三维斑点追踪技术对射血分数正常的重度主动脉瓣狭窄患者左室心肌收缩功能的评价效果

摘要：目的 探讨三维斑点追踪技术对射血分数正常的重度主动脉瓣狭窄患者左室心肌收缩功能的评价效果。方法 选择2015年7月到2017年5月之间在我院诊断为射血分数正常的重度主动脉瓣狭窄患者80例作为病例组,另外选择同时间段内在我医院进行健康体检的患者80例作为对照,利用三维超声斑点技术对患者的心脏进行扫描,对结果进行评价。结果 病例组和对照组患者的左心室舒张末期内径,左心室收缩末期内径,左心室射血分数数据差异不具有统计学意义（P>0.05）,室间隔厚度,左室后壁舒张末期厚度为病例组高于对照组,病例组患者的左心室整体长轴应变,左心室整体径向应变,三维应变低于对照组,左心室整体环向应变,左心室整体面积应变高于对照组,数据差异具有统计学意义（P<0.05）,利用常规心动图和三维斑点追踪技术数据进行患者的判别分析,分类正确率分别为85.31%,100.00%。结论 三维超声斑点追踪技术已经成为临床辅助检查手段之中一种很有价值的方法,在对于射血分数正常的重度主动脉瓣狭窄患者左室心肌收缩功能的评价上有着独特的优势,可以将该部分患者和正常人进行区分,这对该类别患者的诊治有着重大的意义,值得在临床范围内进行推广。     

超声二维斑点追踪技术对单纯冠状动脉左前降支狭窄患者左心室收缩功能的评价

目的探讨二维纵向应变(LS)、左心室壁整体扭转角度(LV-tor)在二维超声未探及左心室壁运动异常,而冠状动脉存在单纯左前降支(LAD)不同程度狭窄时,对左心室壁节段及整体收缩功能改变的评价价值。方法入选行冠状动脉造影的患者75例,取造影正常者27例为对照组,而单纯LAD狭窄50%～75%的患者25例(A组)、单纯LAD狭窄≥75%的患者23例(B组),分别采集常规超声心动图的心尖两腔、心尖左心室长轴切面及左心室短轴基底水平、心尖水平切面的16个室壁阶段二维灰阶图像。应用GE Echo PAC软件测量仅由LAD供血的相应左心室壁节段收缩期峰值的LS,以及左心室基底段总扭转角度(Rot-base)、心尖段总扭转角度(Rot-apex)并计算出LV-tor,静息状态下应用M型超声测定左心室壁运动幅度、左心室射血分数(LVEF)、短轴缩短率(FS)等常规参数。结果 A组与对照组比较,LS值和LV-tor的差异均无统计学意义(均为P>0.05)。B组与对照组、A组比较,LAD供应左心室壁相应节段的LS值(-24.2±1.8比-25.2±1.8和-25.1±1.4,P=0.037)和LV-tor(16.4±1.2比17.2±1.1和16.7±1.1,P=0.041)差异均有统计学意义;而3组间比较,LVEF和FS等差异均无统计学意义(均为P>0.05)。结论当单纯LAD狭窄率≥75%时,LS值可敏感地反映出左心室壁节段收缩功能改变,而LV-tor可敏感地反映出左心室壁整体收缩功能的改变;左心室壁除相应节段出现收缩功能减低外,整体收缩功能也受到影响。     

超声二维斑点追踪技术在二尖瓣反流患者左心室纵向收缩功能评价中的应用

目的利用二维斑点追踪技术(2DSTI)评价单纯性二尖瓣反流患者(MR)左心室纵向收缩功能的改变。方法选取MR患者60例,其中中度32例(中度MR组)、重度28例(重度MR组),健康志愿者30例为对照组。采集各组心尖左心室长轴切面(LAX)、心尖四腔心切面(4C)和心尖两腔心切面(2C)的二维动态图像,采用二维应变自动功能成像获取左心室6个心室壁共18个心肌节段收缩期峰值应变(LC)、左心室3个心尖切面的峰值收缩总应变(GLS)及左心室收缩期纵向平均总应变(GLS-Arg)。结果各组LAX-GLS、4C-GLS、2C-GLS、GLS-Avg比较,重度MR组<中度MR组<对照组,P均<0.01。重度MR组及中度MR组前壁LS与对照组比较应变值降低(P均<0.01);各组除前壁外的5个室壁LS比较,重度MR组<中度MR组<对照组,P均<0.05。结论 2DSTI能通过测得MR患者左心室纵向应变的减低早期识别左心室收缩功能的受损。     

二维斑点追踪技术评价老年重度退行性主动脉瓣狭窄并高血压患者左心室收缩功能

目的应用二维斑点追踪技术评价老年重度退行性主动脉瓣狭窄(AS)并高血压患者左心室心肌收缩功能的改变。方法收集LVEF>54%老年重度退行性AS患者58例,按照是否合并高血压,分为AS组28例和合并高血压组30例,收集健康体检者28例为对照组,检测血压和常规超声心动图数据,包括左心室舒张末期内径、左心室后壁厚度、室间隔厚度及左心室质量指数(LVMI);二维斑点追踪技术测量左心室整体收缩期峰值纵向应变(GLS)、圆周应变(GCS)、径向应变(GRS)及扭转角度(Rot)。结果合并高血压组收缩压、舒张压、Rot明显高于对照组和AS组(P<0.01)。对照组、AS组和合并高血压组室间隔厚度、LVMI、GCS逐渐增高,GLS逐渐减低(P<0.01)。AS组和合并高血压组左心室后壁厚度明显高于对照组(P<0.01),GRS明显低于对照组[(32.2±12.2)%,(29.2±9.6)%vs (41.7±11.3)%,P<0.01]。结论与LVEF>54%的老年重度退行性AS患者比较,合并高血压的老年重度退行性AS患者左心室心肌功能进一步减低。二维斑点追踪技术是一种评价心肌早期受损的敏感方法,为临床早期诊断和治疗提供依据。     

超声斑点追踪成像技术评价2型糖尿病患者左心室收缩功能

该文探讨了超声斑点追踪成像技术在评价糖尿病患者左心室收缩功能中的意义。该文运用的方法为随机选取某医院的77名2型糖尿病患者,将其分为两组,然后再选择一个对照组,通过超声斑点追踪成像技术的运用,得出各项检测数值。然后通过对各项数据的分析和比较,得出超声斑点追踪成像技术能够评价2型糖尿病患者早期在心室收缩功能异常。     

三维超声斑点追踪技术在不同冠状动脉狭窄程度患者心肌收缩功能评估中的价值

目的探讨三维超声斑点追踪技术(3D-STI)对不同冠状动脉狭窄程度患者心肌收缩功能的评估价值。方法接受冠状动脉造影检查确认存在冠状动脉狭窄的患者133例,根据冠状动脉造影病变动脉支数分为单支病变组、多支病变组,根据各节段动脉对应的冠状动脉狭窄程度分为五组(0级组、1级组、2级组、3级组、4级组),另选择同期体检健康人50例作为对照组;比较各组3D-STI检查结果,各节段的心肌节段径向收缩期峰值应变率(RS)和径向应变达峰时间(TRS)。结果单支病变组、多支病变组和对照组左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、每搏量(SV)、心输出量(CO)比较差异无统计学意义(P>0.05),单支病变组、多支病变组二尖瓣口血流速度E峰与A峰比值(E/A)显著低于对照组(P<0.05),多支病变组E/A显著低于单支病变组(P<0.05);随冠状动脉狭窄级别增高,室壁节段RS显著降低(P<0.05),与0级组比较,3、4级组不同节段RS显著降低(P<0.05),0级组与1级组不同节段RS比较差异无统计学意义(P>0.05);4级组不同节段RS显著低于3级组、2级组、1级组和0级组(P<0.05);与0级组比较,2、3级组不同节段TRS显著延长(P<0.05),0级组与1级组不同节段TRS比较差异无统计学意义(P>0.05);4级组部分节段TRS较3级组提前(P<0.05)。结论 3D-STI可以评价不同冠状动脉狭窄程度患者心肌收缩能力,对冠心病的早期诊断具有一定价值。     

二维斑点追踪成像评价慢性心力衰竭患者左心室纵向收缩功能

目的：应用超声二维斑点追踪成像技术（2D-STI）评价慢性心力衰竭（CHF）患者的左心室收缩功能。方法：35 例CHF患者与25 例正常对照组常规超声心动图检查得到左心房横径（LAD）、左心室短轴横径（LVD）、左心室收缩末容积（LVESV）、左心室舒张末容积（LVEDV）、左心室射血分数（LVEF）;于标准心尖位左心流出道切面, 四腔心切面, 两腔心切面,应用2D-STI测量各个室壁收缩期最大应变。比较CHF组及正常对照组的二维结构及收缩期最大应变。结果：与正常人相比,CHF患者左房室明显扩大,LVESV、LVEDV增大,心功能减低,收缩期左心室心尖各切面室壁的最大纵向应变明显低于正常组（P〈0.01）。结论：2D-STI可以准确地反映左心室收缩功能。     

超声二维斑点追踪成像技术评价2型糖尿病患者右心室局部纵向收缩功能

目的应用超声二维斑点追踪成像(speckle tracking imaging,STI)技术评价2型糖尿病患者右心室心肌纵向收缩功能。方法将115例糖尿病患者按并发症分成四组,无并发症组35例(I组),伴微血管并发症44例(Ⅱ组),伴周围大血管并发症19例(Ⅲ组),在Ⅱ组或Ⅲ组基础上合并有冠心病和(或)脑梗死17例(Ⅳ组),正常对照者46例(NC组)。应用STI技术分别观察右心室游离壁基底段、中间段和心尖段纵向收缩峰值位移速度(VL)、收缩期蜂值应变(SL)及应变率(Sr L)、整体的应变、应变率参数。结果 2型糖尿病Ⅳ组右心室游离壁基底段、中间段和心尖段的VL及SL测值均明显低于其他各组(P<0.05),Ⅰ组、Ⅱ组、Ⅲ组基底段、心尖段的SL测值均低于对照组(P<0.05),Ⅱ组和Ⅳ组心尖段的SL测值明显低于其他各组(P<0.05),Ⅱ组和Ⅳ组心尖段的Sr L测值低于对照组(P<0.05),而糖尿病各组间Sr L值差异无统计学意义(P>0.05)。正常人右心室游离壁基底段和中间段SL高于心尖段,且中间段略高于基底段,但差异均无统计学意义(P>0.05)。结论超声二维斑点追踪技术可定量评估2型糖尿病患者右心室各节段收缩功能的指标。     

超声二维斑点追踪显像技术评价2型糖尿病患者左心室心肌扭转运动

目的探讨超声二维斑点追踪显像技术(STI)在2型糖尿病(T2DM)患者左心室心肌扭转运动中的运用价值。方法选择该院2014年1月至2015年1月收治的T2DM患者50例,根据组织多普勒成像技术(TDI)检查结果,二尖瓣环舒张早期峰值运动速度(Em)/舒张晚期峰值运动速度(Am)>1患者为左室舒张功能正常组(TN组)19例,Em/Am≤1患者为左室舒张功能异常组(TA组)31例,另纳入同期来该院体检的健康成人24例为对照组。所有研究对象入院后接受彩色多普勒超声检查,并应用超声二维STI软件分析扭转角度峰值(PTw)、扭转角度达峰时间(TPTV)、解旋速度峰值(PUV)和解旋率(Untw R)。结果 TN组和TA组PTw、PUV均显著高于对照组(均P<0.05),TN组和TA组Un Tw R均显著低于对照组(均P<0.05),且TA组显著低于TN组(P<0.05),三组TPTV比较无统计学意义(P>0.05)。结论超声二维STI技术对于评价T2DM患者左室心肌功能具有更高的敏感性,能够较早发现患者左室扭转异常。     

Left atrial function by two-dimensional speckle tracking echocardiography in patients with severe rheumatic mitral stenosis and pulmonary hypertension

We studied left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using two-dimensional speckle tracking echocardiography (STE). Eighty patients with isolated severe MS in sinus rhythm and 40 controls underwent comprehensive echocardiography including STE derived LA strain [reservoir strain (LAS_r), conduit strain (LAS_cd) and contractile strain (LAS_ct)]. The mean MVA was 0.93 ± 0.21 cm². The mean values of LAS_r (14.73 ± 8.59%), LAS_cd (?7.61 ± 4.47%) and LAS_ct (?7.16 ± 5.15%) in patients were significantly lower (p < 0.001) vs. controls 44.11 ± 10.44%, ?32.45 ± 7.63%, ?11.85 ± 6.77% respectively and showed decreasing trend with increasing MS severity and higher NYHA class. In conclusion, LA dysfunction is prevalent in severe MS irrespective of NYHA functional class.     

二维斑点追踪技术评价社区人群左心房应变率与左心室舒张功能的相关性

目的:应用二维斑点追踪技术评价社区人群左心房应变率,及其与左心室舒张功能分级的相关性。方法:研究对象为左心室射血分数正常的社区人群,共708例脱机处理,根据多普勒二尖瓣口血流、二尖瓣环组织、肺静脉血流对左心室舒张功能进行分组:A组(左心室舒张功能正常组)、B组(左心室舒张功能轻度受损组)、C组(左心室舒张功能中/重度受损组)。采用二维斑点追踪技术(STE),测量收缩期左心房应变率峰值SRs,舒张早期左心房应变率峰值SRe和舒张晚期左心房应变率峰值SRa。结果:①B组、C组SRs较A组降低,分别为(1.07±0.35)s-1、(0.90±0.24)s-1和(1.12±0.28)s-1(P<0.01),B组、C组SRe较A组亦明显降低,分别为(-0.79±0.35)s-1、(-0.65±0.29)s-1和(-1.02±0.33)s-1(P<0.01);SRa在B组高于A组[分别为(-1.60±0.58)s-1和(-1.48±0.47)s-1,P<0.05],亦高于C组[分别为(-1.60±0.58)s-1和(-1.24±0.48)s-1,P<0.01],且C组显著小于A组[分别为(-1.24±0.48)s-1和(-1.48±0.47)s-1,P<0.01]。②SRs、SRe与左心室舒张功能分级均呈负相关(r分别为-0.178和-0.366,P<0.01)。结论:二维斑点追踪技术测量左心房应变率,可间接反映左心室舒张功能。     

二维斑点追踪应变率技术研究正常人节段性左心房功能评价

目的:应用二维斑点追踪应变率技术,评价正常人节段性左心房功能。方法:在心尖四腔及两腔心切面,应用二维斑点追踪技术,评价44例正常人各节段左心房长轴方向的应变率(SR)。比较心室收缩期(SR-S)、舒张早期(SR-E)和舒张晚期(SR-A)心房间隔、侧壁、下壁、前壁以及基底段、中间段和房顶部SR之间的差异性。结果:SR-S、SR-A的基底段和中间段均为下壁最高,间隔最低(均P<0.05);SR-E 4个房壁同一节段之间差异均有统计学意义。SR-S、SR-E下壁和侧壁基底段均高于房顶部(均P<0.05);SR-A则仅为下壁基底段高于房顶部(P<0.05)。结论:正常人心动周期中表现为左心房下壁和侧壁变形能力最高,且基底段高于房顶部。二维斑点追踪技术,可为临床上评价不同病理状态下左心房功能节段性改变的位置和程度提供重要信息。     

Two dimensional speckle tracking echocardiography in detection of subclinical left ventricular systolic dysfunction in patients with severe aortic stenosis

Introduction

Subclinical left ventricular (LV) systolic dysfunction may develop in patients with severe aortic stenosis (AS) despite normal LV ejection fraction (EF%).

The aim of the study

To evaluate the role of two dimensional (2D) speckle tracking echocardiography (STE) in detection of subclinical LV systolic dysfunction in patients with severe AS.

Patients and method

The study included 50 patients with severe AS (mean age: 45 ± 9 years) and 30 age-matched healthy individuals (mean age 43 ± 7 years. Conventional echocardiographic parameters used for the assessment of AS severity were measures and 2D Speckle tracking imaging of the peak systolic strain curves of the Inferior septum and lateral wall in the apical four-chamber view (4C-PLS), the Inferior and anterior wall was in the apical two chamber view (2C-PLS), and the infero lateral and anterior septum in the apical three-chamber view (3C-PLS) were obtained. Left ventricular global longitudinal systolic strain (LV-GLS) was calculated by averaging the peak systolic values of the 6 LV walls.

Results

LV-GLS was significantly reduced in patients with AS compared to controls (<0.001) and negatively correlated with left ventricular mass index (LVMI) (r = −0.47, p = 0.01) irrespective of EF%, maximum velocity, peak pressure gradient and mean pressure gradient across the aortic valve and the aortic valve area.

Conclusion

Patients with severe AS have evidence of subclinical LV systolic dysfunction despite preserved EF%. 2D speckle tracking appears to be useful in detection of subclinical LV dysfunction in patients with AS.     

Quantitative assessment of left ventricular volume and ejection fraction using two-dimensional speckle tracking echocardiography

Aims: Two-dimensional speckle tracking echocardiography (2DSTE) allowsmeasurements of left ventricular (LV) volumes and LV ejectionfraction (LVEF) without manual tracings. Our goal was to determinethe accuracy of 2DSTE against real-time 3D echocardiography(RT3DE) and against cardiac magnetic resonance (CMR) imaging. Methods and results: In Protocol 1, 2DSTE data in the apical four-chamber view (iE33,Philips) and CMR images (Philips 1.5T scanner) were obtainedin 20 patients. The 2DSTE data were analysed using custom software,which automatically performed speckle tracking analysis throughoutthe cardiac cycle. LV volume curves were generated using thesingle-plane Simpson's formula, from which end-diastolic volume(LVEDV), end-systolic volume (LVESV), and LVEF were calculated.In Protocol 2, the 2DSTE and RT3DE data were acquired in 181subjects. RT3DE data sets were acquired, and LV volumes andLVEF were measured using QLab software (Philips). In Protocol1, excellent correlations were noted between the methods forLVEDV (r = 0.95), ESV (r = 0.95), and LVEF (r = 0.88). In Protocol2, LV volume waveforms suitable for analysis were obtained from2DSTE images in all subjects. The time required for analysiswas <2 min per patient. Excellent correlations were notedbetween the methods for LVEDV (r = 0.95), ESV (r = 0.97), andLVEF (r = 0.92). However, 2DSTE significantly underestimatedLVEDV, resulting in a mean of 8% underestimation in LVEF. Intra-and inter-observer variabilities of 2DSTE were 7 and 9% in LVvolume and 6 and 8% in LVEF, respectively. Conclusions: Two-dimensional speckle tracking echocardiography measurementsresulted in a small but significant underestimation of LVEDVand EF compared with RT3DE. However, the accuracy, low intra-and inter-observer variabilities and speed of analysis make2DSTE a potentially useful modality for LV functional assessmentin the routine clinical setting.     

Left ventricular myocardial performance in patients with dengue hemorrhagic fever and thrombocytopenia as assessed by two-dimensional speckle tracking echocardiography

ObjectivesWe obtained longitudinal, radial and circumferential strains in patients with dengue hemorrhagic fever (DhF) and thrombocytopenia using two-dimensional (2D) speckle tracking echocardiography to analyze left ventricular (LV) myocardial performance.MethodsIn this prospective study, 2D echocardiographic images of the left ventricle in the four-, three- and two-chamber views and parasternal short-axis views at the basal, mid and apical levels were obtained in 40 subjects: 20 patients (23 ± 8 years, 12 male) with DhF and thrombocytopenia and 20 healthy controls (23 ± 5 years, 11 male). Of the 20 patients, imaging was performed again in 19 at discharge after a hospital stay of 8 ± 1 days. Longitudinal, circumferential and radial strains were quantified and compared in an 18-segment model using a novel speckle tracking system.ResultsLeft ventricular global ejection fraction was reduced in patients with DhF at presentation as compared with controls (51.25 ± 0.96% vs. 59.32 ± 1.26%; p = 0.032). Peak longitudinal strain in patients with DhF was significantly attenuated in the subendocardial region compared with normal controls (p < 0.001). A significant increase in circumferential strain for patients with DhF was evident only in the subepicardial region (p = 0.009). Patients with DhF showed significantly higher radial strain than controls (p < 0.001). On multivariate analysis, subendocardial longitudinal strain independently predicted the duration of hospital stay in patients with DhF.ConclusionAssessment of speckle tracking echocardiography-derived LV mechanics helps in understanding myocardial mechanics in patients with DhF and thrombocytopenia. Identification of reduced LV longitudinal strain helps in understanding the mechanism of reduced LV myocardial performance seen in patients with DhF.     

Longitudinal left ventricular 2D strain is superior to ejection fraction in predicting myocardial recovery and symptomatic improvement after aortic valve implantation

Background

Predicting improvement of myocardial function after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) remains a challenge. As ejection fraction (EF) may be of limited value in detecting early myocardial dysfunction and predicting outcome, we assessed the potential of echocardiographic longitudinal function in this setting.

Materials and methods

Left ventricular (LV) function was assessed using EF, mitral annular plane systolic excursion (MAPSE), peak longitudinal 2D strain (LS) and strain rate (SR) in101consecutive patients with severe symptomatic AS (age 81 ± 11 years) undergoing TAVI. Echocardiography and assessment of clinical status including NYHA functional class were performed prior and after intervention (median 70 days).

Results

Pre-interventional EF was 57 ± 17% and 32 patients (32%) had an EF < 50% while 58 patients (57%) were found to have an impaired LS. After TAVI there was no significant change in EF. In contrast, LS, SR and MAPSE improved significantly (− 14.0 ± 4.4 vs. − 15.5 ± 4.0%; p = 0.007, 0.68 ± 0.24 vs. 0.78 ± 0.23/s, p = 0.002; and 9.1 ± 3.2 vs. 10.2 ± 3.3 mm, p = 0.006, respectively). Receiver Operating Curve characteristic analysis identified a pre-TAVI LS > − 13.3% as the optimal cut-off value for predicting lack of LS recovery post TAVI. There was a marked improvement in NYHA FC after intervention (p = 0.0002). Among the studied echocardiographic parameters LS change correlated closest with NYHA class improvement (r = 0.42, p = 0.0008).

Conclusion

Overall, LS appears to be more sensitive for detecting early myocardial damage in patients with AS compared to conventional echocardiographic parameters. More importantly, pre-interventional LS may identify irreversible myocardial dysfunction and LS improvement correlates with symptomatic improvement after intervention.     

实时三维超声结合斑点追踪超声评价阵发性房颤患者射频消融术后左室同步性及收缩功能

目的 探讨实时三维超声心动图（RT-3DE）联合斑点追踪超声（STE）无创评价阵发性房颤（PAF）患者射频消融手术前后左心室同步性及收缩功能变化。方法 40例接受环肺静脉射频消融治疗的PAF患者术前、术后3个月窦性心律下进行RT-3DE及STE检测。Qlab7.0脱机分析3D-Advanced软件得到左室17节段时间-容积曲线,将左室特定节段到达最小收缩容积（Tmsv）时间的标准差校正值和达到最小收缩容积（Tmsv）最大时间差的校正值（Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%）作为评价左室收缩同步性的指标。Qlab7.0脱机分析TMQA软件得到左室整体纵向收缩期峰值应变（GlS）、径向收缩期峰值应变（GrS）和圆周收缩期峰值应变（GcS）。结果 40例PAF患者术后3个月有4例复发,36例患者维持窦性心律（PAF组）。PAF组左室整体射血分数（GLVEF）与正常对照组相比未见统计学差异（57.4±6.6 vs 59.3±7.7 P>0.05）。维持窦律者纳入术后研究,PAF组术前Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%与对照组比较均显著延长（P均<0.05）。术后3个月上述指标较术前缩短,差异有统计学意义（P<0.05）。与正常对照组相比,PAF组GlS、GrS、GcS明显降低（-12.61±5.46 vs-23.42±7.59,-18.71±9.74 vs -33.22±8.67,-15.43±7.11 vs -25.49±9.63 P<0.05）;术后3个月与术前相比,上述指标明显增加（-16.40±6.55 vs-12.61±5.46,-25.37±8.36 vs -18.71±9.74,-18.74±7.56 vs -15.43±7.11 P<0.05）。结论 RT-3DE联合STE可评价PAF患者环肺静脉射频消融术后左室协调性及收缩功能。