CAJ | 학술논문

目的：初步探讨实时三维超声结合运动负荷试验评价健康成人心脏－血管耦联关系的可行性。方法选取40例健康志愿者，应用实时三维超声于运动负荷试验各时期测量其左室基底、心尖水平室壁各节段心内膜下心肌环向应变和心外膜下心肌环向应变，计算有效动脉弹性（Ea）、左室弹性（Ees）及二者比值（心脏－血管耦联指数，VVI）。采用多元线性回归分析筛选预测VVI的心肌应变指标，建立回归方程。结果所有受检者每搏输出量在不同试验时期呈逐步减小趋势，心输出量呈先增加后减小趋势（P＜0．01）。心底水平心内、外膜下心肌环向应变呈先减小后增大趋势（P＜0．01），心尖水平心内、外膜下心肌环向应变在试验各时期无明显变化。 Ees和Ea在不同试验时期先增大后减小，VVI变化不明显。回归方程为：VVI=0.032x1-0.019x2+3.65（x1为等容舒张末期心尖水平内膜下心肌环向应变，x2为收缩末期心底水平心内膜下心肌环向应变）。结论健康成人运动后，Ees和Ea增高，VVI维持“恒定”，心脏－血管存在耦联关系。实时三维超声可有效评价健康成人心脏－血管耦联。
목적：초보탐토실시삼유초성결합운동부하시험평개건강성인심장－혈관우련관계적가행성。방법선취40례건강지원자，응용실시삼유초성우운동부하시험각시기측량기좌실기저、심첨수평실벽각절단심내막하심기배향응변화심외막하심기배향응변，계산유효동맥탄성（Ea）、좌실탄성（Ees）급이자비치（심장－혈관우련지수，VVI）。채용다원선성회귀분석사선예측VVI적심기응변지표，건립회귀방정。결과소유수검자매박수출량재불동시험시기정축보감소추세，심수출량정선증가후감소추세（P＜0．01）。심저수평심내、외막하심기배향응변정선감소후증대추세（P＜0．01），심첨수평심내、외막하심기배향응변재시험각시기무명현변화。 Ees화Ea재불동시험시기선증대후감소，VVI변화불명현。회귀방정위：VVI=0.032x1-0.019x2+3.65（x1위등용서장말기심첨수평내막하심기배향응변，x2위수축말기심저수평심내막하심기배향응변）。결론건강성인운동후，Ees화Ea증고，VVI유지“항정”，심장－혈관존재우련관계。실시삼유초성가유효평개건강성인심장－혈관우련。
Objective To preliminarily explore the feasibility of evaluating ventricular-arterial coupling by real-time three -dimensional echocardiography. Methods Forty healthy volunteers were studied. Real -time three -dimensionalechocardiography was applied to measure the circumferential strain under endomyocardial(EN-CS)and epicardial(EP-CS) atthe levels of basement and cardiac apexby during echocardiography exercise test. The arterial elastance(Ea), left ventricularend-systolic elastance(Ees) and ventricular-arterial coupling index(VVI) were calculated, respectively. The myocardial strainindexes for VVI indicator were screened by multiple linear regression analysis and a mathematical model was developed byregression equation. Results Different stages of trial: ①stroke volume showed a gradually decreasing trend. Cardiac outputincreaesd firstly and then decreased (P < 0.01). ②EN-CS and EP-CS at the levels of basement decreased firstly and then increased(P < 0.01). EN-CS and EP-CS at the levels of cardiac apex did not change significantly. ③Ees and Ea showed adecreasing trend after increasing, but VVI did not change significantly. ④The regression equation was VVI=0.032x1-0.019x2+ 3.65. Conclusion Exercise led to synchronously increasing in ventricular and arterial stiffness, and ventriculoarterial couplingwas maintained. Real-time three - dimensional echocardiography could be used to evaluate the ventricular-vascular coupling.