【作者】 温江田；

【导师】 张军； 刘丽文；

【作者基本信息】 第四军医大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 第一部分慢性心力衰竭患者左室收缩后收缩的初步研究目的研究慢性心力衰竭(chronic heart failure,CHF)患者在等容舒张期出现的左心室壁收缩后收缩(post–systolic shortening,PSS)现象和临床意义。方法利用组织速度成像技术(tissue velocity imaging,TVI)检测60例CHF患者及30例正常对照组的心肌运动,应用QLAB分析软件测量左心室各壁基底段和中段心肌收缩期峰值速度(systolic peak velocity,Vs)、持续时间(regional systolic time,Ts)及PSS峰值速度(post-systolic shortening velocity,Vpss)、持续时间(post-systolic shortening time,Tpss)。结果CHF组基底段和中间段在等容舒张期PSS的发生率均为34%,其中病理性PSS的发生率分别为29%、30%。对照组基底段和中间段在等容舒张期PSS的发生率分别为27%、21%,无一例发生病理性PSS。与对照组的生理性PSS相比CHF组的病理性PSS峰值速度增高、持续时间延长(P <0.05～0.01)。结论CHF患者的病理性PSS与对照组的生理性PSS有明显差别,病理性PSS峰值速度高、持续时间长,可能是导致CHF患者左心室不同步运动的原因之一。第二部分应用组织速度成像技术评价不同QRS间期慢性心力衰竭患者左室收缩同步性目的应用组织速度成像(Tissue velocity imaging,TVI)技术评价不同QRS时限慢性心力衰竭患者(chronic heart failure,CHF)左室收缩的同步性。方法选择40例纽约心脏病学会(NYHA)分级心功能Ⅲ～Ⅳ级的慢性心力衰竭患者,其中QRS时限<120ms者17例,QRS时限≥120ms者23例,以及30例正常人,均接受组织多普勒检查。TVI模式下测量12个节段从QRS波群起始部到射血期峰值的时间(time to peak systolic,Ts),计算标准差(Ts-SD-12)。将左室Ts-SD-12>32.6ms作为左室内收缩不同步的指标。统计各组收缩不同步性的发生率。结果本研究发现不同QRS间期心力衰竭患者均存在不同程度的左室收缩运动的不同步,其中QRS时限<120ms的心力衰竭患者中有29.41%患者存在收缩不同步,而QRS时限≥120ms者中有78.26%患者存在收缩不同步,二者差异有统计学意义( P<0.01)。结论心力衰竭患者无论QRS时限长短均存在一定比例的左室收缩运动不同步,QRS时限长者,不同步的发生率高。组织速度成像技术可比QRS时限更敏感地反映心脏运动的同步性,可为心脏再同步化治疗(CRT)选择合适的人群。更多还原

【Abstract】 PART one Preliminary study of the post-systolic shortening of left ventricular wall in chronic heart failure patientsObjective To study the post-systolic shortening (PSS) during isovolumic relaxation phase and its clinical meanings in regional myocardium in chronic heart failure (CHF) patients.Methods Left ventricular regional myocardium movement in 60 CHF patients (CHF group) and 30 normal persons (control group) were assessed by Tissue Velocity Imaging (TVI). Qlab software was used to measure the systolic peak velocity (Vs), regional systolic time (Ts), post-systolic shortening velocity (Vpss) and post-systolic shortening time (Tpss) at the basal and middle levels of left ventricle.Results In CHF group, the rate of isovolumic relaxation phase PSS was 34% both in basal and mid segments, the rates of pathological PSS were 29% and 30% respectively. The rates of isovolumic relaxation phase PSS in basal and mid segments in normal persons were 27% and 21%, none of them was pathological. Compared with the physiological PSS of control group, the pathological PSS of CHF group had a higher peak velocity and a longer time(P<0.05-0.01).Conclusion The pathological PSS of CHF group is obviously different from the physiological PSS of control group. The peak velocities of pathological PSS is higher and the duration is longer, it may be one of causes which lead to the asynchronous movement of left ventricle in CHF group.PART two Assessment of left ventricular systolic synchrony in heart failure patients with normal and wide QRS duration using tissue velocity imagingObjective To evaluate the prevalence of Synchrony in heart failure patients with difference QRS duration using tissue velocity imaging.Methods Forty heart failure patients with idiopathic dilated cardiomyopathy (23 with wide QRS complex , 17 with normal QRS complex) underwent standard tissue velocity imaging examinations. TVI was used to measure the standard deviation of the time to regional peak systolic velocity (Ts) of 12 LV segments in ejection phase (Ts-SD-12- ejection). Intraventricular dyssynchrony was defined as a delay of 32.6ms of Ts-SD-12.The incidence of dyssynchrony between two groups was compared.Results The study found that all the patients with different QRS duration had synchronized left ventricular systolic movement.Dyssynchrony was observed in 29.41% heart failure patients with normal QRS complex versus 78.26% patients with wide QRS complex.There was a significant difference between the prevalence of dyssynchrony derived from echo criteria in two groups ( P<0.05-0.01).Conclusion Dyssynchrony is commonly seen in patients with chronic heart failure regardless of QRS duration. The prevalence of dyssynchrony is significantly related to QRS duration. Tissue velocity imaging technique is more sensitive than the QRS duration to evaluate the dyssynchrony,and could be used to choose suitable patients for CRT.更多还原