21.VAI TRO SIEU AM CHAN DOAN SUY TIM

8/4/2019 21.VAI TRO SIEU AM CHAN DOAN SUY TIM

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P G S T S N G U Y N A N H V I H C Y D C H U

T R U N G T M T I M M C H H U

Cp nht siu m trong nh gisuy tim


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ACC/AHA 2009

y Siu m l thm d chn on hu ch nht nhgi bnh nhn c suy tim bi v c kh nng nhgi khng xm nhp chc nng tht cng nh

nguyn nhn ca bnh l cu trc tim.y Suy tim biu hin lm sng vi cc triu chng mt

v kh th.


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Siu m trong suytim

3 vn chnh cn nm r:

y EF c bnh thng haygim?

(Lu phng php tnh EF theo tnh hung bnh l).

y Cu trc tht tri ?

y Bt thng cu trc khc (van tim, mng tim, thtphi) c th ng vi biu hin lm sng ca suytim?


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Vai tr ca siu m & Doppler

y o kch thc tim (chiu dy, ng knh), hnhdng tht.

y Chc nng tm thu: tht tri v phi

y Chc nng tm trngy nh gi huyt ng: p lc nh tri, p lc lm y

tht tri, p lc ng mch phi tm thu, p lc TMtrung tm, th tch tng mu.

y Chm on bnh l cu trc ca tim: vn ng vng,van tim, mng tim


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nh ngha suytim tm trngEuropean Societyof Cardiology

y C triu chng suytim

y EF >40-50%

y Bng chng tng BNP

y Ri lon chc nng tm trng trn siu m Dopplertim.

Dch t: gn bnh nhn suytim.


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K thut thng thng

Siu m M-mode

Siu m 2D

Doppler xung, lin tc,mu

y u: tt cho cng vichng ngy. Nhanh vonline.

y Nhc: Doppler phithng hng dng chy,siu m l thuc chtlng hnh. Sai s cc lno v gia cc ngi o.


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K thut mi v nhc im chnh

- Siu m 3D: tnh Vv EF

- Doppler m (TDI), bindng m (strain) v vn tc

bin dng (strain rate)

- nh du m (speckletracking)

y Chi ph cao (3D): u d,phn mm.

y L thuc gc (TDI)

y Cn phn mm coffline (vi strain vspeckle tracking)


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Vai tr EF/nhc im

y EF l thng s chnh nh gi chc nng tm thu

y Khng cho thng tin v chc nng vng (VD: bnh mchvnh)

y Suy tim nhng EF bnh thng

y Khng tng quan gia EF v kch thc tht tri vi triuchng suy tim, kh nng gng sc v tiu th O2 c tim.

y Cho thng tin v tin lng.

y T l mc bnh v t vong lin quan cht ch vi EF v V thttri


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EF 3D : chnh xc


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Siu m vi vai tr cung cp thng s thng tim


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Mi lin h suytim tm trng v NYHA


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EAE/ASE 2009


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EAE/ASE 2009


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Ti l E/E

y E/E


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T l E/E bnh l


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Ph phi cp

y T l E/E v E/Vp c chng minh c mi tng quantt vi p lc mao mch phi.

y t ra chng cng gip phn bit p lc mao mch phi cao

hay thp v t phn bit ph phi huyt ng hay tnthn g t nh hng iu tr.


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Ch sTei nh gi chc nng tht ton b

y Hn EF trong tin lng t vong vmc nng ca bnh nu >0,77.

y u im l c th o ngay c khi hnhnh siu m xu.

y Khng l thuc tn s tim, khng cngi nh hnh dng tht khi tnh.

y C th o trn Doppler qui c vm.

y Nhc im: gi tr bnh thng thayi theo tui.


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EF so vi Tei v V nh tri

y Bnh nhn c NMCTchnh ln ST th EF tt hn ch sTei v th tch nh tri d bo nhp vin v suy tim.


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Ch s Tei v EF

y C mi lin h gia EF v cc kiu bin i hnh thitht tribnh nhn THA trong khi vi Teiindex thkhng.

(K

amiluMK

araye. CardiovascularUltrasound 2011, 9:21)


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CRT

y Mt ng vn c th gia 2tht hoc trong cng tht.

y Chn da trn: EF


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Colour-coded tissue Doppler image


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speckle-tracking radial strain


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Pulsed Wave & PET: cut-off 40ms

Lesson learned from the PROSPECT study is that the routine pulsed Dopplermeasures of interventricular mechanical delay(IVMD)have a high yield and arevery reproducible


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Kt qu nghin cuPROSPECT 2008

y Khng c thng s siu m no khuyn dng chnla bnh nhn lm CRT do nhyv c hiukhng cao.


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CRT (ASE 2011)


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CRT (ASE 2011)


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CRT (ASE 2011)


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y Sng Sm >7,5cm/s c nhy 79% v c hiu 88% lchc nng tht tri ton b bnh thng.

( Alam M, Wardell J, Andersson E, Samad BA, Nordlander

R: J Am Soc Echocardiogr 2000, 13:343-52.)

TDI


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Nhc im ca TDI

y L thuc gc

y Vn tc ctim b nh hng bi vn ng ca tim, cutrc ln cn v dng mu.

y Tnh thng sbin dng m da TDI b nhiu.


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Vn k thut: TDI l thuc gc v khng kho stc vn ng trc xoay v trc ngn.


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Song S va E: suytim mn v chong tim

y Cng mc gim EF nhng bnh nhn chong tim cvn tc sng S v Ethp hn bnh nhn suy tim mntnh.


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Song S va E: suytim mn v chong tim


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y K thut speckle tracking nh gi chc nng tht tritheo 3 trc: dc, nan hoa, xoay


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K thut nh du m (STE)


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u nhc im ca 2D STE

y Khng l thuc gc

y Tnh c cc thng svn tc, bin dng m theonhiu hng.

y Nhc: phi c cht lng hnh p, phi c phnmm chyoffline v phn mm ca hng nykhngchychung d liu ca myhng khc.


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u tm thuGia tm thu

Gia tm thu nhn t mm

VN NG XOAYVN XON THT


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Vn ng xoay, vn xon tht (ASE 2011)

y Trc kia ch nh gi c nhMRI

y C vai tr quan trng trong chc nng tht tm thuv tm trng

y C th dng TDI mu phn gii cao nh ginhng 2D STE d s dng hn vi a sbnh nhn

y Bnh thng gc xoay7,73,5

y Gi trbnh thng thayi theo tui (tng theo tui)


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Vn xon (twist) v nh xon tht tri (ASE 2011)

Xon Nh xon T- nh nhxon

Suy tim

EF bo tn BT hoc tng BT hoc tng Tr

EF gim Gim Gim Tr

Bnh mch vnh

NMCT di ni tm mc BT BT Tr

NMCT xuyn thnh Gim Gim Tr

Ph i tht tri

Tng huyt p BT hoc tng Gim Tr

BCT ph i Thay i Thay i Tr

Hp ng mch ch Gim BT hoc tng Tr

BCT gin Gim Gim Tr

Bnh mng ngoi tim Gim Gim Cha r


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Bnh thng v i tho ng khng dytht tri(ASE 2011)


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nh gi hnh thi chc nng tht phi

y o ng knh v chiu dy ctht phi

y op lc ng mch phi t dng chy hvan ba l v hphi

y Trong tc ng mch phi, hi chng t qu h hp cp c th

thy v

ch lin th

t y sang tri

.N

u

c thm gin th

t ph

i

cth gy gim huyt p v cung lng tim.

y Khuyn co ASE/EAE 2010 nh gi chc nng tm thu v tmtrng tht phi ch yu da vo TAPSE, Doppler m.


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TAPSE & bnh ctim gin

c im Nhm chng(n=30)

Nhm bnh(n=61)

p

LVDd (mm) 46,03 3,96 63,35 5,83


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o TAPSE

o Sa trn Doppler m

TAPSE & TDI nh gi chc nng tht phi


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Kt lun

- Siu m Doppler c th gip xc nh nhanh chngnguyn nhn suy tim.

- C th s dng k thut ny nh gi tt chc nng

tm thu v tm trng ca cc tht.- Gip o p lc ng mch phi v nh gi p lc mao

mch phi.

- Cng c hng dn iu tr: ch nh truyn dch, li tiu,

thuc tng co ctim, thuc gin mch, thuc vn mchcng nh gip chnh cc thng s thmy.

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21.VAI TRO SIEU AM CHAN DOAN SUY TIM