应变成像与心肌病早期病变的相关性研究

Cardiomyopathy is known as insidious onset and aspecific clinical symptoms, with bad prognosis in some cases. Therefore, early diagnosis of cardiomyopathy has been a key-problem of medical imaging. Our previous studies and related references showed that the early regional myocardium dysfunction could be detected by strain or strain rate imaging (SR/SRI) before the global cardiac function decreased, and strain parameters are correlated with the pathological changes degree. However, the relationship between strain indices and histology changes, interstitial components changes in eraly stage of cardiomyopathy is not clear. Thus, further fundamental exploration on histology and biomechanics features is of great scientific significanceis for early diagnosis and therapeutic evaluation of cardiomyopathy by strain analysis.In this research protocol, animal experiment,pathology study,biomechanics and clinical research will be used as methodology.We plan to analyze histologic and biomechanics fundamentals in depth during early stage of cardiomyopathy, exlpore correlation relationship between strain indices and basic pathologic changes, fibrosis degree of interstitial tissue, apoptosis cells count, and also biomechanics parameters such as left ventricle diastolic pressure (LVDP), myocardium systolic and diastolic velocity (±dp/dt). Futhermore,the alarm value of strain imaging in early diagnosis will be set up and therapeutic efficiency evaluation will be studied also. This project will contribute to: (1) further explain the histologic and biomechanics fundation of strain changes in cardiomyopathy disease, promote accuracy and sensitivity of cardiomyopathy early diagnosis; (2) definite the feasibility and utility of strain imaging in therapeutic efficiency evaluation and clinical outcomes prediction. In summary, this research will be of significant medicinal value in providing new ways of cardiomyopathy early diagnosis and prognosis prediction.

心肌病起病隐匿，临床表现缺乏特异性，部分预后差，早期诊断一直是影像医学的难点。我们的前期研究和文献表明：应变成像可检测出早期心肌病变，应变量值与病变程度及间质成分变化存在量化相关，但应变量值与早期心肌组织学、力学变化关系尚不清楚，深入研究其组织学、生物力学基础对于早期诊断、治疗心肌病具有重要的科学意义。本研究拟采用动物实验、组织病理、生物力学、临床研究等方法，分析心肌病发病初期应变成像的组织学和生物力学基础；探讨应变量值与心肌病理改变、间质纤维化程度、凋亡细胞计数、左室舒张末压、收缩舒张速率等病理学和生物力学特性的相关性；建立应变成像早期诊断心肌病的预警值并协助评估疗效、判断预后。本研究有助于：（1）进一步阐明应变成像的组织学和生物力学基础，提高心肌病早期正确诊断率；（2）进一步明确应变量值在心肌病疗效评估、预测转归中的作用，为早期诊断心肌病、有效评估预后开辟了新方法，有重要的医学价值。

心肌病起病隐匿，临床表现缺乏特异性，部分预后差，早期诊断一直是影像医学的难点。我们的前期研究和文献表明：应变成像可检测出早期心肌病变，应变量值与病变程度及间质成分变化存在量化相关，但应变量值与早期心肌组织学、力学变化关系尚不清楚，深入研究其组织学、生物力学基础对于早期诊断、治疗心肌病具有重要的科学意义。本研究采用动物实验、组织病理、临床研究等方法，分析心肌病发病初期应变成像的组织学和生物力学基础；探讨应变量值与心肌病理改变、间质纤维化程度、凋亡细胞计数、左室舒张末压、收缩舒张速率等病理学和生物力学特性的相关性；建立应变成像早期诊断心肌病的预警值并协助评估疗效、判断预后。.本项目完成了不同时间节点心肌病小鼠模型的常规超声心动图成像与心肌应变成像，测量各节点常规心功能参数、以二维斑点追踪技术为基础的超声应变参数筛选与测量，探讨心肌病病程与超声参数改变直接关联；完成了心肌病组织学特点分析，并初步探讨了心肌病应变值与病变程度、胶原容积指数、炎细胞侵润程度、凋亡指数等病理学特性之间的关联。统计分析应变指标（纵向、径向、环向PK%、TPK、MOWD）与各病理指标之间的相关性；完成了临床收集的成人心肌病、早衰症心肌病变组及正常同龄儿童和生理年龄相当的健康老年人对照组进行三维超声心动图参数分析、比较，评价三维超声应变参数在评估心脏早期功能改变中的应用价值。.本研究有助于：（1）进一步阐明应变成像的组织学和生物力学基础，提高心肌病早期正确诊断率；（2）进一步明确应变量值在心肌病疗效评估、预测转归中的作用，为早期诊断心肌病、有效评估预后开辟了新方法，有重要的医学价值。