超声血流向量成像技术评价维持性血液透析患者左心室舒张期血流能量损耗

Evaluation of diastolic flow energy loss of left ventricle in maintenance hemodialysis patients by ultrasonic vector flowing mapping

目的应用血流向量成像(VFM)技术探讨左心室(LV)能量损耗定量评价维持性血液透析(MHD)患者舒张期左心室腔内血流动力学改变。方法选取MHD患者32例(血透组)和同期健康体检者31例(对照组)。采用VFM技术脱机分析获取各组LV等容舒张期(P1)、快速充盈期(P2)、减慢充盈期(P3)、心房收缩期(P4)平均整体能量损耗(aEL-T)及基底段能量损耗(aEL-B)、中间段能量损耗(aEL-M)、心尖段能量损耗(aEL-A)和LV涡旋面积、循环强度,比较两组间的差异。结果血透组和对照组P1的aEL-T、P2的aEL-T、aEL-B、aEL-M、aEL-A及P3的aEL-A、P4的aEL-T、aEL-M、aEL-A差异有统计学意义(P<0.01或P<0.05);血透组涡旋面积在P1、涡旋强度在P2、P4较对照组增高,差异有统计学意义(P<0.01或P<0.05);血透组P2与P4的aEL-T均与E/e呈正相关(分别r=0.402,P<0.05;r=0.732,P<0.01)。结论 MHD患者舒张期多个时相LV整体和心室不同水平能量损耗增高,提示该期血流动力学异常改变,VFM技术可为左心室舒张功能变化提供更为精准的量化评价指标。

Objective To explore left ventricular （LV） energy loss in assessing the change of left ventricular hemo- dynamics quantitatively during diastole of maintenance hemodialysis patients （MHD） by Vector Flow Mapping （VFM）. Methods Thirty two patients with MHD （hemodialysis group） were employed while matched with 31 healthy people （control group）. The average total energy loss （EL-T）, basal level energy loss （EL-B）, papillary muscular level energy loss （EL-M） and apical level energy loss （EL-A） of LV , LV vortex area and LV circulation of isovolumetric diastolic phase（P1）, rapid filling phase （P2）, slow filling phase （P3）, atrial systolic phase （P4） were obtained by a dedicated VFM workstation. The difference of energy parameters between the two groups was compared. Results aEL-T in P1, aEL-T, aEL-B, aEL-M, aEL-A in P2,aEL-A in P3 and aEL-T, aEL-M, aEL-A in P4 of hemodialysis group were higher than those of control group （P〈0.05 or P〈0.01）. The vortex area in P1, circulation in P2 and P4 of hemodialysis group were higher than those of control group （P〈0.01 or P〈0.05）. There was a positive correlation between aEL-T and E/e in P2 and P4（r= 0. 402, P〈0.05 ; r = 0. 732, P〈0.01）. Conclusion The energy loss of LV at different levels during diastole in maintenance hemodialysis patients has been increased, which suggests that a significant the left ventric- ular hemodynamics change occured abnormally during diastole, and VFM might be used to provide innovative quantitative indicators to evaluate the changes of the left ventricular diastolic function in maintenance hemodialysis patients precisely.