CAJ | 학술논문

目的应用超声血流向量成像(VFM)技术评价梗阻性与非梗阻性肥厚型心肌病(HCM)患者左心室血流流场特点,比较二者的血流动力学状态.方法随机选取HCM患者40例为病例组,根据有无梗阻将其分为梗阻组(Ⅰ组)和非梗阻组(Ⅱ组);健康志愿者40例为对照组.测量常规超声心动图参数及VFM参数收缩期总负向流量(SQ-)、收缩期峰值流速(Vs)、峰值流量(Fs)等,比较三组间各参数的差异,并将Ⅰ、Ⅱ组间差异有统计学意义的VFM参数与左室流出道(LVOT)中间段梗阻处的压差做相关性分析.结果与对照组比较,病例组室间隔厚度、LVOT中间段流速及压差均明显增加(P＜0.05),三组间左室射血分数差异无统计学意义(P＞0.05);与对照组比较,病例组基底段SQ-绝对值降低,中间段和心尖段SQ-绝对值增加,基底段、中间段及心尖段Vs及Fs绝对值增加,涡流圈数与强度明显增加,涡流直径明显增大,差异均有统计学意义(P＜0.05).与Ⅱ组比较,Ⅰ组基底段和心尖段SQ-绝对值减小,中间段SQ-及各节段Vs和Fs绝对值增加,涡流圈数和涡流直径增加,差异有统计学意义(P＜0.05).Ⅰ组中心尖段Fs、涡流圈数与梗阻处的压差有一定的相关性(r分别为0.60、0.65).结论 VFM技术能直观显示梗阻性及非梗阻性HCM左室内血流流场的分布特征,且梗阻性HCM心尖段Fs、涡流圈数与梗阻程度有一定相关性,能够量化评估HCM的梗阻程度.
목적 응용초성혈류향량성상(VFM)기술평개경조성여비경조성비후형심기병(HCM)환자좌심실혈류류장특점,비교이자적혈류동역학상태.방법 수궤선취HCM환자40례위병례조,근거유무경조장기분위경조조(Ⅰ조)화비경조조(Ⅱ조);건강지원자40례위대조조.측량상규초성심동도삼수급VFM삼수수축기총부향류량(SQ-)、수축기봉치류속(Vs)、봉치류량(Fs)등,비교삼조간각삼수적차이,병장Ⅰ、Ⅱ조간차이유통계학의의적VFM삼수여좌실류출도(LVOT)중간단경조처적압차주상관성분석.결과 여대조조비교,병례조실간격후도、LVOT중간단류속급압차균명현증가(P＜0.05),삼조간좌실사혈분수차이무통계학의의(P＞0.05);여대조조비교,병례조기저단SQ-절대치강저,중간단화심첨단SQ-절대치증가,기저단、중간단급심첨단Vs급Fs절대치증가,와류권수여강도명현증가,와류직경명현증대,차이균유통계학의의(P＜0.05).여Ⅱ조비교,Ⅰ조기저단화심첨단SQ-절대치감소,중간단SQ-급각절단Vs화Fs절대치증가,와류권수화와류직경증가,차이유통계학의의(P＜0.05).Ⅰ조중심첨단Fs、와류권수여경조처적압차유일정적상관성(r분별위0.60、0.65).결론 VFM기술능직관현시경조성급비경조성HCM좌실내혈류류장적분포특정,차경조성HCM심첨단Fs、와류권수여경조정도유일정상관성,능구양화평고HCM적경조정도.
Objective To evaluate the left ventricular flow field characteristics in patients with obstructive and non-obstructive hypertrophic cardiomyopathy (HCM) using vector flow mapping (VFM),then assess the left ventricular hemodynamics.Methods 40 patients with HCM were randomly selected as case group,among which 20 patients with left ventricular outflow tract(LVOT) obstruction (group Ⅰ) and 20 patients without LVOT obstruction(group Ⅱ),40 healthy adult volunteers served as control group.The conventional parameters:left ventricular ejection fraction(LVEF),interventricular septal thickness and radial and pressure gradient of left ventricular outflow tract and VFM parameters:left ventricular peak systolic velocity (Vs),systolic flow (Fs),total negative systolic flow (SQ-) and vortex parameters were measured and compared.The correlation between LVOT pressure gradient and VFM parameters were assessed.Results There was no significant difference of LVEF in three groups.Compared with control group,interventricular septal thickness in group Ⅰ and group Ⅱ was much higher(P ＜0.05).Radius in group Ⅰ was much lower than that of group Ⅱ and pressure gradient of LVOT in group Ⅰ was significantly higher compared with group Ⅱ (P ＜0.05).Comparison of VFM parameters:①Compared with control group,SQ-of basal segments in case groups were lower (P ＜0.05),while SQ-of mid and apical segments were higher(P ＜ 0.05),Vs and Fs of all segments increased (P ＜0.05),and number of vortex,vortex diameter and vorticity of obstruction and non-obstruction groups were higher(P ＜0.05).②Compared with group Ⅱ,SQ-of basal segments decreased and SQ-of mid and apical segments increased in group Ⅰ,Vs and Fs of all segments were higher.The number of vortex,vortex diameter were higher in group Ⅰ (P ＜ 0.05).③ Correlation analysis:Fs in apex,the number of vortex relatively correlated with press gradient of LVOT(r =0.60,0.65,respectively).Conclusions VFM can effectively evaluate the flow field characteristics of left ventricle in patients with obstructive and non-obstructive HCM,and Fs in apex,number of vortex were correlated with the degree of obstruction,then further assess the left ventricular hemodynamics quantitively.