| 摘要: |
| 摘 要 目的 应用血流向量成像（VFM）技术观察肥厚型心肌病（HCM）患者左室收缩及舒张期能量损耗和循环变化，评价其左室收缩及舒张功能。方法 选取26例非梗阻性HCM患者（HCM组）和36例健康志愿者（对照组），分别在标准心尖四腔、三腔及两腔切面提取不同时相循环（涡旋数量、涡旋面积、循环强度）和平均能量损耗（基底段、中间段、心尖段）参数，比较两组间的平均能量损耗及循环在收缩早期、收缩中期、收缩晚期、舒张早期、舒张中期及左房收缩期6个时相各参数变化。应用双多普勒同步取样技术获取二尖瓣口前向血流速度E、A、E/e（二间瓣口舒张早期血流速度E与室间隔侧二尖瓣环舒张早期运动峰值速度e比）和Tei指数，分别与循环和能量损耗参数进行相关性分析。结果 HCM组与对照组在舒张早期心尖段、左房收缩期中间段、收缩早期基底段，以及收缩中、晚期各段（基底段、中间段、心尖段）的平均能量损耗（EL）比较，差异均有统计学意义（均P＜0.05）；两组间EL在各个时相从基底段到心尖段依次减低（均P＜0.01）。两组在舒张早期涡旋数量和舒张中期涡旋数量、涡旋面积、循环强度比较，差异均有统计学意义（均P＜0.05）；两组间在收缩早期、收缩中期仅涡旋面积差异有统计学意义（P＜0.05）。舒张早期循环强度与E峰呈正相关（r=0.456，P＜0.001）；房缩期循环强度与A峰呈正相关（r=0.485，P＜0.001）；收缩中期基底段EL与心指数呈负相关（r=-0.363，P＜0.01）；房缩期基底段、中间段与E/e均呈正相关（r=0.31，P＜0.05；r=0.444，P＜0.001）。Tei指数与EL及循环均无相关性。结论 HCM患者左室EL在整个收缩期各阶段及舒张早期心尖段、房缩期中间段均增高，在舒张期涡旋数量、涡旋面积、循环强度及收缩期涡旋面积均减低。与传统超声指标相比，这些新指标对于早期发现心功能异常更加敏感，VFM超出新技术能量损耗和循环参数可做为评价心脏早期功能变化的新指标。 |
| 关键词: 血流向量成像技术 超声心动描技术 肥厚型心肌病 能量损耗 循环 心室功能，左 |
| DOI： |
| 投稿时间：2016-06-28修订日期：2017-01-14 |
| 基金项目: |
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| Preliminary evaluation of left ventricular function in hypertrophic cardiomyopathy by using vector flow mapping |
| yangyan,duanyunyou |
| () |
| Abstract: |
| ABSTRACT Objective To observe the variation of Energy Loss and Circulation of left ventricular systolic and diastolic periods by vector flow mapping and evaluate the left ventricular systolic and diastolic function in patients with hypertropic cardiomyopathy.Methods Twenty-six non-obstructive hypertropic cardiomyopathy patients（HCM group）and Thirty-six healthy volunteers（control group）were enrolled.The quantitative parameters，including average energy loss（EL-base，EL-mid，EL-apex）and circulation（vortex quantity，vortex area，circulation）were measured in the different periods of VFM imaging mode in an apical four-chamber view，apical three-chamber view and apical two-chamber view respectively.The difference of parameters was evaluated between two groups during early systole，mid-systole，late-systole，early diastole，mid-diastole and atrial contraction period.The early transmitral valve blood flow velocity E，the late transmitral valve blood flow velocity A， the ratio of early transmitral valve blood flow velocity to the early diastolic mitral valve velocity E/e and Tei index was derived via dual-Doppler imaging technology.Meanwhile，correlationship was analyzed between two groups parameters including average energy loss and circulation and E、A、E/e and Tei index，separately.Ressults EL-apex during early diastole，EL-mid during left atrial contraction period，EL-base during early systole and all segments during mid-systole and late-systole there were different between two groups（P＜0.05）；EL decreased gradually from the basal to the apical portion between two groups during six periods that mentioned above（P＜0.01）；The vortex quantity during early diastole and the vortex quantity，vortex area and circulation during mid-diastole were different between two groups（P＜0.05）.The vortex area during early systole and mid-systole was only different between two groups（P＜0.05）；The circulation had positive correlation with E during early diastole for all subjects（r=0.456，P＜0.001）.The circulation had positive correlation with A during left atrial contraction period for all subjects（r=0.485，P＜0.001）.EL-base during mid-systole were negatively correlated with cardiac index for all subjects（r=-0.363，P＜0.01.At the basal and mid segment of atrial contraction period，there were positive correlation between EL and E/e（r=0.31，P＜0.05；r=0.444，P＜0.001），EL and circulation was not corrrlated with tei index.Conclusion EL was increased at all segments of systole，apex segment of early diastole and mid segment of atrial contraction in HCM patients compared with controls .The vortex quantity，vortex area and circulation during diastolic periods and the vortex area during systolic periods were decreased for cases compared with controls .And indeed this values may be a more sensitive parameters for detecting cardiac dysfunction in non-obstructive hypertrophic cardiomyopathy patients than conventional echocardiographic indexes.The new ultrasound technique -Energy Loss and Circulation can serve as new indexs of evaluating early cardiac function by vector flow mapping. |
| Key words: Vector flow mapping Echocardiography Hypertropic cardiomyopathy Energy loss Circulation Ventricular function Left |
