| 摘要: |
| 目的 应用超声血流向量成像（VFM）技术评估继发孔型房间隔缺损（ASD）患者右心室流场和能量损耗（EL）的变化规律，为定量评估ASD右心室流场运动和功能提供参考依据。方法 选取继发孔型ASD患者97例，根据所测肺动脉收缩压分为：无肺动脉高压（PAH）组30例（≤30mmHg）、轻度PAH组25例（30mmHg＜肺动脉收缩压≤50mmHg）、中度PAH组22例（50mmHg＜肺动脉收缩压≤70mmHg）和重度PAH组20例（＞70mmHg），另选健康志愿者29例为对照组，应用VFM技术测量五组右心室涡流参数和EL大小，对右心室整体EL与右心收缩、舒张功能参数进行相关性分析。结果 对照组、无PAH组、轻度PAH组流线成像均显示舒张早期的快速充盈期（P1）、舒张中期（P2）三尖瓣口附近存在较多涡流，中度PAH组和重度PAH组在心动周期不同时相下右心室内均有大小、方向、数目不一样的涡流出现；对照组与无PAH组各时相下涡旋面积、循环强度、涡旋数量、EL值比较差异均无统计学意义（P>0.05），轻度PAH组、中度PAH组、重度PAH组各参数随PAH压力的升高逐渐增大；EL峰值均出现在P1期（均P＜0.05）；相关性分析结果显示：EL值分别与Tei指数、三尖瓣E峰流速、E/e呈正相关（r=0.768，0.941，0.937；均P<0.05），与三尖瓣环收缩期位移（TAPSE）、右心室面积变化率（RVFAC）、三尖瓣环速度e呈负相关（r=-0.864，-0.734，-0.817；均P<0.05）。结论 VFM技术可以评价ASD患者右心室内流场运动和EL的变化规律，为定量评估ASD右心室流体力学变化、PAH压力及右心室EL大小的应用分析提供有力的依据。 |
| 关键词: 超声示心动描记术 血流向量成像 房间隔缺损 肺动脉高压 流场 能量损耗 |
| DOI： |
| 投稿时间：2020-05-06修订日期：2020-08-12 |
| 基金项目:国家自然科学基金(81460268),云南省心血管超声临床研究中心项目(2017NS330) |
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| Evaluation of changes in right ventricular flow field and changes in energy loss of secundum atrial septal defect by ultrasonic flow vector imaging |
| ZhangJian,WangQingHui,DingYunChuan,ChenJian,HouZongLiu,SuXuan,LiJianHua,ZhangYu |
| (Yan’an Hospital Affiliated to Kunming Medical University) |
| Abstract: |
| Objective To evaluate the characteristics of right ventricular flow field and EL in secundum ASD by VFM, and provide a reference basis for quantitative assessment of right ventricular structure and function in ASD. Methods 97 patients with ASD were divided into 30 patients with non PAH group（＜=30mmHg），25 patients with mild PAH（30-50mmHg），22 patients with moderate PAH（50-70mmHg） and 20 patients with severe PAH（＞70mmHg）. 29 healthy volunteers served as control group. Right ventricular vortex parameters and EL were measured by VFM，and the related evolution laws were analyzed and summarized. Results Streamline of the control group, the non PAH group and the mild PAH group all showed that there were more vortices near the tricuspid valve orifice in P1 and P2. In moderate PAH group and severe PAH group, there were different size, direction and number of vortices in right ventricle at different time phases of cardiac cycle; There was no significant difference in vortex area, circulation, vortex quantity and EL between the control group and the non PAH group at each time phase(P>0.05）, while they increased with the increase of PAH pressure in the mild，moderate and severe PAH group (P<0.05), and EL peak appeared in P1; EL was positively correlated with Tei index, E and E/e respectively (r=0.768, 0.941, 0.937, P<0.05) and negatively correlated with TAPSE, RVFAC and e(r=-0.864, -0.734, -0.817, P<0.05). Conclusion VFM imaging technology can display the characteristics of flow field and EL of right ventricular blood flow in ASD. It can provide a powerful basis for quantitative evaluation of right ventricular hemodynamics, PAH pressure and analysis of right ventricular EL application in ASD. |
| Key words: Echocardiography Vector flow mapping Atrial septal defect Pulmonary arterial hypertension Flow field Energy loss |
