Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes

BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus(DM).Therefore,early detection of left ventricular systolic function(LVSF)damage in DM is essential.AIM To explore the use of the three-dimensional speckle tracking technique(3D-STI)for measuring LVSF in DM patients via meta-analysis.METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023.The current study involved 9 studies,including 970 subjects.We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI.RESULTS Night articles including 970 subjects were included.No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group(P>0.05),while differences in global longitudinal strain,global circumferential strain,global radial strain,and global area strain were markedly different between the controls and DM patients(all P<0.05).CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.

Left Ventricular Systolic Strain of the Cardiac Allograft Evaluated with Three-dimensional Speckle Tracking Echocardiography

Three-dimensional speckle tracking echocardiography was employed to evaluate the changes of left ventricular systolic strain in 23 heart transplant recipients at 1 st, 3rd, 6th and 12th month after heart transplantation, and 23 healthy subjects served as controls. The three-dimensional full-volume echocardiographic images of left ventricle were recorded and then were analyzed using EchoPAC software. The strain curves and peak systolic strain values for each segment and overall left ventricular wall were obtained. Left ventricular global peak longitudinal strain （GPSL）, global peak radial strain （GPSR）, global peak circumferential strain （GPSC） and global peak area strain （GPSA） were measured and then statistically analyzed. There were no significant differences in left ventricular ejection fraction （LVEF） and cardiac output （CO） between heart transplant recipients and controls. The GPSL in heart transplant recipients at 1st month after surgery was significantly lower than that in controls, but close to the normal value at 3rd month after surgery and later. The GPSC, GPSA and GPSR were significantly lower in heart transplant recipients at 1 st, 3rd, 6th and 12th month after surgery than those in controls. It is suggested that three-dimensional speckle tracking echocardiography can be used for monitoring changes of left ventricular systolic strains and evaluating left ventricular systolic function in cardiac allograft.

Value of myocardial function in children with Kawasaki disease by two-dimensional and three-dimensional ultrasound speckle tracking

Objective:To investigate the value of two-dimensional ultrasound speckle tracking(2D-STI)and three-dimensional ultrasound speckle tracking(3D-STI)in evaluating myocardial function in children with Kawasaki disease.Methods 92 children with Kawasaki disease admitted to our hospital from February 2017 to February 2019 were retrospectively analyzed.50 children who underwent 3D-STI examination were taken as observation group and 42 children who underwent 2D-STI examination were taken as control group.The left ventricular systolic function index,storage time and analysis time of the image,the diameter of coronary artery,the strain difference of left ventricular basal segment,middle segment,apical segment and whole segment were observed.Results The levels of left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular myocardial mass(LVMI)in the observation group were higher than those in the control group(P<0.05),but there was no statistical difference in left ventricular ejection fraction(LVEF)between the two groups(P>0.05).The storage time and analysis time of the image in the observation group were significantly lower than those in the control group(P<0.05).The left coronary artery(LCA)and right coronary artery(RCA)in the observation group were higher than those in the control group(P<0.05).There was no statistical difference between left anterior descending(LAD)in the two groups(P>0.05).The longitudinal peak systolic strain(LS),circumferential peak systolic strain(CS)and radial peak systolic strain(RS)in the observation group were higher than those in the control group(P<0.05).The global longitudinal peak strain(GLS),global circumferential peak strain(GCS)and global radial peak strain(GRS)in the observation group were higher than those in the control group(P<0.05).LS and CS in the middle segment of the observation group were higher than those in the control group(P<0.05).Conclusions Compared with 2D-STI,3D-STI can objectively and accurately reflect the myocardial function of children with Kawasaki disease.

Correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease

Objective:To study the correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease. Methods: Patients who were diagnosed with coronary heart disease and angina pectoris in our hospital between March 2015 and May 2017 were selected as the CHD group of the study, and the healthy subjects who received medical examination in our hospital during the same period were taken as the control group;the three-dimensional speckle tracking parameters, peripheral blood signal molecule expression as well as serum cytokine and collagen metabolism index levels of the two groups were measured.Results: GLS and AGS levels in CHD group were significantly lower than those in control group whereas GCS and GRS levels were not significantly different from those in control group, and peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents were significantly higher than those of control group;GLS and AGS levels in CHD group were negatively correlated with peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents.Conclusions:The changes of three-dimensional speckle tracking parameters GLS and AGS in patients with coronary heart disease are closely related to the changes in signal pathway function, cytokine secretion and collagen metabolism during left ventricular remodeling.

Correlation between three-dimensional speckle tracking imaging parameter and the cardiotoxicity of chemotherapeutics in patients with lung cancer chemotherapy

Objective: To study the correlation between three-dimensional speckle tracking imaging (3D-STI) parameter global area strain (GAS) and the cardiotoxicity of chemotherapeutics in patients with lung cancer chemotherapy. Methods: Patients with lung cancer who underwent chemotherapy in the Second Affiliated Hospital of Xi'an Medical University between February 2016 and May 2017 were selected as the chemotherapy group, the healthy subjects who received physical examination during the same period were selected as the control group, the 3D-STI examination was performed and GAS was calculated;the serum was collected to determine the contents of cardiotoxicity markers as well as apoptosis and oxidative stress indexes, and the peripheral blood was collected to determine the expression of apoptosis and oxidative stress molecules. Results: GAS level, serum ALDH2 and CAT contents as well as peripheral blood Keap1 and Bcl-2 expression intensity of chemotherapy group were lower than those of control group whereas serum Copeptin, CK-MB, cTnI, cMyBP-c, sTWEAK, sFas, MDA and 8-isoPGF2α contents as well as peripheral blood Nrf-2, gp91phox, p22 phox and Caspase-3 expression intensity were significantly higher than those of control group;the GAS level in chemotherapy group was negatively correlated with serum Copeptin, CK-MB, cTnI, cMyBP-c, sTWEAK, sFas, MDA and 8-isoPGF2α contents as well as peripheral blood Nrf-2, gp91phox, p22 phox and Caspase-3 expression intensity, and positively correlated with serum ALDH2 and CAT contents as well as peripheral blood Keap1 and Bcl-2 expression intensity. Conclusion: The changes of 3D-STI parameter GAS in patients with lung cancer chemotherapy can reflect the degree of cardiotoxicity induced by oxidative stress and apoptosis.

Evaluation of left ventricular systolic dyssynchrony by two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography

Background Two-dimensional speckle tracking imaging （2D-STI） and real-time three-dimensional echocardiography （RT-3DE） have more advantages in evaluating left ventricular （LV） systolic dyssynchrony than traditional echocardiographic techniques. The study aimed to evaluate LV dyssynchrony parameters by both 2D-STI and RT-3DE, and the correlation between these two techniques. Methods A total of 43 chronic heart failure （CHF） patients and 27 healthy volunteers were enrolled. There were 23 dyssynchrony parameters selected to evaluate left ventricular systolic synchronization, involving 15 from 2D-STI and 8 from RT-3DE. Results Few of the dyssynchrony parametersshowednegative correlations with LV ejection fraction （LVEF） in the CHF group. The difference between time to peak-systolic radial strain of the anteroseptal and posterior segments at the level of papillary muscles [AS-P（RS）] from 2D-STI showed positive correlations with parts of the parameters from RT-3DE （P 〈 0.05）. Conclusions LV systolic dysfunction does not correlate with dyssynchrony. Moreover, there is a weak association between 2D-STI and RT-3DE in assessment of left ventricular dyssynchrony.

二维斑点追踪技术评价曲妥珠单抗联合蒽环类药物对乳腺癌患者心脏毒性的价值

目的探讨二维斑点追踪技术早期监测左心室收缩功能评价乳腺癌患者在接受蒽环类药物联合曲妥珠单抗联合治疗后产生心脏毒性的价值。方法乳腺癌术后患者50例,均接受蒽环类药物联合曲妥珠单抗联合治疗,分别于治疗前、治疗中期及治疗后期常规进行心电图、二维超声心动图及二维斑点追踪技术监测,主要观察指标为左心室射血分数(LVEF)及整体纵向应变(GLS),30例健康志愿者作为对照组。结果①GLS在化疗中期及后期时较对照组、化疗前均明显减低(P<0.05)。②LVEF在化疗中期及后期对比化疗前或对照组差异均无显著意义。结论应用二维斑点追踪技术测得的整体纵向应变值(GLS)能评价乳腺癌患者治疗后药物所致的左心室功能障碍的微小变化,尽早发现心肌功能的损害。

二维斑点追踪技术联合右室量化分析系统评价淋巴瘤患者化疗后右室功能改变

目的:应用二维斑点追踪技术(2D-STI)联合右室量化分析系统(QAS-R)评价淋巴瘤患者化疗后右室功能改变。方法:选取确诊淋巴瘤并接受蒽环类药物化疗患者40例。根据化疗周期分为化疗前(T0)、完成2个周期(T1)、完成4个周期(T2)及完成6个周期(T3)。常规超声心动图测量左室射血分数(LVEF)、三尖瓣环收缩期峰值流速(S’)、三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(FAC)、三尖瓣环舒张早期峰值流速(E)、三尖瓣环舒张晚期峰值流速(A),计算E/A;二维斑点追踪技术测量右室游离壁基底段应变(Sb)、右室游离壁中间段应变(Sm)、右室游离壁心尖段应变(Sa),计算右室游离壁纵向应变(RVFWLS);右室量化分析系统测量右室射血分数(RVEF)。比较上述参数化疗前后差异。结果:与T0相比,LVEF、E/A在T1、T2和T3无明显差异(P>0.05);与T0相比,RVFWLS、Sb、Sm、RVEF在T1、T2、T3明显降低(P<0.05),Sa、RVFAC在T2、T3明显降低(P<0.05),TAPSE、S’在T3明显降低(P<0.05);与T1相比,RVFWLS、Sb、Sm、Sa、RVEF、FAC在T2、T3明显降低(P<0.05);TAPSE、S’在T3明显降低(P<0.05);与T2相比,RVFWLS、Sb、Sm、Sa、RVEF、TAPSE、FAC、S’在T3明显降低(P<0.05)。在相关性分析中,蒽环类药物累积剂量与RVFWLS、Sb、Sm、Sa、RVEF、RVFAC、TAPSE、S’呈负相关,相关系数分别为-0.775、-0.673、-0.628、-0.593、-0.749、-0.468、-0.368、-0.346;RVEF与RVFWLS、Sb、Sm、Sa、RVFAC、TAPSE、S’呈正相关,相关系数分别为0.667、0.597、0.491、0.544、0.354、0.258、0.257。结论:2D-STI联合QAS-R可以评价淋巴瘤患者化疗后右室功能改变。

超声心动图评价动脉性肺动脉高压患者左室功能的研究进展

动脉性肺动脉高压(PAH)是由肺血管重塑导致肺动脉压力升高的进展性疾病,属于第一类肺动脉高压。其主要表现为肺血管阻力进行性增高进而出现右心衰竭,且因双心室依赖性和血流动力学等因素,左心功能亦会受到影响。近年来,超声心动图凭借实时性、无辐射和可重复性等优点,已成为临床上检查心脏结构与功能异常的重要检查。随着斑点追踪成像、压力应变环和三维超声心动图等新技术的日渐成熟,超声心动图对心肌功能的分析更加便捷、准确。本文就超声心动图新技术在评价PAH患者左室功能中的研究进展进行综述。

超声心动图参数评估ICU冠心病患者预后的分析

目的探析ICU冠心病(CHD)患者预后分析中,超声三维心动图(RT-3DE)的应用价值。方法选取108例ICU-CHD患者为对象,所有患者均接受PCI术治疗,分别采用二维斑点追踪技术(2DS)、RT-3DE评估患者预后情况。结果左室RT-3DE参数相比,LVEF术前<术后1个月<术后半年(P<0.05);其他超声参数相比,术前>术后1个月>术后半年(P<0.05)。LAVmax、LAVmin术前>术后1个月>术后半年(P<0.05);IVRT、Ar水平:术后半年<术后1个月<术前;E/A水平:术后半年>术后1个月>术前(P<0.05)。预后评估灵敏度、特异度、符合率相比,RT-3DE均较高(P<0.05)。结论RT-3DE能更加清晰反馈ICU-CHD患者治疗后的左心室、左心房相关参数变化,灵敏度、特异度及符合度均较高,值得推广。

高血压患者血脂水平与左心房功能应变受损的相关性

目的 探索高血压患者血脂水平与心房颤动发生之前左心房功能受损的相关性。方法 连续收集2018年8月~2020年7月期间在北京安贞医院心内科就诊的原发性高血压患者,按照左心房SR-LAs,SRLAe或SR-LAa是否低于参考值划分为左房应变正常组(n=124)和左房应变受损组(n=62)。收集一般情况和血脂等临床资料,并进行二维斑点追踪成像技术(two-dimension speckle tracking imaging, 2D-STI)联合经胸超声心动图检查来评估患者左心房功能受损情况。多变量Logistic回归分析左心房应变受损与血脂水平和其他临床指标的相关性。对血脂综合指数和左心房应变参数进行Pearson线性相关分析。结果 左心房应变受损的患者与左心房应变正常的患者相比,其BMI(P<0.05)、总胆固醇水平(P<0.01)、LDL-C水平(P<0.01)和血脂综合指数(P<0.01)均较低;超声数值方面,左心房应变受损的患者具有较低的左心室射血分数(P<0.05)、较厚的室间隔(P<0.01)和较大左心房内径(P<0.01)。左心房应变受损的患者三个应变指标均降低(均P<0.01)。多变量Logistic回归分析显示LDL-C、血脂综合指数、BMI和LVEF与左心房应变受损独立相关,Pearson线性相关分析分析显示血脂综合指数与左心房应变率参数呈正相关。结论 在高血压患者中,血脂水平中总胆固醇和LDLC与左心房机械功能受损呈独立相关。

心脏超声斑点成像技术对冠状动脉粥样硬化性心脏病的诊断价值分析

目的探讨三维超声斑点追踪成像技术(3D-STI)对冠状动脉粥样硬化性心脏病(CHD)的诊断价值。方法选取我院疑似CHD的患者128例,患者均采用三维超声心动图进行检查,获取心脏的三维全容积动态图,并以3D-STI对心脏三维全容积动态图进行分析。根据冠状动脉造影的检查结果将患者分成正常组、轻度组、中度组及重度组,比较各组患者的年龄、性别、左心房内径(LAD)、左心室舒张末期内径(LVEDD)、舒张期室间隔厚度(IVST)、左心室心肌质量(LV_(mass))、左心室射血分数(LVEF)及三维LVEF(3D-LVEF),测量各组患者左心室整体长轴收缩期峰值应变(GLS)、左心室整体圆周收缩期峰值应变(GCS)、左心室整体径向收缩期峰值应变(GRS)、左心室整体面积收缩期峰值应变(GAS)、GAS变化率(GAS rate)及三维左心室整体应变(3D-Strain),并分析3D-STI各参数对CHD的诊断价值。结果128例患者中,27例冠状动脉正常(正常组)、32例冠状动脉轻度狭窄(轻度组)、37例冠状动脉中度狭窄(中度组)、32例冠状动脉重度狭窄(重度组)。重度组患者的LVEDD显著大于其他3组(P<0.05),LVEF和3D-LVEF显著低于其他3组(P<0.05),LV_(mass)显著大于轻度组和正常组(P<0.05)。各组患者GAS rate比较,差异无统计学意义(P>0.05)。重度组患者的各项3D-STI参数明显低于其他3组(P<0.05);中度组患者的GRS、GLS、GAS、GCS及3D-Strain均低于正常组和轻度组(P<0.05)。以冠状动脉造影检查结果作为CHD诊断的金标准,通过各项3D-STI参数对中度组及重度组患者进行CHD预测,并建立ROC曲线,结果显示,中度组患者的3D-Strain、GAS、GLS、GCS、GRS的曲线下面积(AUC)分别为0.954、0.657、0.890、0.938、0.940,重度组患者的3D-Strain、GAS、GLS、GCS、GRS的AUC分别为0.975、0.839、0.932、0.970、0.978;与中度组相比,重度组患者3D-Strain、GAS、GLS、GCS、GRS对应的AUC稍高。结论3D-STI可作为CHD患者左心室冠状动脉狭窄的诊断方法,尤其对中重度狭窄患者具有极高的诊断价值,且具有重复性、无创、方便等优势,可为临床CHD患者的冠状动脉狭窄的诊断提供可靠依据。

三维动态心脏模型评估射血分数保留的心力衰竭患者左心房容积和功能的价值

目的:以心脏磁共振成像(CMR)为金标准,探讨三维动态心脏模型(DHM)评估射血分数保留的心力衰竭(HFpEF)患者左心房容积和功能的价值。方法:前瞻性选取2020年9月至2021年11月因气促、胸闷、乏力、运动耐量下降就诊于中国医学科学院阜外医院患者96例,并根据HFA-PEFF评分分为HFpEF组(HFA-PEFF≥5分,n=36)与对照组(HFA-PEFF评分≤4分,n=60)。使用二维超声心动图(2DE)、DHM、CMR检查两组患者左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房射血分数(LAEF)三个参数,并比较2DE、DHM单个心动周期测值(DHM_s)和DHM自动测量的多个心动周期测值的均值(DHM_ave)与CMR所测上述参数的差异,及相关性和一致性,并评价DHM技术的重复性。结果:HFpEF组和对照组2DE所测的LAVmax、LAVmin均低于同组CMR测值,2DE所测的LAEF均高于同组CMR测值,DHM所测的LAVmin均低于同组CMR的测值,差异具有统计学意义(P均<0.01)。在对照组,DHM与CMR所测的LAVmax、LAVmin中度相关(r值0.706~0.764,P均<0.01),在HFpEF组高度相关(r值0.834~0.914,P均<0.01)。HFpEF组DHM_s与DHM_ave比CMR所测的LAVmax分别平均低估3.67 ml、2.94 ml,一致性界限(LOA)分别为-35.14~42.47 ml、-33.96~39.85 ml;DHM_ave与CMR所测的LAEF中度相关(r值为0.546,P<0.01),LOA为-24.22%~21.38%。DHM获得的左心房容积和LAEF重复性较好(组内相关系数为0.951~0.983,P均<0.05)。结论:DHM可准确快速测量左心房容积和功能,对HFpEF患者的心脏形态和功能的评估提供了新的方法。

超声心动图三维斑点追踪技术对乳腺癌曲妥珠单抗治疗中心脏毒性评估的应用

目的 探讨超声心动图三维斑点追踪技术对乳腺癌曲妥珠单抗治疗中心脏毒性评估的应用。方法 选取昆明医科大学第一附属医院2020年11月至2022年7月收治的应用曲妥珠单抗治疗乳腺癌患者65例,分别在治疗后3个月、6个月、9个月、12个月后给予常规超声心动图及三维斑点追踪技术(threedimensional speckle tracking technique,3D-STI),观察不同时间点的心脏指标参数的差异,包括左室射血分数(LVEF)、左房容积指数(LAVI)、二尖瓣舒张早期血流速度/二尖瓣环舒张早期移动速度(E/Em)、二尖瓣环舒张早期移动速度/二尖瓣环舒张晚期移动速度(Em/Am)、二尖瓣环收缩期移动速度(Sm)、二尖瓣舒张早期血流速度(E峰)、二尖瓣舒张晚期血流速度(A峰)、二尖瓣舒张早期环移动速度(Em)、二尖瓣舒张晚期环移动速度(Am)、左室扭转(LVtw)、左室整体纵向应变(GLS)、整体环周应变(GCS)、整体径向应变(GRS)、整体面积应变(GAS)指标。结果 治疗后3个月、6个月、9个月、12个月相关参数和治疗前相比,LAVI、E/Em、Am有所升高,Em/Am和Em有所下降,LAVI和E/Em之间呈正相关性;与治疗前相比,治疗后3个月、6个月、9个月、12个月的LVEF、GLS、GRS、LVtw、GCS、GAS均有所下降(P <0.05)。结论 乳腺癌患者应用曲妥珠单抗治疗时应用超声心动图三维斑点追踪技术效果理想,可以早期、准确对心脏毒性情况进行判断,可以为早期治疗提供参考依据,改善预后、临床结局方面价值显著。

二维超声斑点追踪成像技术评价冠心病患者冠脉旁路移植术后心肌功能的临床价值

目的探讨二维超声斑点追踪成像技术定量评价冠状动脉旁路移植术(CABG)患者术前、术后心肌功能的临床价值。方法将拟行CABG的冠状动脉粥样硬化性心脏病(CHD)患者32例作为研究人群分为两组,60岁以上为老年组18例,60岁以下为中年组14例。同时,随机选择20例门诊健康体检者作为对照组。全部患者分别于术前1周及术后1、3、6月行常规超声心动图检查,然后应用二维斑点追踪技术进行分析,通过检测心脏左心室室壁各节段的纵向应变值分析超声心动图一般参数和心肌应变测量值,以比较各组患者心脏左心室局部及整体心肌收缩功能相关指标的变化。结果对照组与两亚组术前基线资料、超声心动图常规参数差异均无统计学意义。与对照组比较,CHD患者CABG术前及术后心脏运动纵向应变值比较均有差异显著(P<0.05)。在CABG各组患者中,与术前比较,CHD患者术后1月心脏运动纵向应变值均差异不显著;患者术后3、6月心脏运动纵向应变值均显著增高(P<0.05)。仅老年组术后6月心脏运动纵向应变值与术后3月比较显著增高(P<0.05)。结论斑点追踪技术可以定量评价CHD患者CABG治疗前后心肌收缩功能,辅助评价治疗效果及预后。

压力应变环参数评估类风湿关节炎患者的心肌做功

目的:应用压力应变环(PSL)参数评估类风湿关节炎(RA)患者左心室做功状况.方法:前瞻性选取扬州大学附属医院2021年5月-2022年2月确诊的RA患者90例,按病程≤1年、1~5年和>5年依次分为A组、B组和C组,每组30例,另以同期30名健康志愿者为对照组.对比分析各组传统超声心动图参数、整体心肌纵向应变(GLS)、左室整体心肌做功指数(LVGWI)、左室整体有用功(LVGCW)、左室整体无用功(LVGWW)和左室整体做功效率(LVGWE).结果:与对照组比较,A组LVGWW增加,LVGWE下降;B组和C组GLS绝对值、LVGWI、LVGCW、LVGWE明显下降,LVGWW明显升高,且差异均有统计学意义(均P<0.05).GLS绝对值、LVGWI、LVGCW、LVGWE按A组、B组、C组顺序逐渐降低,LVGWW按顺序逐渐增高,差异均有统计学意义(均P<0.05).GLS、LVGWI、LVGCW、LVGWW、LVGWE的组内相关系数(ICC)在医师内分别为0.947、0.959、0.911、0.957、0.904,医师间分别为0.906、0.953、0.908、0.922、0.871,医师内比医师间高,复测信度高.受试者工作特征曲线分析显示GLS、LVGWW的曲线下面积分别为0.858、0.957,可准确地用于RA患者左心室做功降低的诊断.结论:PSL能有效评估RA患者左心室心肌做功状况,为临床的诊断评估提供新的检测技术.

压力-应变环技术评估多种风湿免疫病患者的左心室做功状况

目的应用压力-应变环技术评估不同风湿免疫病患者的左心室做功状况。方法前瞻性选择于2021年4月~2022年11月于扬州大学附属医院确诊的风湿免疫病患者171例,按照疾病类别分为系统性红斑狼疮组30例、强直性脊柱炎组33例、干燥综合征组35例、类风湿关节炎组43例、痛风组30例,病程均≤5年;另选取同期健体检者32例为对照组。所有参与者均行常规超声心动图采集图像,线下ECHOPAC分析得出压力-应变环参数;分析各组之间常规参数及心肌做功之间的相关性,评估左室心肌做功状况。结果与对照组相比,风湿免疫疾病组的A值均增高、E/A比值均降低(P<0.05);系统性红斑狼疮组及干燥综合征组的E值降低,差异有统计学意义(P<0.05)。所有风湿免疫疾病组的整体无效做功高于对照组,整体做功效率低于对照组(P<0.05);系统性红斑狼疮组及强直性脊柱炎组的整体纵向应变、整体做功指数、整体有效做功低于对照组,类风湿关节炎组的整体纵向应变、整体做功指数低于对照组,痛风组的整体做功指数低于对照组,差异有统计学意义(P<0.05)。风湿免疫疾病组的整体纵向应变绝对值、左室射血分数、E/A比值与整体做功指数、整体有效做功、整体做功效率之间呈正相关关系,与整体无效做功呈负相关关系(P<0.01)。结论压力-应变环能够有效评估风湿免疫病患者左心室心肌做功状况,将更客观的为临床提供新的诊断依据。

4DAutoVQ、3D-STI在老年慢性心力衰竭患者心功能评价中的应用研究

目的探讨四维超声自动左心房定量技术(Automatic left atrial quantification with four-dimensional ultrasound,4DAutoVQ)、三维斑点追踪成像技术(Three-dimensional speckle tracking imaging technology,3D-STI)在老年慢性心力衰竭(Chronic heart failure,CHF)患者心功能评价中的应用价值。方法选取2020年1月至2022年4月重庆大学附属沙坪坝医院重庆市沙坪坝区人民医院心血管内科收治的老年CHF患者167例设为研究组,另选取同期健康体检者167例设为对照组。采集两组受检者性别、年龄、体质量指数(Body mass index,BMI)、舒张压、收缩压、研究组美国纽约心脏病学会(New York Heart Association,NYHA)分级等资料,实施3D-STI、4DAutoVQ检查。比较研究组与对照组、研究组不同NYHA分级患者4DAutoVQ、3D-STI参数,分析4DAutoVQ、3D-STI参数与研究组NYHA分级的关联性。结果(1)研究组左心室整体径向收缩期峰值应变(Global radial systolic peak strain of left ventricle,GRS)、整体环向收缩期峰值应变(Global circumferential peak systolic strain,GCS)、整体纵向收缩期峰值应变(Overall longitudinal peak systolic strain,GLS)、左房排空容积(Left atrial emptying volume,LAEV)、左房射血分数(Left atrial ejection fraction,LAEF)、左房被动射血分数(Left atrial passive ejection fraction,LAPEF)、左房主动射血分数(Left atrial active ejection fraction,LAAEF)、左房储备期纵向应变(Longitudinal strain of left atrial reserve,LASr)、左房储备期圆周应变(Peripheral strain of left atrial reserve period,LASr-c)低于对照组,左房最大容积指数(Maximum left atrial volume index,LAVImax)、左房最小容积(Minimum left atrial volume,LAVmin)、左房收缩前容积(Left atrial pre systolic volume,LAVpreA)、左房最大容积(Maximum left atrial volume,LAVmax)、左房通道期纵向应变(Longitudinal strain of left atrial passage,LAScd)、左房收缩期纵向应变(Longitudinal strain of left atrium during systole,LASct)、左房收缩期圆周应变(Left atrial systolic circumferential strain,LASct-c)、左房通道期圆周应变(Circumferential strain of left atrial passage,LAScd-c)高于对照组,差异有统计学意义(P<0.05)。(2)研究组不同NYHA分级患者4DAutoVQ、3D-STI参数比较,差异有统计学意义(P<0.05),且随着NYHA分级增高,GRS、GCS、GLS、LAEV、LAEF、LAPEF、LAAEF、LASr、LASr-c呈降低趋势,LAVImax、LAVmin、LAVpreA、LAVmax、LAScd、LASct、LASct-c、LAScd-c呈增高趋势,差异有统计学意义(P<0.05)。(3)Spearman相关性分析结果显示,GRS、GCS、GLS、LAEV、LAEF、LAPEF、LAAEF、LASr、LASr-c与CHF病情分级存在负相关关系,LAVImax、LAVmin、LAVpreA、LAVmax、LAScd、LASct、LASct-c、LAScd-c与CHF病情分级存在显著正相关关系(P<0.05)。(4)Logistic分析结果显示,GRS、GCS、GLS、LAEV、LAEF、LAPEF、LAAEF、LASr、LASr-c、LAVImax、LAVmin、LAVpreA、LAVmax、LAScd、LASct、LASct-c、LAScd-c均是CHF重要影响因素(P<0.05)。结论通过4DAutoVQ、3D-STI检查可评估老年CHF患者心功能及结构状态,相关参数增高或降低程度与疾病病情关系密切,可评估疾病NYHA分级。

三维斑点追踪技术评价高血压患者左室功能与升主动脉弹性之间的关系

目的:应用三维斑点追踪成像技术(3D-STI)评价原发性高血压患者左室收缩功能的变化,并分析其与升主动脉弹性之间的相关性。方法:选取2022年10月—2023年3月于宜昌市中心人民医院就诊的70例原发性高血压患者作为研究对象(高血压组),43例健康体检者作为对照组。应用3D-STI获取左室功能参数,包括整体纵向应变(GLS)、环向应变(GCS)、径向应变(GRS)、扭转角度峰值(LVPtw)、收缩不同步指数(SDI)以及扭矩(Torsion)。应用M型超声获取升主动脉弹性参数,即升主动脉应变(AS)、僵硬指数(ASI)、顺应性(AC)、扩张性(ADIS)和压力-应变弹性系数(AEp)。比较上述参数在两组之间差异并采用Spearman法比较高血压组患者左室功能与升主动脉弹性间相关性。结果:与对照组比较,高血压组GLS、GCS、GRS、AS、ADIS和AC均明显降低(均P<0.05),LVPtw、SDI、Torsion、ASI及AEp均显著增高(均P<0.05)。相关性分析显示,高血压组患者LVPtw、Torsion与AS、ADIS和AC呈负相关,与ASI和AEp呈正相关(均P<0.05);SDI与AS和ADIS呈负相关,与ASI和AEp呈正相关(均P<0.05)。结论:三维斑点追踪技术可评价原发性高血压患者左室收缩功能的变化,左室扭转运动的增加及心肌运动不同步与升主动脉弹性的降低有一定相关性。

TTE联合3D-STI评价启闭功能正常的BAV患者升主动脉弹性与左室收缩功能

目的应用经胸超声心动图(TTE)联合三维斑点追踪成像技术(3D-STI)评价启闭功能正常的主动脉瓣二叶式畸形(BAV)患者升主动脉弹性与左室收缩功能并探讨两者之间的相关性。方法选取启闭功能正常的BAV患者60例,正常人60例为对照组。常规采用经胸超声心动图测量升主动脉收缩末期(AoS)及舒张末期内径(AoD)、室间隔舒张末期(IVSD)及左室后壁舒张末期厚度(LVPWD)、左室射血分数(LVEF)等参数,公式计算升主动脉应变(Aortic strain)、升主动脉僵硬指数(AoSI)、升主动脉扩张性(AoDIS);应用三维斑点追踪成像技术获取左室整体纵向应变(GLS)、左室整体圆周应变(GCS)、左室整体径向应变(GRS),比较BAV组与对照组各参数的差异,探求BAV组升主动脉弹性与左室收缩功能的关联性。结果BAV组AoS、AoD、AoSI值高于对照组,Aortic strain、AoDIS值低于对照组(P<0.05),LVEF值差异无统计学意义(P>0.05);GLS、GCS和GRS与对照组比较明显减低(P<0.05)。BAV组左室GLS、GCS、GRS与Aortic strain、AoSI、AoDIS无相关性。结论启闭功能正常的BAV患者升主动脉弹性与左室收缩功能均减低,两者之间无明显相关性。