无创性定量左室心腔内涡流的方法及临床应用.docVIP

无创性定量左室心腔内涡流的方法及临床应用118MolecularCardiologyofChina,April2010,Vo1.10No.2(SerialNo.51无创性定量左室心腔内涡流的方法及临床应用张家芬李澎【摘要】定量观察左室腔内涡流,可以评价左室的收缩功能和舒张功能.涡流的形态及位置随心功能减低而发生变化.已经证实,MRI及超声心动图均能够准确观测左室内的涡流.虽然观测方法仍存在一些局限性,借助声学造影的超声心动图方法是能够用于临床的最为准确有效的技术.该方法利用声学微泡流动与涡流的一致性特征对心室重构及心肌做功进行定量研究.敏感参数包括涡流深度比(0.482±0.06),长度比(0.467±0.05),宽度比(0.128±0.06),球形指数(3.66±0.6),相对强度比(2.104-0.8),涡流的相对强度(1.19±0.5)和脉动相关系数(1.314-0.5);舒张早期涡流半径(34-1mm),舒张早期充盈血流前锋速度Vp(47±6cm/s)及Vp/E(0.594-0.07).但是,由于临床试验研究对象的例数较少,临床应用效果仍缺乏相应的循证医学的依据.【关键词】心腔内涡流;声学造影;超声涡流成像NoninvasivemethodstoquantifythevortexintheleftventricularchamberandclinicalapplicationsZHANG,LIPeng.EehoeardiologyDeparternent,FuwaiHospital,PekingUnionMedicalCollegeandChineseAcademyofMedicalSciences,Beijing,10037,China【Abstract】Quantitativeanalysisofthevortexinleftventricular(LV)chamberduringcardiaccyclescanbeusedtoevaluateLVsystolicanddiastolicfunctions.ThevariationsofvorticalshapeandlocationhavebeendescribedfollowingLVfunctionaldecreases.IthasbeenprovedthatMRIandechocardiographyarebethfeasiblyabletoassesscardiacflowpatterns.However,limitationsofthisthistechniqueremainsunsolvedal—thoughechocardiographyhasbeenevaluatedasapromisingmodalityinclinicpavilionsbyusingcontrasta—gents.Quantificationofventricularreconstructionandmyocardialpumpingfunctionisabletobeachievedusingechocontrastmicrobubbles.VortexparametershavebeenvalidatedassensitivepredictorsofLVfunctions,suchasaveragevortexdepth(VD,0.482±0.06),vortexlength(VL,0.467±0.05),vortexwidth(Vw,0.1284-0.06),sphericalindex(SI,3.664-0.6),relativestrength(2.10±0.8),vortexrelativestrength(VRS,1.194-0.5)andvortexpulsationcorrelation(1.31±0.5);vortexradiusintheearlydiastolicphase(VR,3±lmm),thevelocityoffiHingflowfrontVp(474-6cm/s)andVp/E(0.594-0.07).But,broad—basedclinicaltrialsonrelativeapplicationsarestillrequiredtoprovideepidemiologicalevidences.【Keywords】Cardiacvortex;Contrastechocardiography;Echocardiographicvorteximaging左心室腔内血液涡流源于心脏泵血运动,涡流的位置,形状及旋转方向由于血液携带动能特点的不同在舒张期和收缩期存在较大差异.从涡流形成的物理原理上分析,在左室舒张期,当腔内压力低于左房压时,二尖瓣