130 ms作为左室收缩不同步标准,同时测量18个心肌节段纵向应变峰值与收缩末应变的差值之和作为纵向应变延迟指数(LSDI),LSDI≥25％作为左室不同步标准.结果 急性心肌梗死组同步性参数较对照组增加(P ＜0.001或P＜0.05);心肌缺血组同步性参数较对照组增高(P＜0.05); LSDI与TAS-POST呈正向线性相关(r=0.676,P＜0.05);急性心肌梗死组中,LSDI检测左室不同步敏感性高于TAs-POST(P＜0.05).结论 二维斑点追踪应变成像技术能准确评价左室不同步性,LSDI与TAS-POST可定量评价冠心病患者左室不同步性.     

二维斑点追踪成像评价舒张性心功能衰竭患者左心室局部收缩功能

目的 探讨二维斑点追踪成像(speckle tissue imaging,STI)评价射血分数正常的舒张性心功能衰竭(diastolic heart failure,DHF)患者的左心室心肌局部收缩功能.方法 临床确诊的DHF患者与正常对照组各32例.分别存储胸骨旁左心室短轴基底水平、乳头肌水平及心尖水平连续3个心动周期的二维灰阶图像,使用Qlab7.0工作站进行脱机分析,记录上述三个短轴切面共18个节段径向收缩期峰值应变率;记录基底水平、心尖水平旋转角度峰值,计算左心室扭转峰值(Twist).结果 DHF组的各节段径向应变率曲线形态与正常对照组相似,两组内同一水平不同节段间的径向应变率峰值差异均无统计学意义(P>0.05).与正常对照组相比,DHF组左心室心尖水平前间隔、侧壁、后壁、下壁,乳头肌水平后壁、后间隔,基底水平后壁、下壁及后间壁的收缩期峰值应变率低于正常对照组(P<0.05).DHF组左心室心尖、基底水平旋转角度峰值及左心室整体扭转角度峰值均较正常组减低,但差异无统计学意义(P>0.05).结论 二维斑点追踪成像显示左心室射血分数正常的DHF患者早期存在局部心肌收缩功能异常.     

斑点追踪显像对房间隔缺损患者左心旋转和扭转运动的初步研究

目的 探讨房间隔缺损(ASD)患者右心容量负荷和压力负荷过重对左心旋转和扭转运动的影响.方法 应用斑点追踪显像技术分别测量35例单纯ASD患者(其中18例伴肺动脉高压)左室基底部短轴和心尖部短轴6个节段的旋转峰值及其收缩早期反方向旋转的平均峰值和平均持续时间;绘制左室扭转-时间曲线,计算扭转峰值及达峰时间;双平面Simpson法测量左室射血分数(EF).21例正常人作为对照组.结果 与ASD肺动脉高压阴性组及正常组相比,ASD肺动脉高压阳性组基底部后壁、下壁、后室间隔的顺时针旋转角度峰值降低(P＜0.05),6个节段早期逆时针旋转的平均峰值增加(P＜0.05),平均持续时间延长(P＜0.05),左室整体扭转角度峰值亦降低(P＜0.05).ASD肺动脉高压阴性组各指标与正常组的差异无统计学意义.左室扭转角度峰值与肺动脉收缩压呈明显负相关(r=-0.57,P=0.001).三组间射血分数无明显差异.结论 单纯ASD引起的右心容量负荷增加并不明显改变左室旋转和扭转运动,而肺动脉压增高时左室扭转峰值降低,且与肺动脉收缩压呈明显负相关.