摘要
目的应用血流向量成像（VFM）技术可视化观察扩张型心肌病（DCM）患者左室血流流场状态，定量评价收缩及舒张期左心室心腔内平均能量损耗（EL）和循环。方法选取健康志愿者36例为对照组，DCM患者32例为病例组，并根据反流程度分为中重度DCM组（17例）和轻度DCM组（15例）。在标准心尖四腔、三腔和两腔切面分别提取各期的循环（涡旋数量、涡旋面积、循环强度）和EL（基底段、中间段、心尖段）参数，比较各组间的差异；同时利用双多普勒同步取样技术获取二尖瓣血流E、A、E／A、E／e及Tei指数，分别与EL和循环参数进行相关性分析。结果①与对照组比较，EL在舒张早期中间段及心尖段、收缩中期中间段、收缩晚期中间段及心尖段均减低（均P〈0．05）；病例组与对照组间舒张早期涡旋数量、涡旋面积、循环强度及房缩期涡旋面积、循环强度差异均有统计学意义（均P〈0．05），两组间在舒张中期仅涡旋面积差异有统计学意义（P〈0．01）。②中重度反流DCM组舒张期各段及收缩期基底段EL高于轻度反流DCM组（P〈0．05），中重度反流DCM组舒张期循环强度高于轻度反流DCM组（P〈0．05）。③舒张早期、舒张中期及房缩期涡旋面积和循环强度均与E／e呈正相关（r1=0．630，P1〈0．001；r2=0．345，P2=0，004；r3=0．468，P3〈0．001；r4=0．316，P4=0．009；r5=0．663，P5〈0．001；r6=0．264，P6=0．029）;舒张早期及房缩期涡旋面积与E／A值及Tei指数呈正相关（均P〈0．01）。收缩晚期中间段EL与左室舒张末期容积、左室收缩末期容积及左室射血分数有相关性（r1=-0．335，P1=0．005；r2=-0．312，P2=0．01；r3=0．340，P3=0．045）；舒张中期基底段EL与E／A呈正相关（r1=0．376，P1=0．002）。结论VFM技术能直观显示并定量分析DCM患者左心室流体力学变化，为诊断、治疗及预后评价提供了新的参考指标。
Objective To observe the blood flow changes of left ventricular cavity and quantify the energy loss （EL） and circulation of left ventricular during systole and diastole in patients with dilated cardiomyopathy（DCM） via vector flow mapping（VFM）. Methods Thirty-six healthy volunteers and 32 DCM patients were enrolled. According to the severity of mitral regurgitation（MR）, DCM patients were divided into two groups. The quantitative parameters, including average energy loss（ EL-base, EL-mid, ELapex） and circulation （vortex quantity, vortex area, circulation） were measured in the different periods of VFM imaging mode in apical four-chamber view, apical three-chamber view and apical two-chamber view respectively. The difference of parameters was evaluated between different groups during the different periods. 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, the ratio of early transmitral valve blood flow velocity to the late transmitral valve blood flow velocity E/A and Tel index were derived via dual-Doppler imaging technology. Meanwhile, the correlation between VFM parameters with E, A, E/A, E/e or Tel index was also analyzed. Results ①The level of EL were decreased significantly among EL-mid and EL-apex during early diastole, EL-mid during mid-systole, EL-mid and EL-apex during late-systole （ P 〈0.05）, when compared with the control group. The vortex quantity, vortex area and circulation during early diastole and the vortex area and circulation during atrial contraction period were significantly different between two groups （all P〈 0.05）. As for mid-diastole, only vortex area showed significant difference （P 〈 0.01 ）. ② When compared with different grades of MR in DCM patients, the level of all segments EL during diastole and EL-base during systole increased with severity of MR（ P 〈0.05）. The circulation during diastole also increased with the severity of MR（ P d0.05）. ③The vortex area and circulation had positive correlation with E/e during diastole in all subjects（all P 〈0.05）. The vortex area during atrial contraction period and early diastole had positive correlation with E/A and Tel index in all subjects（r =0.630,0.345,0.468,0.316,0.663,0.264,respectively,all P 〈0.01）. EL-mid during late-systole were negatively correlated with LV end-diastolic volume, end-systolic volume, but positively correlated with ejection fraction in all subjects（ r = 0. 335, - 0. 312,0. 340, respectively, all P 〈0.05）. While, there was positive correlation between E/A with the basal segment of mid-diastole（ r = 0.376, P 〈0.01）, Conclasions The visualization of hydromechanics inside the heart of DCM patients could he directly accomplished by VFM, which can provide a new method for diagnosis and evaluation of DCM.
出处
《中华超声影像学杂志》
CSCD
北大核心
2017年第5期374-380,共7页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
心肌病
扩张型
心室功能
左
Echocardiography
Cardiomyopathy, dilated
Ventrieular function, left
