利用二尖瓣反流连续多普勒频谱测算左房压的方法学研究

The left atrial pressure (LAP), the preload of the left ventricle, is an ideal index for clinical hemodynamics. Presently LAP is directly measured with the catheter method, or replaced by measuring pulmonary artery wedge pressure(PAWP). However, both of these two methods are invasive and thus cannot be used as routine tests. Over the years scholars have explored a variety of noninvasive methods to measure LAP, such as “Doppler + sphygmomanometer" method, but all the methods are not applied in clinical practice due to their inaccuracy and complexity. In other words, LAP application is almost blank in clinical routine diagnosis and treatment..When we study the left ventricular relaxation time constant (τ), we deduce a new "binary linear equation group" involving two variables, τ and LAP, based on three classical formulas. When the mitral regurgitation spectrum decreases, we measure two time periods, and if they are introduced into the binary linear equation group, LAP is eliminated and τ will be worked out, and this method has been experimentally verified. If τ is eliminated, then LAP will be worked out. This project aims to compare the method above with the catheter method and the "Doppler + sphygmomanometer" method in terms of accuracy and effectiveness to measure LAP through a series of animal tests and clinical tests..If the proposed method is validated, the "one-touch" to measure LAP will be achieved by adjusting the internal settings of the ultrasound system and introducing the binary linear equation group. Therefore, this study is of great clinical importance for it will promote the accuracy of the routine diagnosis and treatment of clinical heart disease.

左房压（LAP）为左室前负荷，为临床梦寐以求的血流动力学参数，主要通过导管法直接测量，或测肺动脉楔压代替LAP，为创伤性检查，不能作为常规检查方法。多年来学者们探索了多种无创评价LAP方法，如“多普勒+血压计”法等，因欠准确、复杂等不足，均没能应用于临床。.我们在前期的利用二尖瓣反流频谱测算左室松弛时间常数（τ）研究中，用三个经典公式，运用数学方法推导出一个全新的“二元一次方程组”，有τ和LAP两个变量，在二尖瓣反流频谱测量2个时间，代入方程组，消除LAP可计算出τ，已得到实验验证。反之，该“二元一次方程组”也应可以测算LAP。本项目拟研究用该法测算LAP，以导管法为“金标准”，进行系列动物与临床验证实验，并与“多普勒+血压计”法对比。如得以验证，调整超声仪设置、内置相应软件及方程组，可实现超声检查时“一键”实时测量LAP，促进心脏疾病临床诊疗迈向精准化阶段。

左房压（LAP）为左室前负荷，为临床梦寐以求的血流动力学参数，主要通过导管法直接 测量，或测肺动脉楔压代替LAP，为创伤性检查，不能作为常规检查方法。多年来学者们探索了多种无创评价LAP方法，如“多普勒+血压计”法等，因欠准确、复杂等不足，均没能应用于临床。我们在前期的利用二尖瓣反流频谱测算左室松弛时间常数（τ）研究中，用三个经典公式 ，运用数学方法推导出一个全新的“二元一次方程组”，有τ和LAP两个变量，在二尖瓣反流 频谱测量2个时间，代入方程组，消除LAP可计算出τ，已得到实验验证。反之，该“二元一次方程组”也应可以测算LAP。本项目研究用该法测算LAP，以导管法为“金标准”，进行系列动物与临床验证实验，并与“多普勒+血压计”法对比。.研究结果：①推导出应用超声无创定量测算左房压的新公式。②先后与迈瑞公司及东北大学软件学院的团队进行合作，建立了基于深度学习的频谱包络线描记法，取得计算机软件著作权2项：超声心动图连续多普勒频谱智能分析系统V1.0；超声心动图报告科研数据收集分析系统V1.0。③动物验证实验结果：这种新的超声方法可测算左房压大小，与金标准导管测量法比较，该方法测量左房压无创、准确、简单、方便。④临床验证实验结果：采用20例冠脉搭桥术患者和20例瓣膜病二尖瓣成形术患者，验证了该方法可测量左房压、利用软件测量左房压的可操作性，并与“多普勒+血压计”法对比，相关性良好。.将来，经过临床多中心大样本临床实验验证后，可调整超声仪设置，内置相应软件及方程组，可实现超声检查时“一键”实时测量LAP，促进心脏疾病临床诊疗迈向精准化阶段。