daii mo d benh nhan suy tim man tmh Danh gia van dong xoan cua that trai bang sieu am danh

i NGHIEN C I A J LAM SANG

Danh gia van dong xoan cua that trai bang sieu am danh daii mo d benh nhan suy tim man tmh

Do van Chign*, Phgm Th^Thp*

Nguyen Cong Thanh**, * * Pham Nguyen Son

*\/i§n Tim mach Quan doi

**Benh vien Trung uong Quan ffoi 108 TOMTAT

0 binh nhin suy tim mgn tinh, chi sd sieu am EF dflde eoi Ii quan trgng nhat tren Iam sang. Tuy nhien, vgn dgng xoan ciia that trai ed y nghia khdng kim phin quan trong trong danh gia chflc nang that trai. Phfldng phap sieu i m danh diu md (speckle tracking) la mdt phfldng phip silu im mdi ed dp ehinh xac eao gin diy dflde ip dung tren Iam sang de danh gia van dpng xoin cnia that trai, Muc tieu: Khio sit vi dinh gii sfl biln ddi van ddng xoan cua that trii va mdi lien quan gifla cie chi sd xoin cua that trai trin sieu im danh dau md vdi mpt sd ehi sd sieu am tim 2D cnia suy tim. Ddi tflpng va phfldng phap: Cd 41 ngflcA khde mgnh va 70 benh nhan suy tim man tinh theo tilu chuan Framingham dilu tri tai khoa Ndi Tim maeh- Benh vi?n Trung flcing Quan dpi 108 tfl thing 3/2014 den thing 4/2014 dddc dda vao nghiin ciiu. Tat ei cae benh nhin dfldc khim lim sang, dien tim, xlt nghiim sinh hda va lam sieu am ghi hinh fheo cie mat chuan. Hinh anh sieu im dflpc phan tieh vi do dgc bang phin mim ECHOPAC 112 (GE, Hoa Ky). Ket qua: Tat ea cae ehi sd sieu am tim danh gia van dpng xoan eua that trii (AR, ARV, BRy T, TV) deu giam hdn d nhdm suy tim so vdi nhdm ngflcfi khde manh cd y nghia thdng ke vdi p<0,05. Thdi gian dat dinh dp xoan cua that trai (thdi gian AR, ARy BR, BRV, T, TV) diu keo dai hdn d nhdm suy tim so vdi nhdm ngfldi khde mgnh ed y nghia thdng ke. Benh nhan suy tim sau nhdi mau cd tim cd dp xoin giim thap nhat (T=6,3 dp), sau dd la dai thao dflcftig (T=6,5 dp) va it giim nhat la nhdm tang huyet ap (T=8,1 dp). Benh nhan cd NYHA cang ning thi mflc dp giim gdc xoan cang nhieu. Chi so T ed tfldng quan thuan chit vdi EF (r=0,83; p<0,00l) va nghich vdi Dd (r=-0,72; p<0,00l). Ketlu^ns

\ ^ ddng xoan ciia thit trai la mgt thdng sd quan trpng dinh gia mde dp suy tim va cd tfldng quan thugn ehgt vdi ehi sd EF, tfldng quan nghich chat vdi chi sd Dd trin silu i m 2D.

OAT VAN DE thit trd (EF) dfldc xem la quan tirpng nhat trong Suy tim la mot hoi chtog benh ly t h i i n g gap ^ ^ » * "^^ " ^ 8 to NgUil ta da bien rang cac trong lam sang va la giai doan cuffl cung cua cac ' * ^^ * " ^^ '^" *'=° ^ ^ "S""8 va co ngin l?i b?nh ly tim mach, day la hau qua cua nhieu benh * = " ^l^^" ^^'^ ^ " ' ' ^ S 7™ « ^ b i - q"y=' * * IjJ tim mach khac nhau nhn van tim, c« tim, mang ^ ^ ' ^ ''"P ™> '=<* t™- ^ 1 / i*ien cd tim lai co mot ngoai tim, loan nhip tim, tang huyet ap benh dong "^^ ^<^ "o*" '^ '''*' ^ <^ 'Vc co khong dong mach vanh... Suy tim lam giam hoac mat hin sulc hiidng. Mpt so tac gia thay ring nSu cO tim chi day lao dpng cua benh nhan va la mpt trong nhflng len va co ngan lai thi EF chi dat dupc toi da 45% va nguyen nhan hang dau dan den tiivong. [4] 15%c6nlailadolv(cxoantaonen.[7]

Trong thuc hanh lam sang chi sd tong mau Txinhi3ngiiaml990ngUciitabatdauapdung 144TAP CHiTIM MACH HOC VIET NAM-SO 68.2014

NGHIEN CU'U LAM SANG i

phdctag phap cdng h f l ^ ^ ttf tim (MRI) d l danh gia van ddng van xoan eiia that triL Tuy nhien sfl dung cdng hiidng td thfldi^ cd gia thanh cao, tdn nhilu thcd gian va khd phan tich hinh anh. Nhd nhiihg ti&i bd ve la thuit silu am die biet li )d thuit silu am danh dau md (speckle tracking) eho phep chiing ta danh gia van dpng xoin vi eua tiiat trai mpt each ddn gian vi hieu qua hcfti.

Sfl biln ddi van ddng xoan khdng chl la mot yeu td phit hien suy tim scftn 1^ nhay hcfti so vcS EF ma cdn li mot ylu ^ lim lim suy tim ngng len va cd y n^]ia quan trpng trong quin ly va tien Itidng benh nhan. Ngfldi ta thay ring benh nhin suy tim ed tiiat trai eai^ gian thi khi nang xoin cang giim dL Dl hiiu rd them ve vai trd eua van dpng xoan ciia that trii troi^ suy tim ehiing tdi tien hanh n ^ e n cniu vdi muc tilu sau:

Khao sat va danh gia sfl bien ddi van dpng xoan cua that trai va moi lien qnan g i & cac chi s6 xoin c:ua that trai tren sieu am danh dau md vol mpt sd dii so sieu am tim 2D cua suy tim.

Ddi tfldng va phflcA^ phap nghien cflu Trong khoang thdi gian tfl thing 3 nam 2013 den thing 3 nam 2014 chiing tdi thu nhan dflde 70 b|nh nhin dflde xac dinh ed suy tim dieu tri tai khoa Ngi Tim maeh, Benh vien Trung ddng Quin dpi 108 va 41 benh nhin la ngddi binh thfldng den khim benh tgi phdng kham benh, Benh vien Tnmg ddng Quin dpi 108.

Tiiu (huan Itia chgn

Suy tim dflde ehuan doan theo tieu ehuan Framingjiam[4], ehan doan dai thio dfldiig typ LI diidc xie dinh theo ADA 2010[2], ting huylt ap theo WHO 1999[1]. Benh nhin dupe coi la cd b|nh dpi^ mgch vanh nlu cd mgt trong cie tilu ehi sau: ed tien sfl nhdi mau cdtim, cd sdng Q_dliai chuyen dao liln tue trin dien tim, cd htnh anh chup d g i ^ maeh vinh vdi ket qua dddtig lanh hep tien 50% hogc da dfldc phiu thuit bae ciu chu vanh.

Tieu chudn loqi trii

Benh nhin khdi^ ddngy tham gia nghiin ctiu, lunh inh silu im tim khdng du dieu kien phin tich, ed benh cap ti'nh kem theo hoac suy tim do benh van tim.

Tat c i cae ddi tfl^ig n ^ e n cflu deu dflde khim lam sang ti mi, dien day du thdng tin theo miu hd sd n ^ u l n ctiu. Lim eae xet n^dem sinh hda can thil^ ghi diin tim 12 c h u y ^ dao va ghi hinh silu im tim de phin tich.

Phdn tich hinh dnh siiu dm tim bang phdn mem ECHOPAC

Tat ei eie benh nhin dflde eit d mat eit ehuan vdi td thi nam nghieng trii. Cae mgt cat ehuan bao gdm eanh fle true dpc, true ngang qua that phan nin va phan mdm, mat cat 4 va 5 budng tai mdm.

Hinh inh sieu im dtipc ghi lgi d it nhat 3 chuyin dao Uen tuc d l phin tieh. Dit dau dd Doppler xur^ tai diem dau van hai la detinh thdi gian md, ddng van hai la (MVO, MVC). Dat Doppler xung tai dfldng ra that trii de ti'nh thdi gian ddng, md van d d i ^ maeh chu (AVO, AVC). Cie thdng sd MVO, MVC, AVO, AVC dflde dimg de can chinh thiA gian va xie dinh tiidi gian tim ihu vi tam tnJdng.Cliat Iflcftig hinh inh sieu i m 2D rat quan trgng trong silu im dinh dau md, may tinh se chi diap nhin nhflng vung cd tim ro rang tren silu im vi nhflng hinh anh khdng du dilu kien se khdng dflde chap nhin.

Mot so tiidng sd tren siiu dm tim ddnh ddu md Gdc xoay ca mdm tim (AR -dp) - la dinh chicftig ldn nhit trin dd thi 3K)ay cua mdm tim. Thdi

^ a n dat dinh dp »3ay(thcfl gian AR - ms) - Ii thdi

^ a n tfl 0 giay cho den dinh ddcftig Idn nhat tren dd thi xoay cua mdm tim. \ ^ tdc xoay eua mdm tim ( A R V - dp/giiy) - la dinh ddcftig ldn nhat trin do thi van tdc xoay eua mdm tim. Thdi gian dat dinh van tdc xoay (thcfi gian ARV -ms) - la thcfi gian tfl 0 giiy den dinh ddcftig Idfti nhat

TAPCHiTIMMACH HOCVIETNAM-5068.20141145

! NGHIEN CLTU LAM SANG

• A ,-^-"*.:^ 2 1 degree

: . / \

o . . " - 1 9 0 degree/sec

/ \

Hinhl. Cddi tinhAR, thdi gian AR, AW, thdigianARV

Goc xoay eiia nin tun (BR -dp)- la dinh am nhd nhat trin dd thi van ddng xoay eua nin tim. Thdi gian dat dinh dp xoay( Thdi gian BR - ms)- la thcfi gian tfl 0 giiy den dinh am nhd nhat tren dd thi ^^^y cua nin tim. Vin tdc xoay cua nin tim (BRV - dp/giiy) - la dinh am nhd nhat trin dd thi van tdc xoay eua nin tim. Thdi gian dgt dinh dp xoay (BRV - ms) - la thdi gian td 0 giiy din dinh im nhd nhat tren dd thi van tdc xoay ciia nen tim

HinhZ Cdch tinh BR, Dg xoin (T) vi van tdc xoan (TV) Clia that trai dflpc tinh dfla trin dp xoan va van tdc xoay trung binh eua nin tim va mdm tim: Dp xoan that trii T (dp) = Gdc xoay mdm tim(AR) - gdc xoay nin tim (BR). Vgn ddng xoay ngflpc chilu kim ddng hd cd gia tri dfldng(+) va van ddng cung chilu kim ddng hd ed gii tn im(-). Cich tinh tfldng tfl ip dijng cho van tdc xoay cua that trai.

Phiidngphdp thdng ke

Cie s6 lieu nghien cflu dfldc xd ly tiieo cae thuat toan thdng kl y hgc bang chfldng trinh phan

in BR, BRV, thdigian BRV

mim EPUNFO 7.0 (CDC-WHO). Cac bien dflpc bieu dien dfldi dang trung binh ± dp lech ehuan (MeantSD), tinh ti ll phin trim (%). So sinh so trung binh gifla hai nhdm bang thugt toin Student T-test So sanh hai ty ll bing tht4t: toan ^2, theo Fisher Exact testGii tri p < 0,05 dfldc coi li cd y nghia thdng ke.Tflcftig quan tayin tinh gifla cac thdng sd dfldc xie dinh bang phip tinh phan ti'ch hdi qui tuyln tinh ddn bien thdng qua he sd tfldng quan Pearson-Tinh h | sd tflcftig quan r ddi vdi 2 biln dinh Ifldng khi p < 0,05.

ffl TAP CHI TIM MACH HOCVIETNAM-SO 68.2014

NGHIEN CLfU LAM SANG fe.

Ket qua

Bdng 1. Bdc diim ehung cda nhom nghiin cdu Dac diem

Tuoi Gidi Nam(%)

Na(%) DTD THA BSnhDMV

NYHAI N^TIAII NYHA III NYHAIV

Nb6mchA^(n=4l) 57,5±17,9 24(58,5%) 17(41,5%)

0 0 0 0 0 0 0

Snytim (n=70) 60,2+16,7

42(60%) 28(40%) 18(25,4%) 31(44,2%) 33(47,8%) 6(8%) 21(31%) 43(61%) 0(0%)

P

>0,05

>0,05

>0,05

Khdng cd sfl khie bi?t cd y nghia thdng ke vl tudi, gidigifla nhdm ehflng va nhdm suy tim. Cac nguyin nhan gay suy tim d benh nhin suy tim ehu yeu la benh dgng mgch vanh 47,8%, tiep theo la benh tang huylt ap vdi ti II 44,2% va dii thio dfldng typ II chilm 2S,4%.C nhdm nghien cflu, phan ldn benh nhin nam d nhdm NYLLA i n chiem 61 %, ti^ theo la nhdm NYHA II chiem 31 %, nhdm NYHA I chi&n ti 1? 8% va khdng ed benh nhin nao d nhdm NYHA IV

Bdng 2. Dqc diem siiu dm cda nhom ngfiiin cdu DIcdiSm

Dd Ds EDV

ESV FS EF

Rhong sny tun(n=41) 41,23±9,87 28,78±643 90,1±17,6 30,1±8,3 37,19±11.2

65,8±9,5

Suytiin(n=70) 57,I7±8,56 48,32*9,08 130,05+21,5

87,06 16±8,4 342±54

P

<0,001

<0,00I

<0,05

<0,001

<0,05

<0,001 Cic chi sd ve Idch thflde that trai nhd Dd, Ds, EDV, ESV d nhdm benh nhan suy tim deu tang hcfti d nhdm ehflng ed y nghia thdng ke. Cie ehi sd ve chflc n a i ^ that trii nhfl FS, EF d nhdm suy tim diu gjam hdn so vdi nhdm b|nh cd y nghia thdng ke vdi p<0,001 vi <0,05.

Bdng 3. Dqc diim van dgng xoay cda nen tim d nhdm nghiin cdu

D^c diem BR (do)

Thdi gian BR (ms) BRV(d6/s) Thai gian BRV (ms)

Kh6ngsaytim (n=41) -10,1+2,4 107,3+21,9

^1,5±8,5 281,3±82,3

Snytim (n=70) -3,8±2 127,4+32,4

-26,7+5,9 293,6+68,3

P

<0,001

>0,05

<0,05

>0,05 TAP CHi TIM MACH HOC VIET NAM-SO 68.20141147

NGHIEN cub LAM SANG

Cac ehi sd van ddng d nin tim nhfl dinh xoay (BR), toe dd xoay diu giam hdn d nhdm suy tim so vdi nhdm khdng suy tim. Thcfi gian dat dinh xoay, thdi gian dat dinh vgn tdc xoay d nin tim d nhdm suy tim vi nhdm khdng suy tim khae bi|t khdng ed y nghia thdng ke vdi p>0,OS.

Bdng 4. Vdn dgng xoay cua mom tim dnhom n^iin cdu

Dac di€m

AR(d6) Thdi gian AR (ms) ARV(d6/s) Thai gian ARV(ms)

Khong sny tim (n=4l) 2I,8±64 86,4±5,6 75,5±2S 312,4+743

Snytim (n=70) 41±1,5 I07,6±ll,2 46,3±194 405,3±59,3

P

<0,00I

<0,05

<ft001

<0,001 Ddi vdi eae ehi sd d van ddng d mdm nhfl dinh xoay d mdm (AR), dinh van tdc xoay d nhdm suy tim giam ed f nghia thdng kl so vdi nhdm khdng suy tim. Thdi gian dgt dinh xoay vi dinh vin tdc xoay cao hdn d nhdm suy tim ting cao hdn d nhdm suy tim cd y nghia thdng ke.

BdngS. Vdn ddngxodn cua thdt trdi dnhom nghiin ctiu

D#c diem TV (dp/s) Thdi gian TV (ms)

T(d6) 'IhciigianT(ms)

Kh6ngsnytim (n=4l) 58,3±14,3 195,5±80,4

16,6±6,6 222,5±51,I

Snytim (n=70) 31,5±1I,7 287±76,1 6,87±3,I 315,8±32,7

P

<0,05

<0,00I

<0,001

<0,05 Dinh xoin(T), thdi gian dgt dinh xoan (Thdi gian T), van tdc xoan (TV) va thdi gian dat dinh vgn tdc xoin (Thdi gian TV) deu giam d nhdm suy tun cd f nghia thdng kl.

Bdng 6. Vdn ddngxodn d binh nhdn suy tim do DTD, THA vd BMV

Dac di^m

T(d6) Thdi gian T (ms) TV(dd/s) Thcii gian TV (ms)

DTD(l) (n=18) 6,5±1,2 321,4±78,6

36,6±8,2 276,4±48,6

THA(2) (n=31) 8,1 ±1,7 309±57,8 3I,4±2,9 269,4±654

DMV(3) (n=33) 6,3±0,9 3134±87,9

29,4±I2,5 289,2±745

P - .

<0,05

<0,05

<0,05

>0,05 P...

<0,05

>0,05

>0,05

>0,05 P,.,

>0,05

>0,05

<0,05

>0,0S

^ ^ dpng xoan eua thit trii d benh nhan suy tim do b|nh dgng mgeh vinh va binh dii thio dflcftig giam hcfti so vdi nhdm binh nhin ting huyet ip vdi p<0,05. Thcfi gian dat dmh van tdc xoin d nhdm suy tim do tang huyet ap thip hdn d nhdm dai thao dddng ed y nghia thdng ke vdi p<0,05. Wn tdc xoan d nhdm tang huylt ap va ed binh dpng mach vanh ed y nghia thdng kl vdi p <0,05. Thdi gian dat dinh vin tdc xoan khdng ed sfl khie biit gifla eic nhdm tren.

148ITAP CHI TIM M\CH HOC VIET NAM-SO 68.2014

NGHIEN CU'U LAM SANG k.

Bang7. Van xoan ciia tiidt trdi theo fhan dg NYHA

^ D l c d i ^ TV(d6/s) Thdi gian TV

(ms) T(d6) ThcJi gian T

(ms)

N¥HAI(1)

38,5±I7,2 267,5±81,5

7,66+2,6 308,4±78,9

NYHAn(2) ( n r f l ) 31,S±10,7 278±66,4 4,43±I,9 3I1,7±56,8

NYHAin(3) (n=43) 29,4±1I,4 291,3±75,9 3,42±I,2 330,2±88,9

Pui

<0,01

<0,05

<0,0I

>0,05 P™

<0,05

<0,0S

>0,0S

<0,0I

Pi-ni

<0,05

<0,01

<0,05

<0,05 Gdc xoan cda that trii giim dan td NYHA 1 vi NYHA III, Icfti nhat d nhdm NYHA I va nhd nhat d nhdm NYHA HI, sfl khae hilt gifla gdc xoin gifla nhdm NYHA II va III khdng cd f nghia thdng kl vdi p>0,05. Thdi gian dat dinh xoin d nhdm NYHA UI la ldn nhit va sfl khie biet niy kha rd ring so vdi nhdm NYHA I va NYHA n. Vin tdc xoan eua nhdm NYHA i n thap nhat so vdi nhdm IsIYHA I va NYHA II, sfl khae biet nay ed y ng^a thdng ke vcft p<0,05 va 0,01.

Bdng 8. Moi liin quan gida do xoan cda thdt trdi tren sieu dm vdi cdc chi so sieu dm tim khde

Ihong so si£u&m

Dd Ds EDV ESV SV FS EF E

T r -0,72 -0,21 -0,18 -0,44 0,12 0,32 0,73 0,06

P

<0,001

>0,05

>0,05

<0,0I

>0,05

<0,0I

<0,001

>0,05

I h d i gian T r -0,47 -032 -0,25 -0,34 0,23 0,33 0,48 0,08

P

<0,001

<0,01

>0,05

<0,01

>0,05

<0,0I

<0,001

>0,05

TV r

^),66 -0,26 -0,23 -0,25 0,16 0,37 0,75 -0,12

P

<0,00I

<0,05

>0,05

>0,05

>0,05

<o,ai

<0,00I

>C,05

Ihdi gian TV r -0,42 -0,09 -0,01 0,16 0,08 0,17 0,42 0,11

P

<0,01

>0,05 .>0,05

>0,05

>0,05

>0,05

<0,00I

>0,05 Dd xoan cda that trai ed tddng quan nghich chit vdi chi s6 dfldng kinh that trai cudi tam trfldng Dd (r=-0,72; p<0,00l), vi thdi gian dgt dinh dp xoin cd Uen quan nghich vfla vcfi Dd (r=:-0,47; p<0,00l).

V^n tdc xoin, thdi gian dgt dinh dp xoan cd tfldng quan nghich viia vdi chi sd Dd (r=-0j66; p<0,001 va r=-0,42; p<0,001). Dp xoan, van tdc xoan cua thit trai ed tflcftig quan tiiuan chat vdi phin suat tdng mau that trai EF (r=0,73;p<0,001 vi r=0,75;p<0,00l). Thdi gjan dat dinh dp xoin va thdi gian dgt dinh van tdc xoan ed tfldng quan thuan vda vdi ehi sd EF. Chi sd eo ngan that trai FS ed tflcftig quan thuan vfla vdi dp xoan va van tdc xoan cua that trii. Dp xoin va thdi gian dat dinh xoan cd tflcftig cjuan nghich vfla vdi thi tieh that tirii cudi tam thu vdi r=-0,44; p<0,01 va r=-0,34; p<0,01.

BAN LUAN

Dac diem lam sang cua nhom n ^ e n cdn

Ddi tfldng nghien ciiu cua chiing tdi cd dp tudi trung binh la 60,2 ± 16,7, nam gidi chiem 60%, nfl gidi ehilm 40%, cac nguyen nhan giy suy tim d day chu yeu la benh ddng mgch vanh (47,8%), ting TAPCHiTIMMACH HOC VIET NAM-5068.20141149

A NGHIEN CLfU LAM SANG

huylt ap (44,2%), dii thao dfldng (25,4%). Nhfl viy, ddi tfldng nghiin cflu la nhflng benh nhin ed ti 11 suy tim eao.

V^n ddng xoay va xoan cua that trai d benh nhdn suy tim

Trong nghien eiiu eua ehung tdi, cac chi sd xoay d nen tim deu giim mdt cich rd ret so vdi nhdm chdng, dp xoay eua nen tim (BR) d nhdm binh Ii -3,8 do, giam rd ret so vdi nhdm ehflng, vdi P<0,001, van tdc xoay d nin tim (BRV) d nhdm benh la -26,7 giam ed y nghia thdng ke so vdi nhdm chdng vdi p<0,05. Theo Fuchs va cdng sfl [5] dblnhnhansuytim thi gdc xoan trong tiu tam thu d nin tim giam cdn 2,9''±2 so vdi nhdm chiing vi giim cdn 0,7''±2 trong thi tam trflcftig. Tac gii edn theo ddi tiep sfl bien ddi cua hien tflpng xoay cfla thit trii sau 6 thing dieu tri suy tim theo phie do chuan va nhin ra rang eie chi sd trin cai thiln ding ke, gdc xoan tang lin la 4,1° trong thi tim thu va tang len 2,4° trong thi tim trfldng. Tie gii cho ring danh gja hieu qui dilu tri suy tim khdng chi dfla vao cac ehi sd sieu im dinh gii chflc nang tdng mau that trii EF m i cdn dfla vao danh gii van ddng xoay cua thit trai.

VI chflc nang xoay eua mdm tim, kit qua nghien ctiu cua chting tdi eho thay gdc xoay (AR) va van tdc xoay (ARV) cua nhdm suy tim deu giam

hcfti so vffi nhdm ehtjftig, AR d nhdm suy tim la 4,1°, ARV d nhdm suy tim la 43,6 "/giiy so vdi kit qui cuanhdmchiingla21,8va 75,5, sfl khic biet la cd y nghia thdng kl d ca hai nhdm vdi p<0,001.

Tilp tyc ddi chilu vdi nghiin cflu cua Fuchs va cdng sfl [S] cho thiy ca AR va ARV d nhdm benh nhan suy tim diu giim.

\ ^ ddng xoan cua thit trai dflde danh gii bang hieu sd gifla dp xoay d mdm tim va nen tim nen chi sd nay phti thude vao ci hai gii tri AR va BR. Trong ng^en ctiu cua chting tdi, gia tri dg xoan eua that trai thu dflpc Ii 6,87° vi van tdc xoin la 31,5°/giay. Ca h d gii tri trin diu giam cd y nghia thdng ke so vdi eae gia tr; tddng dddng d nhdm chiing. Trong mdt sd nghiin cflu gin diy dfldc tic gia Aaron vi cdng sfl[8] tdm tat Iai eho tiiay tit ci cac nghien cniu vl van ddng xoan dbenh nhan suy tim bang silu am dinh dau md va chi ra rang cie chi sd ve vgn dpng xoay d mdm tim va nen tim, vgn dgng xoin eua that trii deu giim d nhdm benh nhin suy tim theo nghiin cflu eua Zhang va Bertini [3 ]. Fuchs thi eho kit qua li van ddng xoay d mdm tim va nin tim giam nhiftig dd xoin khdng thay ddi. Trong khi do Russd vi Wang [7] lai chiing minh rang dg xoan that trai thay ddi nhflng dp xoay d nin tim va mdm tim khdng cd sfl thay ddi. Ket qua cua chting tdi khi tflcftig ddng vdi hai tic gii Zhang va Bemiti.

Mdtsd nghiin cdu vivdn ddngxodn cua that trdi Nghien ciiu

Zhangvacs2008 Bertini vacs 2009 Fuchs vacs 2004 Russel vacs 2009 Wang vacs 2008 Chiing tdi, 2013

V^n ddng xoay d mdm Glim Giim Giam Khong thay ddi Khong thay ddi

Giam

V ^ ddng xoay d nen Giam Giam Giim Khong thay ddi Khong thay ddi

Giam

V|n ddng xoin Giim Giam Giira Giam Giam Giim (Nguon: BMC cardiovascular disorders 2012,12:46)

Mdc do suy tim vd van ddngxodn

Trong nghiin cflu eua chiing tdi nhdm suy tim nang hcfti NYHA II va III, ehi sd BR giim rd, ed y nghia thdng kl so vdi nhdm suy tim nhe hcfti la NYHA I. Tfldng td nhd vay chi sd BRV cung giim rd d ISDTAP C H I TIM MACH HOC VIET NAM - SO 68.2014

NGHIEN Cl/U LAM SANG b

nhdm benh nhan ed suy tim nang hcfti NYHA II va IIL Sti khic biet gifla nhdm NYHA n va NYHA III khdng CO y nghia thdng kl vdi p>0,05. Cac chi so khac danh gii vgn ddng xoay d mdm tim nhfl AR, van d d i ^ xoan cua that trai nhd T, TV deu cho kit qua tflcftig td. Chi duy nhat ed chi sd van tdc xoay d mdm tim khdng tdctag ting vdi dp nang cua suy tim vdi thdi gian. Ket qua n^iiln cda cua tie gia Bertini vi cdng sfl [3] ciing eho ket cjua tflcftig dflcftig.

Rdi loqn vdn ddng xoan d binh nhdn suy tim do cdc nguyin nhdn khde nhau

Kit qua Clia chiing tdi eho thay gdc xoan T giam nhieu nhat d nhdm ed benh dpng mgeh vanh va nhdm dai thio dfldng type II vdi gdc xoan 6,3°

d nhdm cd b | n h d d i ^ mach vanh va 6,5° d nhdm cd dii thio dflcftig. Trong khi do d nhdm benh nhin tang huyet ap vi dii thio dddng fhi van tdc xoin la nhiing gia bri thap nhat Tuy nhien trong nhdm benh nhan eua chting tdi cd rit nhieu benh nhin cd ei b#nh dpng mgch vanh va tang htiyet ap hoae dii thio dddng nin khd ed thiphin biet rd rang dflde benh nhan nao cd dii thio dddng, tang huyet ip hoac benh ddng mach vanh.

Ttidng quan giSa cht so vdn ddng xoan trin aiu dm ddnh ddu md vdi mgt sd chi so sieu dm tim 2D

Ket qui cho thay ehi sd EF ed tdcftig quan chat vdi T (n=0,73, p<0,00l), Thdi gian T (r=0,48, p<0,00l), TV(r=0,75, p<0,00l). Trong nghiin cflu cnia Jianwen Wang va cdng sfl [7] eung cho thiy dg xoan eua that trai tflcftig quan thuin chit vdi EF(r=0,7, p<0,001). Ngoai ra tic gii edn danh gii mdi tflcftig cjuan giiia dp xoin vc^ mdt sd chi sd khic nhfl vdi EDV (r=-0,68, p<0,001) so vdi kit qua ciia chting tdi Ii( r=-0,44, p<0,0l). Chi sd EF la thflde do chinh dinh gii mflc do suy tim d benh nhan suy tim mgn tinh. Chi sd nay phi;i thude vao nhilu yeu td nhfl tien ganh, hiu ganh va kha ning CO bdp cfla ed tinLNghiln cniu cua Gibbons Kroeker va cpng sfl [6] dinh gii tie dgng clia cae chi sd tien ginh, hau ganh va sflc eo bdp cua that

trai tren thfle n ^ e m inh hfldng nhfl the nao din van ddng xoay ciia mdm tim. Tie gii d u dinh gia van dpng xoay tai nidm vi gdc xoay tai mdm tim ed gia tri eao hcfti d nen tim rat nhieu, vi vay gdc (juay d mom tim gin nhd quyet dinh gdc quay eua that trii. Chl sd dfldng kinh thit trai cudi tam trflcftig (Dd) cd vai trd quan trpng trong danh gii benh nhin suy tim. Benh nhin cd that trai cang gjan thi Idia nai^ eo bdp eing kem. Taber vi cgng sd [9]

ngliiln cflu van ddng xoan d 26 benh nhan suy tim do benh cd tim the gian eho thay cac sdi ed tim da bi dio ldn vi trit tfl giai phiu ke ci sd Ifldng va gdc n i n lam giam khi nang xoan ciia that trii. Tac gja eho rang khi budng that trai gjan thi van dpng xoan giam Hcfti ndz khi that trii gjan lam cjui tiinh dan diin chim tri ( C ^ ^ gian rgng), kit qui la Idp ed dfldi thflctog tim mac khfl cflc mudn se lam nen tim quay theo chieu ldm ddng hd mudn hcfti va giim khi nai^ xoan eua that triL Kit cjui Clia chiing tdi cho thay ddcft^ Idnh thit trii cudi tam trdcftig Dd ed tflcftig quan n ^ e h chat vdi thdng sd T (r=-0,75, p<0,00l), vdi thdng sd TV (r=-0,66, p<O,O0l) vdi Thdi gjan T ( r^-0,47, p<0,001), Thdi gian TV (E=-0,42, p<0,Ol) dieu niy hoan toan ddng thuin vdi eie tac gia ndi trliL

KETLUAN

Qua ngjiiai cflu tren 70 benh nhin cd suy tim va 41 n ^ d i khde manh chiing tdi thay van dpng xoay d nen tim, mdm tim vi van ddng xoin gjim d nhdm benh nhan suy tim. Mflc do suy tim NYHA cang nang tiii gpc xoay va xoin cang gjim. Benh nhin cd benh ddng mgeh vanh ed dp xoan giim thap hcfti so vdi suy tim do benh dai thio dflcftig vi tang huylt ip. Chi sd xoan Clia that trai tflcftig (juan thuin diat vdi chi sd EF vi tfldng cjuan i ^ ^ c h chat vdi dii sd Dd.

SUMMARY

In chronic heart foilure patients, the ejection fraction index (EF) is clinically considered as the most important However, it is believal tiiat torsiond jMrametors are not less important than TAP CHI TIM MACH HOC VIET NAM - 5068.20141151

A NGHIEN CLTU LAM SANG

those in assessment of left ventricular function.

Speckle tracking echocardiography is new method with high accuracy to assess the torsiond motion ofleft ventride which can be applied cUnically.

Objective: Assessing the changes of left ventricular torsion and its relationship with the other 2D echocardiographic parameters in chronic systolic dysftinctionpatients.

Method: 41 hedthy subjects and 70 patients with left ventricular systolic dysfimction were included in the study. All patients were examined, surfece ECG performed and online echocardiography recorded. After this, the recorded materid is andyzed offline with ECHOPAC 112 software (GE, USA).

Result: All the torsiond parameters induding

AR, ARyBR, BRV, T;rV decreased in heart failure groups in comparison with hedthy group.

Similarly, the time to peak torsiond degree and vdocity are longer in heart fdlure group compared with hedthy. In the group of patients with heart failure due to previous MI, the decline of torsion degree is maximd (T=6,3 degree), and due to hypertension is minimd (T=8,1 degree). Patients with higher level of heart failure (NYHA) have more torsiond dedine. Torsion is well correlates with EF index (r=0,83; p<0,00l) and inversdy widi Dd (r=-0,73; p<0,00l).

Conclusion: Torsion is a pivotd parameter in assessment ofleft ventride function and correlates well with ejection fraction index (EF) and inversely with left ventricular diastolic diameter (Dd).

TAI LI$U THAM KHAO

1. Pham Tii Dddng (2002), "Benh tang huyet ap", Bdigidngsau dqi hgc, Cue qudny, tr. tr, 105-112.

2. American Diabetes Association (2010), "Diagnosis and Dassification of Diabetes Mellitus", Diabetes Care. 33(Supplement l), tr. S62-S69.

3. Bertini M, Nucifora G, Marsan NA (2009), "Left ventiiedar rotationd mechanics in acute myocardial in&rction and in chronic heart failure patients",/Am CoH Caniiol. 103, tr. 1506-12.

4. Clyde W.Yancy, MD, MSc, FACC et d (2013), "2013 ACCF/AHA Guideline for the Management of Heart FailureA Report ofthe American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines", Orculation. 128, tr. 240-327.

5. Esdier Fuchs, Markns F. Mn" Uer, Helmut Oswdd, Harriet Tho'ny, PaulMohacsi, OttoM. Hess (2004), "Cardiac rotation and relaxation in patients with chronic heart failure", The European Journal gf Heart Failure. 6, b:. 715-22.

6. Gibbons Kroeker CA, Tyberg JV; Beyar R (1995), "Effects of load manipdations, heart rate, and contractility on left ventricular apicd rotation. An experimentd study in anesthetized dogs.". Circulation.

92, ti. 130-141.

7. Jianwen Wang, Dirar S. Khoury, Yong Yue, Guillermo Torre-Amione, and v i Nagueh, Sherif F.

(2008), "Preserved left ventricular twist andeircumferentid deformation, but depressedlongitudind and radial deformation in patientswith diastolic heart failure", European Heart Joumal. 29, tr. 1283-1289.

8. PhiUips, Aaron A (2012), "Heart Disease and left ventiicular rotation - a systematic review and quantitative summary", BMC cardiovascular disorders. 12(46).

9. TaberLA,YangM,PodszusWW(I996), "Mechanics ofventrieuIartorsion",7Biomec/i.29,tr. 745-52.

152 TAP CHI TIM MACH HOC Vl|T NAM - SO68.2014