斑点追踪技术评价无左心室肥厚高血压患者左心室扭转与解旋运动

目的探讨无左心室肥厚高血压患者左心室扭转与解旋运动的特点。方法入选无左心室肥厚的高血压患者85例及健康对照者40名,应用超声二维斑点追踪技术(2D-STI)测量并计算短轴心尖部旋转峰值(PAR)及达峰时间、基底部旋转角度峰值(PBR)及达峰时间、左心室整体扭转角度峰值(Ptw)及达峰时间,收缩末期扭转角度(AVCtw)、等容舒张末期扭转角度(MVOtw)、解旋减半时间(HTU)、解旋率。结果高血压组PAR、Ptw、AVCtw、MVOtw高于对照组[(10.55±4.14)°比(8.95±3.46)°,(18.18±4.58)°比(16.33±4.50)°,(17.11±4.82)°比(14.95±4.61)°,(14.33±4.43)°比(12.40±4.86)°,均P<0.05],解旋率低于对照组[(36.06±15.98)%/ms比(48.96±21.16)%/ms,P<0.05]。Ptw与PAR呈正相关,与PBR呈负相关(分别r=0.825,-0.474,均P<0.05);Ptw与LVMI呈正相关(r=0.208,P<0.05),解旋率与左心室质量指数(LVMI)呈负相关(r=-0.231,P<0.05)。结论高血压患者左心室扭转及解旋运动的异常早于室壁厚度的增加,2D-STI技术可定量检测左心室扭转与解旋运动,有可能作为评价高血压患者左心室收缩及舒张功能的早期指标。     

斑点追踪显像评价左室旋转运动的研究进展

心动周期中心尖及心底沿左室长轴向不同方向旋转,引起心脏扭曲或扭转运动。心肌纤维的螺旋状排列是联系心脏旋转运动解剖学与生理学机制的基础。斑点追踪显像可检测心脏扭转运动,对预测及治疗心肌功能障碍提供有价值的信息,是评价心脏旋转运动的新超声心动图技术。     

超声斑点追踪显像评价高血压患者心功能损伤的临床价值研究

目的 分析超声斑点追踪显像对高血压患者心功能损伤的评估价值。方法 纳入2020年2月至2022年2月间的190例高血压患者,根据患者是否合并心肌肥厚分组,单纯高血压患者设置为对照组（n=95）,高血压合并心肌肥厚设置为观察组（n=95）,比较两组二维超声参数和超声斑点追踪显像参数。结果 二维超声参数对比结果显示：观察组左室射血分数更低,左室舒张末期内径、左室收缩末期内径、左室舒张末期容积、左室收缩末期容积更高（P<0.05）;超声斑点追踪显像参数对比结果显示：对照组和观察组等容解旋比例、扭转速度峰值、扭转速度峰值达峰时间对比,差异无统计学意义（P>0.05）,观察组扭转角度峰值为（24.32±2.56）°,收缩末期扭转角度为（23.42±1.78）°,等容舒张末期扭转角度为（21.36±2.21）°,解旋速度峰值为（-145.54±13.21）°/s,解旋速度峰值达峰时间为（30.78±2.72）ms,明显高于对照组,差异有统计学意义（P<0.05）。结论 超声斑点追踪显像可测量高血压患者扭转和解旋运动参数,为患者心功能损伤程度诊断提供依据,有应用价值。     

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。     

二维超声斑点追踪显像技术在评价AMI患者左心室扭转运动中的应用

目的 观察二维超声斑点追踪显像（STI）技术评价急性心肌梗死（AMI）患者左室收缩功能的价值.方法 选择60例AMI患者（AMI组）及20例健康查体者（对照组）,均采用彩色多普勒超声仪以Simpson′s法测量左室射血分数（LVEF）及二尖瓣血流E峰/A峰,以STI技术测量左室心尖和心底各个节段旋转角度,同步记录左室整体扭转峰值（Ptw）、心尖扭转角度峰值（PAR）、心底扭转角度峰值（PBR）、收缩末期末左心室扭转角度（AVCtw）、等容舒张期末扭转角度（MVOtw）、解旋率（UntwR）、解旋减半时间（HTU）,并分析左室扭转参数与LVEF、E峰/A峰的相关性.结果 AMI组Ptw、 PAR、AVCtw、MVOtw明显低于对照组（P〈0.05）,其中前壁心梗者PAR显著低于下壁及前间壁心梗者（P〈0.05）;Ptw与LVEF呈显著正相关（r=0.527,P〈0.05）,UntwR与E峰/A峰无明显相关.结论 STI技术可通过定量检测收缩期左室扭转运动较好的评价AMI患者左室收缩功能改变,是指导临床诊治的新型无创性方法.     

二维超声斑点追踪显像技术对正常人左室旋转和扭转运动的评价

目的:应用二维超声斑点追踪显像技术探讨正常人左室旋转(LVrot)和左室扭转(LVtw)运动特征。方法:入选健康成人志愿者58例,取胸骨旁左室心尖和心底短轴观对LVrot进行定量分析,获LVrot及LVtw角度随心动周期变化曲线,记录心底部与心尖部LVrot角度峰值和LVtw角度峰值及达峰时间。结果:正常人扭转运动主要表现为心底部顺时针旋转和心尖部逆时针旋转,心脏整体表现为心动周期内逆时针方向为主的扭转运动。心尖部和心底部旋转角度达峰时间差异无统计学意义(P>0.05)。扭转角度于收缩末期达峰值。结论:应用二维超声斑点追踪显像技术可无创性评价正常人LVrot和LVtw运动特征。左室心底部及心尖部旋转角度、达峰时间可做为评价左室运动同步性指标之一。     

三维斑点追踪成像评价不同病变血管的冠心病患者左心室扭转运动

目的 应用三维斑点追踪成像(three-dimensional speckle tracking imaging,3D-STI)技术评价不同病变血管的冠心病患者左心室心肌扭转运动。方法 220例研究对象依冠状动脉血管将患者分为正常组、前降支病变组(LAD组)、回旋支病变组(Lcx组)、右冠状动脉病变组(RCA组),应用三维斑点追踪成像技术获得心尖段、基底段、左室整体扭转角度峰值(PAR、PBR、Ptw)及达峰时间(PART、PBRT、PtwT)、左室射血分数(LVEF)等指标,比较各组与正常组之间上述指标的差异。结果 LAD组PART、 PtwT较对照组延长,PAR、Ptw较对照组减低,差异有统计学意义(P<0．05);LCX组、RCA组的PBRT较对照组延长,而扭转参数与对照组比较差异无统计学意义(P>0.05);与对照组比较,多支病变组PART、 PBRT、 PtwT延长,PAR、PBR、Ptw较对照组减低;冠心病组扭转角度峰值与LVEF均有一定相关性,PAT与LVEF相关性最佳(r=0.61,P<0.05)。结论 3D-STI可以检测不同病变血管的冠心病患者左心室扭转运动,不同的冠状动脉血管的冠心病患者左心室扭转运动有所不同。     

二维斑点追踪技术评价心肌梗死患者冠脉 内支架术后左室扭转功能变化

目的 探讨斑点追踪成像技术（STI）在心肌梗死患者冠脉内支架置入术（PCI）疗效评估中的应用价值.方法 选取2011年3月至2013年5月在昆明医科大学第二附属医院心内科接受PCI治疗的心肌梗死患者30例为病例组,正常对照组35例,对正常对照组及接受PCI治疗的患者在术前,术后1周、1个月、3个月、6个月时进行常规超声心动图检查和斑点追踪成像技术分析,测量左室舒张末期内径（LVDd）、左室舒张末期容积（LVESV）、左室收缩末期容积（LVEDV）,以及左室基底段和心尖段收缩期整体旋转角度峰值（Prot-base、Prot-apex）,并计算左心室扭转角度峰值（Ptw）,比较分析各参数在PCI手术前后的变化,结合分析左室扭转功能的改变.结果 与正常对照组比较,病例组PCI治疗前LVDd、LVESV、LVEDV较对照组扩大,LVEF[（43.74±9.47）％比（58.38±4.37）％]较对照组降低,差异均有统计学意义（P均＜0.05）;与PCI治疗前比较,PCI术后1周、1个月LVDd、LVESV、LVEDV及LVEF都没有明显改变,差异无统计学意义（P均＞0.05）;PCI治疗后3个月、6个月时LVDd、LVESV、LVEDV比PCI治疗前有一定缩小,LVEF[（49.33± 11.06）％比（43.74±9.47）％、（53.74±8.06）％比（43.74±9.47）％]增高,差异均有统计学意义（P均＜0.05）.病例组术前Prot base[（-4.57 ±2.16）°比（-8.18±2.67）°]、Prot apex [（5.17±2.25）°比（9.38±2.72）°]、Ptw[（9.74±3.61）°比（17.56±3.41）°]均显著低于正常对照组（P＜0.05）;病例组术后1周Prot base、Prot apex、Ptw均较术前无明显改善（P＞0.05）.病例组术后1、3、6个月Prot base[（-5.84±2.03）°比（-4.57±2.16）°、（-6.68±2.45）°比（-4.57±2.16）°、（-7.56±2.41）°比（-4.57±2.16）°]、Prot apex [（6.58±2.86）°比（5.17±2.25）°、（7.04±3.12）°比（5.17±2.25）°、（8.75±2.63）°比（5.17±2.25）°]、Ptw [（12.42±4.77）°比（9.74±3.61）°、（13.72±     

超声斑点追踪成像技术的临床应用

超声斑点追踪成像技术(speckle tracking imaging,STI)[1]是超声医学领域内新近高速发展起来的一项新技术,该技术通过运算重建心肌组织的实时运动和变形,能定性及定量地显示心肌运动速度、应变、应变率以及心脏整体的旋转角度和旋转速度.该技术为研究心脏整体和局部功能提供了新的方法,有望在科研和临床中起到更为重要的作用.     

斑点追踪成像技术评价扩张性心肌病的研究进展

<正>扩张性心肌病(dilated cardiomyopathy,DCM)是一种以左心室或双心室扩张、收缩功能障碍为特征的不明原因的心肌疾病。由于DCM的临床结局多种多样,如急性心力衰竭、心律失常或心源性猝死等,若没有及时诊断及预防,将严重影响患者生命质量及生存。因此准确诊断与及时治疗该病是至关重要的。超声心动图是确定DCM心室功能障碍、扩张严重程度,以及评估预后特征的一线诊断手段^[1]。而目前在临床上广泛应用的超声技术存在来自噪音、角度及帧频等影响的不足,因此准确性有待提高^[2]。随着近年来斑点追踪成像(speckle-tracking imaging,STI)技术的不断成熟与完善,     

Physiologic determinants of left ventricular systolic torsion assessed by speckle tracking echocardiography in healthy subjects

Background: The associations of left ventricular (LV) systolic torsion with clinical and echocardiographic variables in physiological conditions have not been fully investigated. We explored the independent determinants of LV systolic torsion in a population of normal subjects. Methods: In 119 healthy subjects, peak twist angle (LVtw) and torsion (LVtor) during ejection, and the QRS‐LVtw interval (time‐to‐peak LVtw) were measured by speckle tracking. LV twisting rate and rotational deformation delay were also determined. Results: Stepwise multiple regression showed that LVtw was independently associated with indexed end‐systolic volume (β=–0.200, P < 0.0001), peak early diastolic mitral annulus velocity (β=–0.186, P = 0.0001), heart rate (β= 0.178, P = 0.0003), and male gender (β=–0.174, P = 0.0004). Similar results were found for LVtor. Age was the only parameter, which has demonstrated an independent correlation with time‐to‐peak LVtw (β= 0.329, P < 0.0001). Despite significance of these associations, the proportions of variability explained by regression models were relatively low (range 11–26%), and no accurate predictive models were identifiable for LV twisting rate and rotational deformation delay. Conclusion: In normal individuals, indexed end‐systolic LV volume, LV relaxation, heart rate, gender, and age correlate independently with LV torsion mechanics. However, conventional echocardiographic and clinical variables are not able to predict LV torsion mechanics. (Echocardiography 2011;28:641‐648)     

Left ventricular torsion and strain in patients with repaired tetralogy of Fallot assessed by speckle tracking imaging

Background: In patients with tetralogy of Fallot (TOF), left ventricular (LV) dysfunction is an important factor associated with poor clinical outcome. Objective: The purpose of this study was to investigate the torsion and multidirectional strain of the LV in patients with TOF. Methods: Echocardiographic images were prospectively acquired in 29 patients who underwent TOF repair (age range, 5–25 years) and in 29 normal controls. Torsion and circumferential and longitudinal strain of the LV were assessed using speckle tracking imaging. Results: The torsion in patients was smaller compared to that in the controls due to small apical rotation and/or inverse basal rotation (P < 0.01). Torsion and untwisting rates decreased with increasing age (R = 0.37, P < 0.05). Basal circumferential strain and strain rate (SR) at systole and diastole decreased with age (R = 0.58; R = 0.57; R = 0.57, all P < 0.001) and were smaller in patients compared to those in the controls (all P < 0.01). Septal longitudinal strain and SR at systole and diastole decreased with age (R = 0.52; R = 0.62; R = 0.71, all P < 0.001) and were smaller than those of the controls (P < 0.01), although lateral longitudinal strain and SR were relatively maintained. Conclusion: Abnormal torsion and strain pattern of the LV were observed in patients without symptoms of cardiac failure. Assessment of torsion and strain is a very sensitive tool to detect the early deterioration of LV function in patients with TOF. (Echocardiography 2011;28:720‐729)     

应用斑点追踪成像技术评价心力衰竭患者左室短轴二维应变

目的:应用斑点追踪成像技术（STI）测量正常人及慢性心力衰竭患者(HF)左室短轴各节段二维应变,探讨STI技术评价HF患者左室功能的临床价值。方法: 采集HF患者及对照组左室短轴(二尖瓣、乳头肌、心尖水平)二维高帧频图像,测量各节段的收缩期径向应变（Rs）、环向应变（Cs）。结果: 对照组Rs在同一水平各节段间差异无统计学意义,乳头肌水平显著高于心尖水平,Cs在同一水平各节段间差异有统计学意义（P<0.05）。HF组各短轴水平整体Rs、Cs及各节段的Rs、Cs均显著低于对照组（P<0.01）。结论: HF患者左室各短轴水平及各节段收缩期径向及环向应变均明显低于正常人,提示其左室短轴收缩功能明显受损。     

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.     

Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging.

AIMS: Newly developed two-dimensional ultrasound speckle tracking imaging allows measurements of left ventricular (LV) rotation and twist. Because LV untwisting predominantly occurs during the isovolumic relaxation period, its assessment reflects the process of LV relaxation. The aim of this study was to examine whether LV hypertrophy (LVH) adversely affects LV untwisting and abnormalities in LV untwisting could become a novel marker in assessing LV relaxation abnormalities. METHODS AND RESULTS: We acquired basal and apical LV short-axis images in 49 hypertensive patients. Using two-dimensional strain software, a time-domain speckle tracking was performed, and the mean value of LV rotation was obtained at each plane. LV twist was defined as apical rotation relative to the base. In order to adjust for inter-subject differences in heart rate, the time sequence was normalized to the percentage of systolic and diastolic duration. The degree of LV untwisting was calculated as the percentage of systolic twist : untwisting = (TwistES-Twistt/TwistES) x 100, where Twistt is twist at time t and TwistES is twist at end-systole. Although peak systolic twist was not different, early diastolic LV untwisting and untwisting rate during isovolumic relaxation period was significantly delayed and reduced in parallel to the severity of LVH, as assessed by LV mass index. CONCLUSION: The observed delayed and reduced diastolic untwisting during the isovolumic relaxation period noted in hypertensive patients with LVH may contribute towards the LV relaxation abnormality. Two-dimensional speckle tracking imaging is a novel tool which can be used for the non-invasive assessment of LV relaxation.     

二维斑点追踪成像技术评价频发室性期前收缩患者的左心室功能的应用

目的:探讨二维斑点追踪成像技术评估特发性频发室性期前收缩患者的左心功能。方法:研究纳入50例特发性频发室性期前收缩患者以及20例健康人群对照。两组对照进行基线的普通超声心动图、二维斑点追踪成像技术及24h动态心电图检查。结果:病例组与对照组的左心室射血分数、左心室舒张末内径、左心室收缩末内径的差异无统计学意义(P0.05);病例组的左心室短轴应变、左心室圆轴应变及左心室长轴应变显著低于正常对照组(P0.001)。结论:二维斑点追踪成像技术能够识别频发室性期前收缩患者早期隐匿的左心室功能损害。