Assessment Of Systolic Function Of Left Ventrilular Myocardium With Rheumatic Mitral Stenosis By Strain Rate Imaging And Integrated Backscatter

【topic origin】Because this topic research belongs to the optional topic, therefore scientific research work march completes in the parent unit. The healthy subjects (normal group) and patients with rheumatic mitral stenosis(MS) were extracted from the outpatient service of HeNan SHENGJUNQU Hospital and second Affiliated Hospital of Zhengzhou University.【objective and significance】1.Objective:Collecting two-chamber, four-chamber and apical long axis views of thirty normal group and thirty patients with MS to assess the left ventricular regional systolic and diastolic function in patients with MS by myocardial strain rate imaging (SRI),and discuss the clinic value of the left ventricular regional myocardium in patients with MS by integrated backscatter(IBS).2.Significance:To determine the left ventricular regional myocardium in patients with MS by SRI and IBS for the clinical diagnosis, the treatment, the appraisal prognosis curative effect provide the objective quantification index. 【Materials and Methods】1.Object of study1 Conventional echocardiography and integrated backscatter studyMS group:Selecting patients with MS, who all come from in hospital and the outpatient service in our hospital and the second affiliated hospital of Zhengzhou university, had diagnosed on clinic also, removed heart organic pathological changes (for example the coronary disease, hypertension and so on, and other system pathological change affects the heart (for example thyroid gland disease, nephrosis and so on), altogether 30 examples, male 12 examples, female 18 examples, average age (46±7) years old.Normal group:Elect non-MS subjects from the outpatient service, non-heart illness after each inspection (electrocardiogram, echocardiogram), had not hypertension, kidney disease, also for Dou heart rhythm health 30 examples, male 10 examples, female 20 examples, average age (44±8) years old.2)Technology strain rate studyMS group:Selecting patients with MS, who all come from in hospital and the outpatient service in our hospital and the second affiliated hospital of Zhengzhou university, had diagnosed on clinic also, removed heart organic pathological changes (for example the coronary disease, hypertension and so on, and other system pathological change affects the heart (for example thyroid gland disease, nephrosis and so on), altogether 50 examples, male 22 examples, female 28 examples, average age (44±8) years old.Normal group:Elect non-MS subjects from the outpatient service, non-heart illness after each inspection (electrocardiogram, echocardiogram), had not hypertension, kidney disease, also for Dou heart rhythm health 50 examples, male 20 examples, female 30 examples, average age (40±6) years old. 2.Instrument1)Use PHILIPS IE33 color ultrasonic diagnostic equipment produced by PHILIPS company, frequence 1.0-5.0MHZ. It has QLAB5.0 analysis software and CD-ROM storage, which can analyse Doppler tissue imaging (DTI), Draws the myocardic strain rate and strain curve automatically, also may quantitative analyse strain rate parameter of myocardic segments in cardiac cycles.2)Produced by the United States PHILIPS SONOS 7500 color-type ultrasonic diagnostic apparatus, S4 ultrasonic probe, frequency 1.0-3.0MHZ. SONOS 7500 Color Ultrasonic Diagnostic workstations with Philips QLAB3.0,also comes with acoustic densitometry (acquisition densitometry,AD)-Integrated backscatter (integrated backscatter,IBS) on-line sample analysis processing system software and dynamic magnetic disc recording system.3.Methods1 Conventional echocardiogram inspectionThe inspected subject (the patient of MS and the health) took left side decubitus,with the tranquil breath, connected electrocardiogram, took the standard parasternal left ventricular long axis view. Left ventricular ejection fraction(EF%), left ventricular fractional shortening(FS%) were measured by PHILIPS IE33 color ultrasonic diagnostic equipment produced by PHILIPS company. EF% and FS% take the average of three cardiac cycle.2)Myocardial strain rate curve and valueThe inspected subject took left side decubitus, with the tranquil breath, connects electrocardiogram and use PHILIPS IE33 color ultrasonic diagnostic equipment produced by PHILIPS company, frequence 1.0-5.0MHZ. Equipment was transfered to the DTI condition.To avoid the error which the angle produced,the image depth and sample frame were as far as possible small; The sound beam direction was as far as possible consistent with the myocardial heading, the most wide angle cannot surpass 20°.After gathering the left ventricular two-chamber(inferior wall, anterior wall),four-chamber(posterior interventricular septum, lateral wall) and apical long axis (anterior interventricular septum, posterior wall) views' the dynamic images in continual three cardiac cycle. All images were stored in the magnetism compact disc, assigned out the memory image from the magnetism compact disc, Philips QLAB3.0 workstation quantitative analysed the images. Take a sample frame to put in the middle and basal of myocardium of the left ventricular anterior wall, inferior wall, posterior interventricular septum, lateral wall, anterior interventricular septum, posterior wall separately, carry on manual way to adjust sample frame position by the frame, the system will be automatic draw this segment myocardial velocity, strain and strain rate curve, measure the peak strain in systolic period (Ss) and the peak strain rate in systolic period (SRs)of each segment in the curve separately. Ss,SRs take the average of three cardiac cycle.3)Myocardial integrated backscatter parameterThe inspected subject took left side decubitus,with the tranquil breath, connects electrocardiogram, took the standard parasternal left ventricular long axis view. We use SONOS 7500 color ultrasonic diagnostic equipment produced by PHILIPS company, S4 ultrasonic probe, frequence 1.0-3.0MHZ. Equipment was transferd to the AD-IBS analysis condition.The sampling fixed depth is 14 centimeter,the fixed gain is 64dB,the equipment condition was invariable in the entire experimental study process,62 images were stored in the compact disc by the Loop form in continuous 2.48S, after would be analysed off equipment. When off equipment analysis took the sample frame shape to use the meniscus, the concave faces the left ventricular cavity, the sample frame long axis was vertical in the ventricular wall heading. The sample frame size was 21×21 element. Take the sample frame to put in the middle of myocardium of the interventricular septum and the left ventricular posterior wall and the left ventricular cavity center separately, avoid the endocardium, the epicardium as far as possible and the disturbance of the bright acoustic ray signal. Cyclic variation of myocardical integrated backscatter(CVIB),namely myocardial IBS at the end of diastole substract myocardial IBS at the end of systole, demonstrated automatically by the machine. Calculate the calibrated time averaged value of IBS(IBS%),namely percentage ratio of All and IBS value of the left ventricular cavity in identical sound beam scan line. Calculate the calibrated CVIB(CVIB%),namely percentage ratio of CVIB,IBS%,CVIB,CVIB% take the average of three cardiac cycle.4.Statistics analysisApplied SPSS 13.0 software packages carry on statistics processing, each measurement data indicated by the mean value±tandard deviation, adopting the group the data comparison uses the independent sample T-test, P<0.05 considered to indicate statistics significance.【Result】1. Conventional echocardiogram material comparative analysisIndices of left ventricular overall systolic function:In MS group and normal group, EF%, FS% are all in normal range, two group of difference have not statistics significance.2.Myocardial SR indices comparative analysisCompared with the normal group, the MS group myocardial SRs of the left ventricular inferior wall,anterior wall, posterior interventricular septum,lateral wall, anterior interventricular septum,posterior wall obviously decreases, SRe obviously decreases, SRa obviously increases, two group of differences have statistics significance (P<0.05).3.Myocardial IBS parameters comparative analysis The normal group interventricular septum and the left ventricular posterior wall myocardial IBS curve assumes the periodic variation,at the end of diastole is biggest, at the end of contraction is smallest, approximates the sine curve type; The MS group interventricular septum and the left ventricular posterior wall myocardial IBS curve also assumes the periodic variation, but changes amplititude contraction. Compared with the normal group, the MS group myocardial IBS% obviously increases, CVIB and CVIB% obviously decreases, two group of differences have statistics significance (P<0.05).【Conclusions】1.SRI is a newly developed ultrasonic technique base on the Doppler tissue imaging,SR (SRs, SRe, SRa) as the new quantification index to evaluate regional myocardial functiont, has overcome the heart overall movement (for example rotary motion) and the passive drag from the muscle around them,which have an influence on the ventricular wall velocity of movement. Compared with traditional appraisal of the left ventricle overall systolic and diastole function,SRI may timely reflect left ventricular myocardial regional systolic and diastole function of 2-DM patient.2.IBS is a sure ultrasonic tissue character(UTC) new technology. IBS parameter curve is determined by the new AD system, can quantitatively analyse UTC of myocardium. Compared with the conventional ultrasonic inspection technology, IBS can more sensitively and objectively reflect left ventricular myocardial histological change in MS patient.