摘要
目的应用血流向量成像(VFM)技术定量评估扩张型心肌病(DCM)患者的左心功能异常。方法选取2019年1月至2019年4月于武汉亚洲心脏病医院确诊DCM的患者29例为DCM组,同期匹配健康志愿者32例为对照组。VFM模式下获取两组心尖四腔心、三腔心切面二维彩色多普勒血流动态图,脱机分析对比不同切面等容收缩期(P0)、快速射血期(P1)、等容舒张期(P2)、快速充盈期(P3)、心房收缩期(P4)能量损耗(EL)及各节段室壁剪应力(WSS)平均值的差异,评估DCM患者左心室血流动力学的改变。结果与对照组相比,DCM组在P0、P1及P3期EL均减低[分别为(2.24±1.33)J/(s·m^(3))vs(1.39±0.49)J/(s·m^(3))、(6.14±3.58)J/(s·m^(3))vs(4.17±2.12)J/(s·m^(3))、(10.38±6.67)J/(s·m^(3))vs(4.92±2.73)J/(s·m^(3)),均P<0.05]。DCM组左心室壁在P0期基底段[(0.45±0.30)N/m^(2)vs(0.23±0.13)N/m^(2)],P1、P2期基底段和中间段[分别为(1.24±0.39)N/m^(2)vs(0.93±0.40)N/m^(2)、(0.55±0.30)N/m^(2)vs(0.36±0.23)N/m^(2),(0.29±0.08)N/m^(2)vs(0.12±0.05)N/m^(2)、(0.14±0.08)N/m^(2)vs(0.10±0.06)N/m^(2)],P3期各节段[分别为(0.60±0.24)N/m^(2)vs(0.26±0.08)N/m^(2)、(0.47±0.29)N/m^(2)vs(0.14±0.04)N/m^(2)、(0.13±0.06)N/m^(2)vs(0.06±0.02)N/m^(2)]以及P4期基底段[(0.40±0.15)N/m^(2)vs(0.25±0.12)N/m^(2)]的WSS较对照组均减低(均P<0.05)。对照组WSS同一时相呈现基底段>中间段>心尖段,而DCM组P0、P2和P4期基底段与中间段WSS差异无统计学意义(均P>0.05)。对照组WSS同一节段P0→P1→P2→P3→P4期表现为升高-减低-升高-减低改变(均P<0.05),而DCM组WSS仅基底段P0→P1→P2→P3期表现为升高-减低-升高趋势(均P<0.05),余节段WSS在各时相间变化差异均无统计学意义(均P>0.05)。结论VFM技术中的EL及WSS作为新的血流动力学量化参数,可评估DCM患者左心室功能异常。
Objective To quantitatively assess the left ventricular dysfunction in patients with dilated cardiomyopathy(DCM)by vector flow mapping(VFM)technique.Methods From January 2019 to April 2019,29 patients diagnosed as having DCM who came to Wuhan Asia Heart Hospital were selected as a DCM group.And 32 healthy volunteers were enrolled as a control group during the same period.The hemodynamic images of two-dimensional color Doppler in apical four-chamber and three-chamber views were acquired in VFM.The above images were off-machine analyzed,and the differences in the average energy loss(EL)and wall shear stress(WSS)in the isovolumic contraction period(P0),rapid ejection period(P1),isovolumic relaxation period(P2),rapid filling period(P3),and atrial contraction period(P4)were compared between the two groups.Then,the changes of left ventricular hemodynamics in patients with DCM were evaluated.Results Compared with the control group,EL in the DCM group decreased at P0,P1,and P3[(2.24±1.33)J/(s·m^(3))vs(1.39±0.49)J/(s·m^(3)),(6.14±3.58)J/(s·m^(3))vs(4.17±2.12)J/(s·m^(3)),(10.38±6.67)J/(s·m^(3))vs(4.92±2.73)J/(s·m^(3)),P<0.05].In the DCM group,the WSS values of basal segment at P0[(0.45±0.30)N/m^(2) vs(0.23±0.13)N/m^(2),P<0.01],basal and middle sections at P1 and P2[(1.24±0.39)N/m^(2) vs(0.93±0.40)N/m^(2),(0.55±0.30)N/m^(2) vs(0.36±0.23)N/m^(2),(0.29±0.08)N/m^(2) vs(0.12±0.05)N/m^(2),(0.14±0.08)N/m^(2) vs(0.10±0.06)N/m^(2),P<0.05],all sections at P3[(0.60±0.24)N/m^(2) vs(0.26±0.08)N/m^(2),(0.47±0.29)N/m^(2) vs(0.14±0.04)N/m^(2),(0.13±0.06)N/m^(2) vs(0.06±0.02)N/m^(2),P<0.01],and basal segment at P4[(0.40±0.15)N/m^(2) vs(0.25±0.12)N/m^(2),P<0.01]were significantly lower.At the same phase,the WSS values from basal to middle and apical segments showed a decreasing trend in the control group.However,there was no significant difference between basal and middle segments in the DCM group at P0,P2,and P4(P>0.05).The WSS value at every section from P0 to P4 showed an increasing-decreasing-increasing-decreasing trend in the control group(P<0.05).In the DCM patients,however,the WSS value only at the basal segment from P0 to P3 showed an increasing-decreasing-increasing trend(P<0.05),with no significant difference observed at other segments between adjacent phases.Conclusion The EL and WSS as new hemodynamic quantitative parameters in the VFM technique,can be used to evaluate left ventricular dysfunction in DCM patients.
作者
程冠
夏娟
马小静
Cheng Guan;Xia Juan;Ma Xiaojing(Ultrasound Center,Wuhan Asia Heart Hospital,Wuhan University of Science and Technology,Wuhan 430022,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2021年第10期954-959,共6页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
武汉市科技局项目(2019020701011422)。
