1、2009.12.52009-12-08,血流向量成像技术评价心肌梗死患者左心室血流,智光、周肖、徐勇、霍晓燕、王晶、崔振双 中国人民解放军总医院心内科,PLA General Hospital,2,2009.12.5,星系形成得益于涡流 远在离子复合之前，很强的辐射压力使得物质团中产生出涡流，它们阻滞了物质团的膨胀，同时随电离复合作用的增强，物质大多变成中性之后，辐射压的作用越来越小。物质团内众多的涡流相互碰撞、混和，互相的作用有时会产生强大的冲击波，使涡流中形成一块块物质，它们后来即演化为星系或球状星团。,星系的起源宇宙涡流假设,PLA General Hospital,3,2009.12.
2、5,在飞机的翼尖，形成了强烈的涡流。由于这股涡流改变了气流的正常流向，会形成额外的阻力。不过也可以很清楚的看到，对翼尖涡流而言，内侧的气流向下，而外侧的气流向上，是股免费的升力流,PLA General Hospital,4,2009.12.5,If only one inlet and one outlet,壶口瀑布是我国著名的第二大瀑布。两百多米宽的黄河河面，突然紧缩为50米左右，跌入30多米的壶形峡谷。入壶之水，奔腾咆哮，势如奔马，浪声震天，声闻十里。 “黄河之水天上来”之惊心动魄的景观。,PLA General Hospital,5,2009.12.5,流体的特征,易流动性； 受任何微
3、小剪切力作用都能连续变形，直到外力停止作用为止； 流体微团运动轨迹是直线，但微团绕自身轴线旋转，故它是有旋流动涡流。,PLA General Hospital,6,2009.12.5,流 场,流场（ Flow Field ）：流体运动所占据的空间 ；迹线（Path Line） 流场中某一质点运动的轨迹流线（Stream Line） 某一瞬时在流场中所作的一条曲线，在这条曲线上的各流体质点的速度方向都与该曲线相切,PLA General Hospital,7,2009.12.5,速度分解定理,PLA General Hospital,8,2009.12.5,PLA General Hospita
4、l,9,2009.12.5,PLA General Hospital,10,2009.12.5,血流向量成像技术,血流向量成像技术(Vector Flow Mapping, VFM) 是一种评估血流向量的新技术 通过分析血流方向的成分来测量血流的速度和方向 基于彩色多普勒信息分析血流方向的成分,PLA General Hospital,11,2009.12.5,血流方向的组成：基本流和涡流,PLA General Hospital,12,2009.12.5,B,C,A,标记左心室血流向量,拟合某条线上的血流曲线,测量多条线上的血流向量,PLA General Hospital,13,2009.
5、12.5,目的,用VFM（Vector Flow Mapping，向量血流成像）技术评价心肌梗死心脏左心室腔内血流变化,PLA General Hospital,14,2009.12.5,方 法,随机入选临床明确诊断的心肌梗死患者及正常志愿者 分为前壁心梗组（第一组）、下壁心梗组（第二组）、正常对照组（第三组）、 应用VFM成像技术采集心尖三腔、四腔、五腔切面图像 分析左心室腔内基底段、中间段、心尖段各平面的血流量，并进行组间的比较,PLA General Hospital,15,2009.12.5,结 果,入选心肌梗死患者21名（前壁心梗组12名、下壁心梗组9名）及正常对照组9名 三组之间比
6、较，心肌梗死患者三腔、五腔切面左心室中间段、心尖段血流量明显减低,PLA General Hospital,16,2009.12.5,三腔切面结果,QMAve：中间段血流平均值； QMdAve ：中间段舒张期血流平均值； QAAve ：心尖段血流平均值； QAdAve ：心尖段舒张期血流平均值。,PLA General Hospital,17,2009.12.5,五腔切面结果,PLA General Hospital,18,2009.12.5,3C,5C,PLA General Hospital,19,2009.12.5,正常人,前壁心肌梗死,PLA General Hospital,20,2
7、009.12.5,正常人,前壁心肌梗死,PLA General Hospital,21,2009.12.5,正常人,前壁心肌梗死,PLA General Hospital,22,2009.12.5,正常人,前壁心肌梗死,PLA General Hospital,23,2009.12.5,时间-血流曲线,ant,norm,PLA General Hospital,24,2009.12.5,讨 论,涡流研究的意义心腔内血流有特定几何形态和运行模式，是心脏快速、高效泵血的流体力学基础； 心脏机械功能与心腔内涡流直接相关，任何局部的心脏机械功能的改变都会改变心腔内血流模式，而心腔内涡流紊乱也可以反映机
8、械功能的变化； 传统的心腔内血流概念仅局限于跨瓣血流，而忽略其作为包括流出道、流入道及心室内其它部位血流在内的连续的流体力学整体的特性。,PLA General Hospital,25,2009.12.5,讨论,心肌梗死后涡流的变化有研究证明，心肌梗死病人心腔内会出现梗死节段相关的血流紊乱及心室整体排血的延迟，即局部心肌的缺血和功能障碍即可引起心腔内血流协调性的障碍； 如果能够用某种方法评价心腔内血流，就可以直接反映心脏整体做功能力的变化。,Perk,-G; Remolina,-A; Tunick,-P-A; Kronzon,-I. Unusual intraventricular flow
9、pattern after left ventricular aneurysmorrhaphy. J-Am-Soc-Echocardiogr. 2007 Jun; 20(6): 771.e7-8.,PLA General Hospital,26,2009.12.5,涡流分析方法PIV,Flow in an artificial heart assist system,Flow in a carotid artery,PLA General Hospital,27,2009.12.5,MRI Based CDF (three-dimensional computational fluid dyn
10、amics),PLA General Hospital,28,2009.12.5,人工瓣膜与左室血流,PLA General Hospital,29,2009.12.5,VFM技术,在一个观察平面的血流,Ejection Flow,PLA General Hospital,30,2009.12.5,VFM技术,本研究结果提示VFM技术取得的心腔内平面血流可以较为敏感的检出心肌梗死后心腔内血流的变化，与国外早期研究一致； 心腔内中间段、心尖段血流，尤其是舒张期血流量是有意义的指标，可能可以用于冠心病心肌整体功能的评价。,PLA General Hospital,31,2009.12.5,心肌梗死
11、病人心腔内血流改变,本研究结果提示；心肌梗死病人心腔内血流量指标包括：QMAve：中间段血流平均值；QMdAve ：中间段舒张期血流平均值；QAAve ：心尖段血流平均值；QAdAve ：心尖段舒张期血流平均值。心肌梗死病人与正常人相比较心腔内血流量有著差异，同时前壁心肌梗死病人与下壁心肌梗死病人也有差异，其评指标仍有待于进一步研究。,PLA General Hospital,32,2009.12.5,局限性,研究入选患者例数较少，患者心肌梗死范围、心室功能差异较大； 图像分析过程中平面选取难以在同一水平。,PLA General Hospital,33,2009.12.5,结 论,心肌梗死患
12、者左心室腔内血流量减低；VFM技术可以用于检测左心室腔内血流量的改变,2009.12.52009-12-08,谢 谢 !,PLA General Hospital,35,2009.12.5,2009.12.52009-12-08,Evaluation of Intraventricular Flow in Myocardial Infarction Using Vector Flow Mapping,Zhi Guang, Zhou Xiao, Xu Yong, Huo Xiaoyan, Wang Jing, Cui ZhenshuangChinese PLA General Hospital,
13、PLA General Hospital,37,2009.12.5,星系形成得益于涡流 远在离子复合之前，很强的辐射压力使得物质团中产生出涡流，它们阻滞了物质团的膨胀，同时随电离复合作用的增强，物质大多变成中性之后，辐射压的作用越来越小。物质团内众多的涡流相互碰撞、混和，互相的作用有时会产生强大的冲击波，使涡流中形成一块块物质，它们后来即演化为星系或球状星团。,星系的起源宇宙涡流假设,PLA General Hospital,38,2009.12.5,在飞机的翼尖，形成了强烈的涡流。由于这股涡流改变了气流的正常流向，会形成额外的阻力。不过也可以很清楚的看到，对翼尖涡流而言，内侧的气流向下，而外
14、侧的气流向上，是股免费的升力流,PLA General Hospital,39,2009.12.5,If only one inlet and one outlet,壶口瀑布是我国著名的第二大瀑布。两百多米宽的黄河河面，突然紧缩为50米左右，跌入30多米的壶形峡谷。入壶之水，奔腾咆哮，势如奔马，浪声震天，声闻十里。 “黄河之水天上来”之惊心动魄的景观。,PLA General Hospital,40,2009.12.5,流体的特征,易流动性； 受任何微小剪切力作用都能连续变形，直到外力停止作用为止； 流体微团运动轨迹是直线，但微团绕自身轴线旋转，故它是有旋流动涡流。,PLA General H
15、ospital,41,2009.12.5,流 场,流场（ Flow Field ）：流体运动所占据的空间 ；迹线（Path Line） 流场中某一质点运动的轨迹流线（Stream Line） 某一瞬时在流场中所作的一条曲线，在这条曲线上的各流体质点的速度方向都与该曲线相切,PLA General Hospital,42,2009.12.5,速度分解定理,PLA General Hospital,43,2009.12.5,PLA General Hospital,44,2009.12.5,PLA General Hospital,45,2009.12.5,Vector Flow Mapping,
16、Vector Flow Mapping (VFM) is a new method for measuring blood flow vector To measure the speed and direction of blood flow by estimating the velocity component in the direction This velocity component is estimated from color doppler data,PLA General Hospital,46,2009.12.5,The component of flow: base-
17、flow and vortex,PLA General Hospital,47,2009.12.5,B,C,A,Vector of intraventricular flow,Measuring the flow on some line,Measuring the flow vector on some lines,PLA General Hospital,48,2009.12.5,AIMS,To assess the change of intraventricular flow due to myocardial infarction using VFM,PLA General Hosp
18、ital,49,2009.12.5,METHODS,Myocardial infarction patients and healthy candidates were included divided to anterior wall infarction group (group 1), inferior wall infarction group (group 2), and normal contrast group (group 3) 3C, 4C and 5C images were stored using VFM Intraventricular flow was measur
19、ed at the different locations of LV and compared among groups,PLA General Hospital,50,2009.12.5,RESULTS,21 MI patients and 9 candidates were included into the three groups The flow measured at the middle and apical lines from the 3C and 5C images decreases in the MI groups,PLA General Hospital,51,20
20、09.12.5,3C,QMAve：Flow at the middle level of the LV chamber； QMdAve ：Diastolic flow at the middle level of the LV chamber； QAAve ：Flow at the apical level of the LV chamber； QAdAve ： Diastolic flow at the apical level of the LV chamber.,Group 1: Anterior Infarction Group 2 : Inferior Infarction Grou
21、p 3 : Normal,PLA General Hospital,52,2009.12.5,5C,PLA General Hospital,53,2009.12.5,3C,5C,PLA General Hospital,54,2009.12.5,PLA General Hospital,55,2009.12.5,PLA General Hospital,56,2009.12.5,PLA General Hospital,57,2009.12.5,PLA General Hospital,58,2009.12.5,Time-Flow curve,ant,norm,PLA General Hos
22、pital,59,2009.12.5,The technique of VFM,The results of this study suggested that VFM could be a sensitive method for detection of intraventricular flow changes in patients with myocardial infarction Middle and apex intraventricular flow, and diastolic flow parameters were useful for evaluation of le
23、ft ventricle function,PLA General Hospital,60,2009.12.5,The changes of intraventricle flow in patients with MI,The result of this study show that: intraventricle flow parameters such as QMAve,QMdAve,QAAve and QAdAve were decreased in patient with MI compared with the normal person, which was more si
24、gnificant in anterial wall infarction patient. The more sensitive parameters are needed to be invested in future.,PLA General Hospital,61,2009.12.5,Limitation,The number of the MI patients in this study was relately small, and infarcted location,left ventricle function were defferent. The level of image for analysis were defferent 。,PLA General Hospital,62,2009.12.5,CONCLUSIONS,The volume of intraventricular flow decreased in MI patientsVFM can be used to assess the change of the volume,2009.12.52009-12-08,Thank You !,2009.12.52009-12-08,2009.12.52009-12-08,
