中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2014年
9期
726-731
,共6页
闫晓君%董珊珊%陈少泽%黄磊%刘奎灿%芦桂林
閆曉君%董珊珊%陳少澤%黃磊%劉奎燦%蘆桂林
염효군%동산산%진소택%황뢰%류규찬%호계림
超声心动描记术%心力衰竭%心室功能,左
超聲心動描記術%心力衰竭%心室功能,左
초성심동묘기술%심력쇠갈%심실공능,좌
Echocardiography%Heart failure%Ventricular function,left
目的：探讨慢性心衰患者的左心室旋转、扭转运动及Tei指数与左心室功能的关系，为临床检测慢性心衰患者心肌运动力学特征及左心室功能提供可靠的指标。方法选取慢性心衰患者79例（心功能Ⅱ级32例，心功能Ⅲ级26例，心功能Ⅳ级21例），健康对照者28名。采用二维斑点追踪技术和常规超声心动图检查，采集心尖四腔心切面二尖瓣环组织多普勒频谱、左心室心底水平和心尖水平二维图像，测量并计算慢性心衰患者与健康对照者左心室整体扭转角度、短轴切面各节段室壁旋转角度、Tei指数，分析上述指标在各组间的差异性及其之间的相关性。结果（1）Tei指数在健康对照组、心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组分别为0.33±0.19、0.37±0.18、0.46±0.31、0.49±0.33，各组间比较差异有统计学意义（χ2=88.31，P＜0.01），且Tei指数随心功能降低，逐渐增大。（2）左心室整体扭转角度在健康对照组、心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组分别为（12.89±2.65）、（12.29±1.94）、（12.38±2.13）、（8.46±2.90）度，各组间比较差异有统计学意义（F=25.99，P＜0.01），心功能Ⅳ级组与健康对照组、心功能Ⅱ级组、心功能Ⅲ级组两两比较，差异均有统计学意义（q=6.43、5.71、4.17，P均＜0.05）。（3）健康对照组及心功能Ⅱ~Ⅳ级组受检者左心室心底水平各节段室壁的旋转角度间差异均有统计学意义（F=9.51、9.47、7.41、10.27、9.42、11.34，P均＜0.01）。心底水平各节段室壁的旋转角度与Tei指数呈正相关（r=0.327、0.277、0.266、0.321、0.306、0.325，P均＜0.01），且前壁相关性最好。（4）4组受检者左心室心尖水平各节段室壁的旋转角度间差异均有统计学意义（F=6.17、3.49、3.46、3.50、3.48、2.81，P均＜0.01）。心尖水平各节段室壁的旋转角度与Tei指数呈负相关（r=-0.362、-0.278、-0.251、-0.279、-0.290、-0.288， P均＜0.01），且前壁相关性最好。（5）左心室整体扭转角度与Tei指数呈负相关（r=-0.443，P＜0.01），直线相关方程：左心室整体扭转角度=-18.30 Tei指数+18.89。结论慢性心衰患者左心室整体扭转角度、短轴切面各节段室壁的旋转角度减小，而Tei指数增大。左心室整体扭转角度与Tei指数呈负相关。二维斑点追踪技术与Tei指数可以对慢性心衰患者左心室力学运动的改变和左心室功能进行评价。
目的：探討慢性心衰患者的左心室鏇轉、扭轉運動及Tei指數與左心室功能的關繫，為臨床檢測慢性心衰患者心肌運動力學特徵及左心室功能提供可靠的指標。方法選取慢性心衰患者79例（心功能Ⅱ級32例，心功能Ⅲ級26例，心功能Ⅳ級21例），健康對照者28名。採用二維斑點追蹤技術和常規超聲心動圖檢查，採集心尖四腔心切麵二尖瓣環組織多普勒頻譜、左心室心底水平和心尖水平二維圖像，測量併計算慢性心衰患者與健康對照者左心室整體扭轉角度、短軸切麵各節段室壁鏇轉角度、Tei指數，分析上述指標在各組間的差異性及其之間的相關性。結果（1）Tei指數在健康對照組、心功能Ⅱ級組、心功能Ⅲ級組、心功能Ⅳ級組分彆為0.33±0.19、0.37±0.18、0.46±0.31、0.49±0.33，各組間比較差異有統計學意義（χ2=88.31，P＜0.01），且Tei指數隨心功能降低，逐漸增大。（2）左心室整體扭轉角度在健康對照組、心功能Ⅱ級組、心功能Ⅲ級組、心功能Ⅳ級組分彆為（12.89±2.65）、（12.29±1.94）、（12.38±2.13）、（8.46±2.90）度，各組間比較差異有統計學意義（F=25.99，P＜0.01），心功能Ⅳ級組與健康對照組、心功能Ⅱ級組、心功能Ⅲ級組兩兩比較，差異均有統計學意義（q=6.43、5.71、4.17，P均＜0.05）。（3）健康對照組及心功能Ⅱ~Ⅳ級組受檢者左心室心底水平各節段室壁的鏇轉角度間差異均有統計學意義（F=9.51、9.47、7.41、10.27、9.42、11.34，P均＜0.01）。心底水平各節段室壁的鏇轉角度與Tei指數呈正相關（r=0.327、0.277、0.266、0.321、0.306、0.325，P均＜0.01），且前壁相關性最好。（4）4組受檢者左心室心尖水平各節段室壁的鏇轉角度間差異均有統計學意義（F=6.17、3.49、3.46、3.50、3.48、2.81，P均＜0.01）。心尖水平各節段室壁的鏇轉角度與Tei指數呈負相關（r=-0.362、-0.278、-0.251、-0.279、-0.290、-0.288， P均＜0.01），且前壁相關性最好。（5）左心室整體扭轉角度與Tei指數呈負相關（r=-0.443，P＜0.01），直線相關方程：左心室整體扭轉角度=-18.30 Tei指數+18.89。結論慢性心衰患者左心室整體扭轉角度、短軸切麵各節段室壁的鏇轉角度減小，而Tei指數增大。左心室整體扭轉角度與Tei指數呈負相關。二維斑點追蹤技術與Tei指數可以對慢性心衰患者左心室力學運動的改變和左心室功能進行評價。
목적：탐토만성심쇠환자적좌심실선전、뉴전운동급Tei지수여좌심실공능적관계，위림상검측만성심쇠환자심기운동역학특정급좌심실공능제공가고적지표。방법선취만성심쇠환자79례（심공능Ⅱ급32례，심공능Ⅲ급26례，심공능Ⅳ급21례），건강대조자28명。채용이유반점추종기술화상규초성심동도검사，채집심첨사강심절면이첨판배조직다보륵빈보、좌심실심저수평화심첨수평이유도상，측량병계산만성심쇠환자여건강대조자좌심실정체뉴전각도、단축절면각절단실벽선전각도、Tei지수，분석상술지표재각조간적차이성급기지간적상관성。결과（1）Tei지수재건강대조조、심공능Ⅱ급조、심공능Ⅲ급조、심공능Ⅳ급조분별위0.33±0.19、0.37±0.18、0.46±0.31、0.49±0.33，각조간비교차이유통계학의의（χ2=88.31，P＜0.01），차Tei지수수심공능강저，축점증대。（2）좌심실정체뉴전각도재건강대조조、심공능Ⅱ급조、심공능Ⅲ급조、심공능Ⅳ급조분별위（12.89±2.65）、（12.29±1.94）、（12.38±2.13）、（8.46±2.90）도，각조간비교차이유통계학의의（F=25.99，P＜0.01），심공능Ⅳ급조여건강대조조、심공능Ⅱ급조、심공능Ⅲ급조량량비교，차이균유통계학의의（q=6.43、5.71、4.17，P균＜0.05）。（3）건강대조조급심공능Ⅱ~Ⅳ급조수검자좌심실심저수평각절단실벽적선전각도간차이균유통계학의의（F=9.51、9.47、7.41、10.27、9.42、11.34，P균＜0.01）。심저수평각절단실벽적선전각도여Tei지수정정상관（r=0.327、0.277、0.266、0.321、0.306、0.325，P균＜0.01），차전벽상관성최호。（4）4조수검자좌심실심첨수평각절단실벽적선전각도간차이균유통계학의의（F=6.17、3.49、3.46、3.50、3.48、2.81，P균＜0.01）。심첨수평각절단실벽적선전각도여Tei지수정부상관（r=-0.362、-0.278、-0.251、-0.279、-0.290、-0.288， P균＜0.01），차전벽상관성최호。（5）좌심실정체뉴전각도여Tei지수정부상관（r=-0.443，P＜0.01），직선상관방정：좌심실정체뉴전각도=-18.30 Tei지수+18.89。결론만성심쇠환자좌심실정체뉴전각도、단축절면각절단실벽적선전각도감소，이Tei지수증대。좌심실정체뉴전각도여Tei지수정부상관。이유반점추종기술여Tei지수가이대만성심쇠환자좌심실역학운동적개변화좌심실공능진행평개。
Objective To explore the relationship among the left ventricular rotation and twist, Tei index and left ventricular function in chronic heart failure patients and provide reliable indicator of chronic heart left ventricular myocardial function and mechanical movement. Methods Seventy-nine chronic heart failure patients with cardiac function classⅡ(32 cases), cardiac function classⅢ(26 cases) and cardiac function classⅣ(21 cases) and 28 healthy volunteer were included. All subjects underwent conventional echocardiography and two dimensional-speckle tracking imaging. The mitral annulus tissue Doppler spectrums at apical four chambers view, two-dimensional images of left ventricle at basal and apical level were acquired. The left ventricular twist, segmental rotation at short axis view and Tei index were measured. The differences were compared and the correlations were analyzed. Results (1) There were signiifcant differences for Tei index among the four group (χ2=88.31, P<0.01). The Tei index of healthy control group and chronic heart failure patients with cardiac function class Ⅱ , class Ⅲand class Ⅳwere 0.33±0.19, 0.37±0.18, 0.46±0.31 and 0.49±0.33. The Tei index gradually increased when the heart function decreased. (2) The left ventricular twist were also signiifcantly different among the four groups (F=25.99, P<0.01). The left ventricular twist of healthy control group and chronic heart failure patients with cardiac function classⅡ, classⅢ and classⅣwere (12.89±2.65)°, (12.29±1.94)°, (12.38±2.13)° and (8.46±2.90)°. The left ventricular twist gradually decreased when the heart function decreased. The differences between chronic heart failure patients with cardiac function classⅣand healthy control group, chronic heart failure patients with cardiac function classⅡand classⅢwere signiifcant (q=6.43, 5.71 and 4.17, all P<0.05). (3) The left ventricular segmental rotations at basal level were significantly different among healthy control group and chronic heart failure patients with cardiac function classⅡ,ⅢandⅣ(F=9.51, 9.47, 7.41, 10.27, 9.42 and 11.34, all P<0.01 ). The left ventricular segmental rotations were positively correlated with Tei index and the segmental rotation of anterior wall was most correlated with Tei index (r=0.327, 0.277, 0.266, 0.321, 0.306 and 0.325, all P<0.01). (4) The left ventricular segmental rotations at apical level were signiifcantly different among four groups (F=6.17, 3.49, 3.46, 3.50, 3.48 and 2.81, all P<0.01). The left ventricular segmental rotations were negatively correlated with Tei index and the segmental rotation of anterior wall was most correlated with Tei index (r=-0.362,-0.278,-0.251,-0.279,-0.290 and-0.288, all P<0.01). (5) The left ventricular twist and Tei index were negatively correlated (r=-0.443, P<0.01). Conclusions The left ventricular twist and segmental rotation at short axis view in patients with chronic heart failure decreased and Tei index gradually increased. The left ventricular twist and Tei index were negatively correlated. The combination of two-dimensional speckle tracking technology and Tei index could achieve noninvasive assessment of left ventricular mechanical movement and left heart function in chronic heart failure patients.
