改良的血流向量成像技术评价房间隔缺损患者舒期心室血流流场征

摘要

目的 应用改良的血流向量成像(VFM)技术评价房间隔缺损(ASD)患者舒张期左、右心室腔内血流流场特征.方法 选取继发孔型ASD成人患者26例(ASD组)和健康成人31例(对照组),获取两组常规超声参数,以及VFM参数,包括左、右心室各节段舒张期峰值流速(Vd)、瞬时正向流量(IQ+)、正向总流量(TQ+)及涡量绝对值,并对其进行比较分析;应用Bland-Altman法评估左室基底段IQ+的观察者间及观察者内的差异.结果 两组左室射血分数比较差异无统计学意义;ASD组左房收缩末期内径、右房收缩末期内径及右室舒张末期内径均大于对照组,左室舒张末期内径小于对照组,差异均有统计学意义(均P＜0.05).ASD组左室舒张期IQ+(基底段及中间段)、TQ+(基底段)均小于对照组,右室舒张期Vd、IQ+、TrQ+(基底段、中间段及心尖段)均明显大于对照组,左室(中间段及心尖段)及右室(基底段、中间段及心尖段)涡量绝对值均大于对照组,差异均有统计学意义(均P＜0.05).左室基底段IQ+的观察者间及观察者内一致性良好.结论 改良的VFM技术是一种无创性评价心腔血流流场特征的有效手段,成人ASD患者心室流速、流量及涡量与健康成人存在显著性差异.%Objective To assess the left and right ventricular diastolic blood flow structure in atrial septal defect(ASD) patients by enhanced vector flow mapping(VFM).Methods Twenty-six adult patients with ASD(ASD group) and 31 control subjects(control group) were enrolled in this study.The conventional ultrasonic parameters and VFM parameters,including the left and right ventricular diastolic peak velocity(Vd),diastolic flow(IQ+),diastolic total flow(TQ+) and absolute value of vorticity in apex-mid-basis segment.The inter-observer and intra-observer differences in assessment of IQ+ at basal segment were analyzed by Bland-Altman method.Results The left ventricular ejection fraction of ASD group showed no diffidence compared with that of control group.Left atrium end-systolic diameter,right atrium end-systolic diameter and right ventricular end-diastolic diameter of ASD group were higher than those of control group,while left ventricular end-diastolic diameter was lower than that of control group (all P＜0.05).The left ventricular diastolic IQ+ (basal and apical segment),TQ+ (basal segment) of ASD group were lower than those of the control group(all P＜0.05),while right ventricular diastolic Vd,IQ+ and TQ+(basal mid and apical segment) were higher compared with the control group(all P＜0.05).The left ventricular vorticity(mid and apical segment) and right ventricular vorticity (basal mid and apical segment) of ASD group were higher than those in control group (all P＜0.05).Conclusion The blood flow velocity and vorticity of the left and right ventricle are different between adult ASD patients and control subjects.Enhanced vector flow mapping is an ideal and noninvasive method to evaluate the hemodynamics of cardiac chambers.