【作者】 唐芊；

【导师】 周启昌；

【作者基本信息】 中南大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 研究背景：心力衰竭为各种心脏疾病的终末期表现,为导致心脏病患者死亡的重要原因之一,是具有较高发病率和死亡率的严重疾病,临床上以左心衰竭最为常见。早期诊断,早期治疗对改善患者预后,缩短病程,降低其病死率非常重要。在临床实际中,常通过M型与二维超声心动图结合NYHA分级评价左心功能,但这种指标和分级主观性较强,重复性差,不能准确敏感的反映出心肌功能的改变,不能很好的反映心脏的功能状态和对局部心肌功能进行深入的分析。新近出现的速度矢量成像技术(velocity vector imagingⅤⅥ)能提供多种参数对局部心肌的运动进行定量分析,较准确的评估左心收缩及舒张功能。该技术能为临床医生提供客观依据,有利于左心衰患者的早期诊断和追踪观察,对指导临床用药,改善患者生活质量,提高医生的诊治水平非常有益。目的：应用VVI技术定量检测左心衰患者左心室各节段的心肌收缩和舒张功能,与正常人比较观察其变化特点；观察左心衰患者药物治疗前、治疗后左心室各节段长轴功能的变化趋势；探讨VVI技术在左心衰患者左心室长轴收缩和舒张功能无创估测中的价值；用VVI技术测量左心衰患者左心长轴的心肌功能参数并与实验室左心功能的指标——氮末端脑钠素前体(NT-proBNP)对比,探讨VVI评价左心衰患者左心长轴功能的可行性和准确性。对象及方法：2008年4月至2009年12月在我院心血管内科住院治疗的、符合临床左心衰诊断标准的患者50例；按性别、年龄与左心衰患者相匹配的正常人50例。心力衰竭采用Framingham标准,NHYA分级Ⅲ～Ⅳ级,超声心动图检查左心室射血分数(LVEF)<50%。所有患者均为窦性心律,经检查肝功能、肾功能均在正常范围,无酗酒和毒物接触史,女性处于非围生期。排除标准：瓣膜性心脏病、先天性心脏病史、植入永久型心脏起搏器患者、入选前使用利尿药物及扩血管药物、近期(1月内)脑外伤,缺血及出血性脑卒中史、单纯累及右心系统的肺心病、急性肺栓塞,支气管哮喘急性发作期,呼吸衰竭及COPD患者、全身各系统恶性肿瘤、三个月内发生急性心肌梗死患者、糖尿病、甲状腺疾病、代谢性疾病、结缔组织疾病、营养不良者不在本研究范围内。确诊为心力衰竭的患者经我院心内科正规药物治疗半年后再进行追踪复查。用VVI技术分别测量16节段心肌长轴上两组指标：Ⅰ—收缩期峰值速度(SVmax)、收缩期峰值应变(SSmax)、收缩期峰值应变率(SSRmax);Ⅱ—舒张期峰值速度(DVmax)、舒张期峰值应变(DSmax)、舒张期峰值应变率(DSRmax);每一指标均测三个心动周期,取平均值。受试者均于超声心动图检查的三天内抽血测量血浆氮末端脑钠素前体含量,并与VVI参数及EF测值做相关性研究。结果：正常组收缩期和舒张期心肌长轴方向的峰值运动速度在基底段、中间段、心尖段呈现递减趋势,峰值应变及应变率在基底段、中间段、心尖段无明显差异。心衰组治疗前心肌长轴方向收缩期和舒张期的Vmax、Smax及SRmax在基底段、中间段、心尖段的变化趋势与正常组相似,各节段较正常组测值均显著减低,差异有极显著意义(P<0.01),但心衰组治疗后的SRmax、Smax在侧壁基底段和后壁基底段的值较余节段显著增大(P<0.05)。心衰组治疗后心肌长轴方向收缩期和舒张期的Vmax、Smax及SRmax与心衰组治疗前相应节段相比较,侧壁和室间隔的基底段、中间段、心尖段,下壁和后壁的基底段、中间段,前间隔的基底段增高,统计学上有显著差异(P<0.05),前壁的基底段、中间段、心尖段,下壁的心尖段和前间隔的中间段的改变不明显,未发现明显差异。心衰组治疗后左心长轴方向VVI各参数的改变与血浆NT-proBNP浓度的改变及EF测值的改变均呈正相关(P<0.01)。结论：VVI技术研究显示左心衰患者的左室舒缩功能显著减退,经药物保守治疗后VVI各参数增高,其程度与常规超声左心功能指标EF及实验室指标NT-proBNP具有较好相关性。VVI技术能无创、较准确地评价左心衰患者左室长轴方向局部心肌运动的变化,对于定量判断心功能受损程度,指导和评价心衰治疗,观察判断预后有重要价值。该技术结合NT-porBNP测定能更好地为临床医生诊断和治疗左心衰提供客观依据,具有一定的临床价值,有望广泛应用于临床。更多还原

【Abstract】 Backgroud:Heart failure is the end-stage performance for a variety of heart disease, is one major cause of death which leading to heart disease, is a high morbidity and mortality, serious illness, and left ventricular failure is the most common in clinical. Early diagnosis and early treatment is very important to improve the prognosis of patients, shorten the course, reduce the mortality rate. In clinical practice, often through the M-and two-dimensional echocardiography and assessment of left ventricular function in NYHA classification, but this index and grading subjectivity, poor reproducibility and can not accurately reflect myocardial function sensitive to changes in not a good reflection of cardiac function, regional myocardial function of the depth of analysis. Recently developed new technique-velocity vector imaging (VVI) can provide a variety of movement parameters on regional myocardial quantitative analysis, a more accurate assessment of left ventricular systolic and diastolic function. The technology can provide an objective basis for clinicians, is beneficial in patients with left heart failure and followed for the early diagnosis of clinical treatment, is very useful for improving patient quality of life, improving diagnosis and treatment of a doctors.Objective:To investigate the regional longitudinal contraction and relaxation of left ventricle in Left heart failure patients by velocity vector imaging (VVI). To characterize the regularity of left ventricular longitudinal function in Left heart failure patients before treatment, after treatment. To discuss the important clinical value of velocity vector imaging in quantitatively evaluating regional longitudinal function of left ventricle. Measured left ventricular failure patients with VVI with left ventricular long-axis cardiac function parameters and laboratory indices of left ventricular function N-terminal pro-brain natriuretic peptide (NT-proBNP) compared VVI evaluation of left ventricular long axis function in patients with left heart failure for the feasibility and accuracy.Methods:We examined respectively 50 patients diagnosed left ventricular failure and 50 normal persons. They were matched with for sex and age. Exclusion criteria for all subjects were cardiac valve disease, congenital heart disease, permanent pacemaker implantation in patients with type, selected before the use of diuretic drugs and vasodilators, recently (1 month) traumatic brain injury, history of ischemic and hemorrhagic stroke, simply involved the right heart system, pulmonary heart disease, acute pulmonary embolism, acute attack of bronchial asthma, respiratory failure and COPD patients, the whole system of malignant tumors, three months with acute myocardial infarction, diabetes mellitus, thyroid disease, metabolic disease, connective tissue disease, dystrophy, severe dysfunction of liver and kidney, contact of toxic, alcohol abuse, pregnant woman in perinatal period. To track review the Patients with diagnosed heart failure by the Department of Cardiology into the hospital after six months of regular drug treatment. Two group indexes below were obtained from every 3 heart beat, averaged, in 16 segments respectively to assess left ventricular longitudinal contraction and relaxation:Ⅰ-systolic max velocity(SVmax), systolic max strain (SSmax), systolic max strain rate(SSRmax);Ⅱ-diastolic max velocity(DVmax), diastolic max strain(DSmax), diastolic max strain rate(DSRmax). Subjects were in echocardiography and measurement of blood plasma within three days of N-terminal pro-brain natriuretic peptide levels, with VVI parameters and EF measured values to do with correlation.Results:The Vmax were graduately decrease from base to apex and the Smax and SRmax were not obvious different from the base to apex in normal group. The change trends of the Vmax, Smax and SRmax were similar with the normal group in Left heart failure patients before treatment, but the values were obvious lower than normal group in Left heart failure patients before and after treatment (P<0.01), while the basal part of lateral wall and posterior wall were larger than other segments (P<0.05) in Left heart failure patients after treatment. Heart failure after treatment of myocardial systolic and diastolic long axis of the Vmax, Smax and SRmax with heart failure before treatment compared with the corresponding segment, lateral and basal interventricular septum, middle, apex, inferior wall and posterior wall and basal, middle, basal segments before the interval increased statistically significant difference (p<0.05), anterior basal, middle, apex, inferior wall of the apex and the middle section before the interval Vmax value was no change, no significant difference was found. Left ventricular heart failure after treatment the long axis of VVI change the parameters and plasma NT-proBNP concentrations were observed a negative correlation, with EF measured values were positively correlated (P<0.01).Conclusion:VVI technique showed that left ventricular function in patients with heart failure was significantly diminished, the extent of left ventricular function with conventional ultrasound and laboratory indicators of EF and NT-proBNP has a good correlation. VVI technology is a non-invasive, more accurate evaluation of the long axis of left heart failure in patients with left ventricular regional myocardial motion changes, quantitatively determine the degree of impairment of cardiac function, guidance and evaluation of heart failure treatment, the prognosis of the value of observation. This Technology combined with NT-porBNP will better for medical diagnosis and treatment for clinical patients with left heart failure and objective theoretical basis, have some clinical value, will be expected to widely used in clinical.更多还原