切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (04) : 320 -326. doi: 10.3877/cma.j.issn.1672-6448.2020.04.006

所属专题: 文献

心血管超声影像学

冠状动脉慢血流患者左心室旋转及扭转运动特征与心肌血流灌注的相关性分析
张贺彬1, 高枫1, 郑哲岚2,(), 王晓嫚1, 于妲1, 杨寸芯1, 王明伟3   
  1. 1. 310015 杭州师范大学附属医院超声科
    2. 310003 杭州,浙江大学附属第一医院心血管超声中心
    3. 310015 杭州师范大学附属医院心血管内科
  • 收稿日期:2019-06-09 出版日期:2020-04-01
  • 通信作者: 郑哲岚
  • 基金资助:
    浙江省医药卫生科技计划项目(2018KY591); 杭州市卫生计生科技计划项目(2018A27)

Characteristics of left ventricular rotation and twist and their correlation with myocardial perfusion in patients with coronary slow flow

Hebin Zhang1, Feng Gao1, Zhelan Zheng2,(), Xiaoman Wang1, Da Yu1, Cunxin Yang1, Mingwei Wang3   

  1. 1. Department of Ultrasonography, the Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
    2. Echocardiography and Vascular Ultrasound Center, the First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
    3. Department of Cardiovascular Medicine, the Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
  • Received:2019-06-09 Published:2020-04-01
  • Corresponding author: Zhelan Zheng
  • About author:
    Corresponding author: Zheng Zhelan, Email:
引用本文:

张贺彬, 高枫, 郑哲岚, 王晓嫚, 于妲, 杨寸芯, 王明伟. 冠状动脉慢血流患者左心室旋转及扭转运动特征与心肌血流灌注的相关性分析[J/OL]. 中华医学超声杂志(电子版), 2020, 17(04): 320-326.

Hebin Zhang, Feng Gao, Zhelan Zheng, Xiaoman Wang, Da Yu, Cunxin Yang, Mingwei Wang. Characteristics of left ventricular rotation and twist and their correlation with myocardial perfusion in patients with coronary slow flow[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(04): 320-326.

目的

应用多巴酚丁胺负荷实时心肌造影超声心动图(RTMCE)结合二维斑点追踪(STE)技术评价冠状动脉慢血流(CSF)患者的心肌血流灌注及左心室旋转、扭转运动特征,并进一步分析二者之间的相关性。

方法

选取2017年1月至2019年3月杭州师范大学附属医院因胸痛行冠状动脉造影的患者54例,冠状动脉造影结果为CSF的患者33例为CSF组,结果正常者21例为对照组。应用二维超声测量常规参数,双平面Simpson法获得左心室舒张末容积(LVEDV)及左心室射血分数(LVEF),应用STE技术测量左心室基底水平旋转角度峰值(R心底)、旋转达峰时间(TPR心底)和左心室心尖水平旋转角度峰值(R心尖)、旋转达峰时间(TPR心尖),并获取左心室扭转角度峰值(LVTW)及旋转延迟时间(RDD)。对所有受试者进行多巴酚丁胺负荷试验,在静息和多巴酚丁胺负荷状态下行RTMCE检查,定量分析得出心肌血容量(A值)、心肌血流速率(β值)、心肌血流量(MBF),并获得心肌血流储备(MFR)。采用Pearson相关分析CSF患者左心室旋转、扭转与心肌血流灌注相关参数之间的相关性。

结果

2组受检者LVEDV、LVEF差异均无统计学意义;与对照组比较,CSF组患者R心尖、LVTW、RDD减小,TPR心尖增大,差异有统计学意义(U=2.707,t=-2.379、-4.988、2.422;P均<0.05)。与对照组比较,静息时CSF组患者β值减小,差异有统计学意义(t=-2.218,P<0.05);负荷状态下β值、MBF减小,差异有统计学意义(t=-3.791、-2.612,P均<0.05);CSF组患者MFR较对照组减小,差异有统计学意义(t=-2.585,P<0.05)。Pearson相关分析表明静息时CSF患者R心尖、LVTW分别与MBF存在相关性(r=0.502、0.462,P均<0.05);负荷状态下R心尖、LVTW分别与MBF存在相关性(r=0.436、0.368,P=0.009、0.035)。

结论

CSF患者存在心肌微循环障碍,其R心尖、LVTW降低,心肌微循环障碍可能是左心室旋转及扭转运动减低的主要决定因素之一。

Objective

To analyze the changes of myocardial perfusion and the characteristics of left ventricular (LV) rotation and LV twist (LVTW) in patients with coronary slow flow (CSF), and to assess the relationship between them by using dobutamine stress real-time myocardial contrast echocardiography (RTMCE) and speckle tracking echocardiography (STE).

Methods

A total of 54 patients who underwent coronary angiography for angina were enrolled at the Affiliated Hospital of Hangzhou Normal University, of whom 33 with CSF were included as a CSF group and 21 with normal coronary angiography findings were included as a control group. After conventional echocardiography, LV end diastolic volume (LVEDV) and LV ejection fraction (LVEF) were measured by the biplane Simpson method. And basal and apical rotation of the LV (Rbasal and Rapical) were calculated via Qlab10.4 analysis software offline, the time to basal and apical peak rotation of the LV (TPRbasal and TPRapical) were calculated through graphics semi-automatically, and LVTW and rotation deformation delay (RDD) were also calculated. RTMCE was performed from the apical 4-, 3-, and 2-chamber views at baseline and after dobutamine stress echocardiography, and parameters including myocardial blood volume (A), myocardial blood velocity (β), myocardial blood flow (MBF), and myocardial flow reserve (MFR) were obtained. The correlation between Rapical/LVTW and MBF/MFR was analyzed.

Results

LVEDV and LVEF had no significant difference between the two groups. Compared with the control group, Rapical, LVTW, and RDD significantly decreased and TPRapical significantly increased in CSF patients (U=2.707, t=-2.379, t=-4.988, and t=2.422, respectively; P<0.05). At baseline, the value of β in the CSF group was significantly lower than that in the control group (t=-2.218, P<0.05). After dobutamine stress test, patients with CSF showed significantly decreased β, MBF, and MFR (t=-3.791, -2.612, and -2.585, respectively; P<0.05) compared with the control group. Pearson correlation analysis revealed that Rapical and LVTW were correlated with MBF both at rest (r=0.502 and 0.462, respectively; P<0.05) and after dobutamine stress test (r=0.436 and 0.368, respectively; P<0.05).

Conclusion

Both Rapical and LVTW are impaired in CSF patients, and coronary microcirculation disorder could be an important contributor to the decrease of left ventricular rotation and twist motion.

图1 超声心动图左心室基底水平、心尖水平旋转角度-时间曲线。图a为基底水平曲线,图示收缩期基底水平各节段呈顺时针方向,峰值以负值表示;图b为心尖水平曲线,图示收缩期心尖水平各节段呈逆时针方向,峰值以正值表示
表1 对照组与CSF组一般临床资料及冠状动脉造影结果比较(±s
表2 对照组与CSF组常规超声心动图参数比较(±s
表3 对照组与CSF组左心室旋转、扭转参数比较(±s
图2 冠状动脉慢血流患者和正常对照者实时心肌超声造影声像图。图a为冠状动脉慢血流患者声像图,图示侧壁心肌灌注曲线低平;图b为正常对照者声像图,图示各节段心肌灌注曲线正常
表4 对照组与CSF组心肌血流灌注参数比较(±s
图3 静息时冠状动脉慢血流患者左心室心尖水平旋转角度峰值与心肌血流量的相关性分析散点图
图4 静息时冠状动脉慢血流患者左心室扭转角度峰值与心肌血流量的相关性分析散点图
图5 负荷状态下冠状动脉慢血流患者左心室心尖水平旋转角度峰值与心肌血流量的相关性分析散点图
图6 负荷状态下冠状动脉慢血流患者左心室扭转角度峰值与心肌血流量的相关性分析散点图
1
Hamidreza S, Reza K, Farshad S, et al. Coronary slow flow phenomenon: clinical findings and predictors [J]. Res Cardiovasc Med, 2016, 5(1): e30296.
2
中华医学会超声医学分会超声心动图学组. 中国心血管超声造影增强检查专家共识[J/CD]. 中华医学超声杂志(电子版), 2015, 12(9): 667-680.
3
邢雨蒙, 孔德红, 陆永乐, 等. 实时心肌造影定量评价冠状动脉慢血流患者心肌血流灌注[J]. 中华超声影像学杂志, 2018, 27(4): 277-281.
4
Porter TR, Mulvaqh SL, Abdelmoneim SS, et al. Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography guidelines update [J]. J Am Soc Echocardiogr, 2018, 31(3): 241-274.
5
张贺彬, 郑哲岚, 高枫, 等. 冠状动脉慢血流患者心肌微循环与左心室纵向收缩功能的相关性研究 [J]. 中华超声影像学杂志, 2017, 26(4): 661-666.
6
Gulel O, Akcay M, Soylu K, et al. Left ventricular myocardial deformation parameters are affected by coronary slow flow phenomenon:a study of speckle tracking echocardiography [J]. Echocardiography, 2016, 33(5): 714-723.
7
Pokharel P, Yoon AJ, Bella JN. Noninvasive measurement and clinical relevance of myocardial twist and torsion [J]. Expert Rev Cardiovasc Ther, 2014, 12(11): 1305-1315.
8
韩勇, 陈明, 曲俊朴, 等. 斑点追踪技术检测乳腺癌术后化疗药物对心肌的毒性作用[J/CD]. 中华医学超声杂志(电子版), 2014, 11(5): 397-402.
9
Stöhret EJ, Shave RE, Baggish AL, et al. Left ventricular twist mechanic in the context of normal physiology and cardiovascular disease:a review of studies using speckle tracking echocardiography [J]. Am J Physiol Heart Circ Physiol, 2016, 311(3): H633- H644.
10
柯茜茜, 黎春雷, 王晨阳, 等. 二维斑点追踪技术评价慢性肾病患者左心室扭转运动[J/CD]. 中华医学超声杂志(电子版), 2015, 12(12): 929-933.
11
Foley JRJ, Swoboda PP, Fent GJ, et al. Quantitative deformation analysis differentiates ischaemic and nonischaemic cardiomyopathy: sub-group analysis of the VINDICATE trial [J]. Eur Heart J Cardiovasc Imaging, 2018, 19(7): 816-823.
12
Chen C, Wei J, AlBadri A, et al. Coronary microvascular dysfunction epidemiology,pathogenesis,prognosis, diagnosis, risk factors and therapy [J]. Circ J, 2016, 81(1): 3-11.
13
邢雨蒙, 史静, 颜彦, 等. 二维斑点追踪技术评价冠状动脉慢血流患者左室心肌分层应变 [J]. 复旦学报(医学版), 2018, 45(4): 467-472.
14
Zhou W, Benharash P, Ho J, et al. Left ventricular twist and untwist rate provide reliable measures of ventricular function in myocardial ischemia and a wide range of hemodynamic states [J]. Physiol Rep, 2013(5): e00110.
15
Pagourelias ED, Sotiriou P, Papadopoulos CE, et al. Left ventricular myocardial mechanics in cirrhosis: a speckle tracking echocardio-graphic study [J]. Echocardiography, 2016, 33(2): 223-232.
[1] 杜祖升, 赵博文, 张帧, 潘美, 彭晓慧, 陈冉, 毛彦恺. 应用二维斑点追踪成像技术评估孕周及心尖方向对中晚孕期正常胎儿左心房应变的影响[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 843-851.
[2] 张商迪, 赵博文, 潘美, 彭晓慧, 陈冉, 毛彦恺, 陈阳, 袁华, 陈燕. 中晚孕期胎儿心房内径定量评估心房比例失调胎儿心脏畸形的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 785-793.
[3] 王水清, 赵博文, 潘美, 彭晓慧, 陈冉, 马明明, 狄敏. 16~40周正常胎儿左心房后间隙指数及其Z评分的定量研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 460-469.
[4] 马琳, 彭驰涵, 朱晓霞, 范红霞, 杨家丽, 罗燕. 超声造影定量评估大鼠70%肝切除后不同类型门静脉狭窄残肝微循环灌注的实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(01): 83-89.
[5] 李文秀, 杨爽, 吴江, 耿斌, 苏俊武. 二维经胸超声心动图诊断小儿二尖瓣裂的价值[J/OL]. 中华医学超声杂志(电子版), 2023, 20(11): 1186-1192.
[6] 张婉微, 秦芸芸, 蔡绮哲, 林明明, 田润雨, 金姗, 吕秀章. 心肌收缩早期延长对非ST段抬高型急性冠脉综合征患者冠状动脉严重狭窄的预测价值[J/OL]. 中华医学超声杂志(电子版), 2023, 20(10): 1016-1022.
[7] 任书堂, 刘晓程, 张亚东, 孙佳英, 陈萍, 周建华, 龙进, 黄云洲. 左心室辅助装置支持下单纯收缩期主动脉瓣反流的超声心动图特征[J/OL]. 中华医学超声杂志(电子版), 2023, 20(10): 1023-1028.
[8] 孙佳英, 黄云洲, 任书堂, 王翠华, 陈新华, 于艾嘉, 陈元禄. 无创心肌做功对左束支传导阻滞患者左心室整体及节段心肌收缩功能的评价[J/OL]. 中华医学超声杂志(电子版), 2023, 20(08): 836-843.
[9] 鲁梦远, 赵学刚, 郝嘉文, 盖晨阳, 李聪颖, 张晶, 张庆富. 高压电烧伤大鼠肝脏氧化应激损伤及灯盏花素的干预作用[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(02): 113-118.
[10] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[11] 胡小靖, 张华. 妊娠期卵巢囊肿蒂扭转的诊断与治疗[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 197-201.
[12] 储慧民, 杜先锋. 心腔内超声心动图指导左心耳封堵的规范化标准流程[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 1-5.
[13] 储慧民. 心腔内超声心动图指导下的左心耳封堵术标准流程解析[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 58-58.
[14] 黄锦, 温静, 李佳霖, 韩丹, 刘翠华, 杨殿辉, 张洋洋. 双联抗血小板药物对溃疡性结肠炎患者的影响及处理策略[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(03): 195-199.
[15] 王梦欣, 李莫凡, 王淑敏. 脑微循环成像技术在脑小血管病中的应用研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(03): 281-284.
阅读次数
全文


摘要