超声二维斑点追踪成像技术对尿毒症患者心室动脉偶联情况的评估价值

The predictive value of two-dimensional ultrasonic speckle tracking imaging technology for ventricular arterial coupling in uremic patients

目的探讨超声二维斑点追踪成像(2DSTI)技术对尿毒症患者心室动脉偶联(VAC)情况的评估价值。方法96例尿毒症患者按左心室射血分数(LVEF)分为LVEF正常组(LVEF≥0.55,48例)和LVEF下降组(LVEF<0.55,48例);另选取45例健康体检者作为健康对照组。所有患者均行常规超声心动图检查;测量心功能相关指标变化,计算VAC值。使用2DSTI测量左心室17节段的纵向应变值(LS),计算心底部纵向应变值(LSBA)、乳头肌纵向应变值(LSPM)和心尖部纵向应变值(LSAP)。结果超声心动图结果显示,与健康对照组和LVEF正常组比较,LVEF下降组左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室质量指数(LVMI)升高,左心室短轴缩短率(LVFS)、LSBA、LSPM和LSAP降低(P<0.01)。2DSTI结果显示,与健康对照组和LVEF正常组比较,LVEF下降组左心室收缩末期弹性(Ees)下降,VAC值升高(P<0.05)。相关性分析显示,尿毒症患者LSBA、LSPM、LSAP与Ees、LVEF、LVFS呈正相关(均P<0.05),与有效动脉弹性(Ea)、VAC、外周血管阻力指数(SVRI)、心率血压乘积(RPP)、LVMI呈负相关(均P<0.05)。结论2DSTI可用于评估尿毒症患者的VAC情况。

Objective To study the value of two-dimensional speckle tracing imaging(2 DSTI)in the evealuation of ventricular-arterial coupling(VAC)in uremic patients.Methods A total of 96 uremic patients were divided into two groups based on left ventricular ejection fraction(LVEF):the normal LVEF group(LVEF≥0.55,n=48)and the LVEF decline group(LVEF<0.55,n=48).Forty-five healthy subjects were recruited as the control group.All the patients underwent conventional echocardiography.VAC and myocardial performance index were calculated.Longitudinal strain(LS)of 17 segments was measured using 2 DSTI,and the longitudinal strain values of the bottom(LSBA),papillary muscle(LSPM)and apex(LSAP)were calculated.Results Compared to subjects in the control group and the normal LVEF group,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular mass index(LVMI)were increased,and left ventricular short axis shorting rate(LVFS),LSBA,LSPM,and LSAP were decline in the LVEF decline group(P<0.01).2 DSTI results showed that compared with the control group and the normal LVEF group,Ees decreased and VAC value increased in the LVEF-decline group(P<0.05).Correlation analysis showed that LSBA,LSPM and LSAP were positively correlated with Ees,LVEF and LVFS(all P<0.05),and negatively correlated with effective arterial elasticity(Ea),VAC,peripheral vascular resistance index(SVRI),heart rate,blood pressure product(RPP)and LVMI(all P<0.05).Conclusion 2 DSTI can be used to evaluate VAC in uremia patients.