血流向量成像技术评价室壁瘤患者左心室整体舒张功能

Assessment of left ventricular global diastolic function in patients with ventricular aneurysm by vector flow mapping

目的应用血流向量成像(VFM)技术直观检测正常人和心肌梗死并发室壁瘤患者舒张期左心室血流流场的动态变化,定量评价室壁瘤患者左心室整体舒张功能。方法收集心肌梗死并发心尖室壁瘤患者29例(室壁瘤组)及健康志愿者33例(对照组),应用VFM技术分析等容舒张期、快速充盈期、减慢充盈期、心房收缩期的涡流及流线特征、涡流横径及纵径的比较、舒张早期左心室流入道压力阶差(ΔP),应用组织多普勒测量二尖瓣环舒张早期峰值速度(E')、舒张晚期峰值速度(A')及比值(E'/A')。结果与对照组不同的是整个舒张期室壁瘤组在左心室心尖室壁瘤内均没有检测到涡流及流线信号;心房收缩期和快速充盈期室壁瘤组二尖瓣下涡流横径和纵径显著高于对照组(P<0.05),而在等容舒张期、减慢充盈期两组无显著差异(P>0.05);室壁瘤组舒张早期左心室流入道压力阶差(ΔP)明显低于正常对照组(P<0.05),并与组织多普勒测量的E'/A'呈显著正相关。结论 VFM技术能够直观检测舒张期左心室内血流流场变化,显示室壁瘤组心腔内血流充盈紊乱,同时可定量局部向量速度,从全新的角度证实室壁瘤患者左心室整体舒张功能减低。

Objective To visualize the dynamic changes of left ventricular hemodynamics in myocardial infarction（MI）patients with ventricular aneurysm during the diastolic phase,and quantitively evaluate left ventricular global diastolic function.Methods 29 MI patients with ventricular aneurysm（aneurysm group）and 33 healthy participants（control group）were included,detecting the characteristic of vector and streamline during isovolumic relaxation（IVR）,rapid filling（RAF）,reduced filling（REF）and atrial systole（AS）phase;transverse and vertical diameter of vortex;and the pressure gradient（ΔP）during early diastole in LVIT.The peak velocity in early diastole（E＇）and late diastole（A＇）of mitral annulus,E＇/A＇were detected by doppler tissue imaging（DTI）.Results Compare with control group,no vortex and streamline was detected in aneurysm group in the aneurysm of apex during the diastolic phase.The transverse and vertical diameter of vortex in aneurysm group were both greater than control group during RAF and AS（P0.05）,and no significant vortex had been found in both two groups during IVR and REF（P0.05）.The pressure gradient（ΔP）of LVIT in aneurysm group was lower than that of control group during early diastole（P0.05）.That was highly correlated with E＇/A＇of DTI.Conclusions Vector flow mapping（VFM） could directly observe the change of left ventricular hemodynamics,display disordered ventricular filling in the aneurysm group,and quantitively measure the regional vector velocity.That could confirm the reduction of diastolic function in patients with left ventricular aneurysm from a new perspective.