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GiI THIU

CC TI BO CO TI HI NGH TIM MCH MIN TRUNG- TY NGUYN M RNG LN TH VI TI BUN MA THUT THNG 8 NM 2011

Cp nht siu m trong anh gia suy tim

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

ACC/AHA 2009
Siu m la thm do chn oan hu ich nht anh

gia bnh nhn co suy tim bi vi co kha nng anh gia khng xm nhp chc nng tht cung nh nguyn nhn cua bnh ly cu truc tim. Suy tim biu hin lm sang vi cac triu chng mt va kho th.

Siu m trong suy tim

3 vn chnh cn nm r: EF c bnh thng hay gim? (Lu phng php tnh EF theo tnh hung bnh l). Cu trc tht tri ? Bt thng cu trc khc (van tim, mng tim, tht phi) c th ng vi biu hin lm sng ca suy tim?

Vai tr ca siu m & Doppler

o kch thc tim (chiu day, ng knh), hnh

dng tht. Chc nng tm thu: tht trai va phi Chc nng tm trng anh gia huyt ng: ap lc nh trai, ap lc lam y tht trai, ap lc ng mch phi tm thu, ap lc TM trung tm, th tch tng mau. Chm oan bnh l cu trc ca tim: vn ng vng, van tim, mang tim

nh ngha suy tim tm trng European Society of Cardiology

C triu chng suy tim
EF >40-50% Bng chng tng BNP Ri lon chc nng tm trng trn siu m Doppler

tim. Dch t: gn bnh nhn suy tim.

K thut thng thng

Siu m M-mode Siu m 2D Doppler xung, lin tc, mu
u: tt cho cng vic

hng ngy. Nhanh v online. Nhc: Doppler phi thng hng dng chy, siu m l thuc cht lng hnh. Sai s cc ln o v gia cc ngi o.

K thut mi v nhc im chnh

- Siu m 3D: tnh V v EF - Doppler m (TDI), bin dng m (strain) v vn tc bin dng (strain rate) - nh du m (speckle tracking)
Chi ph cao (3D): u d,

phn mm. L thuc gc (TDI) Cn phn mm c offline (vi strain v speckle tracking)

Vai tr EF/nhc im
EF l thng s chnh nh gi chc nng tm thu Khng cho thng tin v chc nng vng (VD: bnh mch

vnh) Suy tim nhng EF bnh thng Khng tng quan gia EF va kich thc tht trai vi triu chng suy tim, kha nng gng sc va tiu thu O2 c tim. Cho thng tin v tin lng. Ti l mc bnh va t vong lin quan cht che vi EF va V tht tri

EF 3D : chnh xc

Siu m vi vai tro cung cp thng s thng tim

Mi lin h suy tim tm trng v NYHA

EAE/ASE 2009

EAE/ASE 2009

Ti l E/E
E/E <8 d bo LVEDP

<15mmHg. Gi tr hn BNP trong d bo qu ti th tich, ngay c khi EF binh thng. Noi ln p lc mao mch phi tng hay khng (E/E>15).

Ti l E/E bnh l

Ph phi cp
Ti l E/E v E/Vp c chng minh c mi tng quan

tt vi p lc mao mch phi. t ra chng cng gip phn bit p lc mao mch phi cao hay thp v t o phn bit ph phi huyt ng hay tn thng t o nh hng iu tr.

Chi s Tei nh gi chc nng tht toan b

Hn EF trong tin lng t vong va

mc nng ca bnh nu >0,77. u im la co th o ngay c khi hinh nh siu m xu. Khng l thuc tn s tim, khng cn gi nh hinh dng tht khi tinh. Co th o trn Doppler qui c va m. Nhc im: gi tr binh thng thay i theo tui.

EF so vi Tei va V nh trai
Bnh nhn co NMCT chnh ln ST thi EF tt hn chi s

Tei va th tich nhi tri d bo nhp vin vi suy tim.

Chi s Tei v EF
C mi lin h gia EF v cc kiu bin i hnh thi

tht tri bnh nhn THA trong khi vi Tei index th khng.
(KamiluMKaraye. CardiovascularUltrasound 2011, 9:21)

CRT
Mt ng vn co th gia 2

tht hoc trong cung tht. Chn da trn: EF<35%, QRS gian, nhp xoang, suy tim va nng (NYHA 34). Co nhiu thng s siu m nh gi mt ng vn: Mmode, TDI, SR.

Colour-coded tissue Doppler image

speckle-tracking radial strain

Pulsed Wave & PET: cut-off 40ms

Lesson learned from the PROSPECT study is that the routine pulsed Doppler measures of interventricular mechanical delay(IVMD)have a high yield and are very reproducible

Kt qu nghin cu PROSPECT 2008

Khng c thng s siu m no khuyn dng chn

la bnh nhn lm CRT do nhy v c hiu khng cao.

CRT (ASE 2011)

CRT (ASE 2011)

CRT (ASE 2011)

TDI
Sng Sm >7,5cm/s co nhy 79% va c hiu 88% l

chc nng tht tri toan b binh thng. ( Alam M, Wardell J, Andersson E, Samad BA, Nordlander R: J Am Soc Echocardiogr 2000, 13:343-52.)

Nhc im ca TDI
L thuc gc
Vn tc c tim b nh hng bi vn ng ca tim, cu

trc ln cn v dng mu. Tnh thng s bin dng m da TDI b nhiu.

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

Song S va E: suy tim mn v chong tim

Cung mc gim EF nhng bnh nhn chong tim co

vn tc song S va Ethp hn bnh nhn suy tim mn tinh.

Song S va E: suy tim mn v chong tim

 K thut speckle tracking nh gi chc nng tht tri

theo 3 trc: dc, nan hoa, xoay

K thut nh du m (STE)

u nhc im ca 2D STE
Khng l thuc gc
Tnh c cc thng s vn tc, bin dng m theo

nhiu hng. Nhc: phi c cht lng hnh p, phi c phn mm chy offline v phn mm ca hng ny khng chy chung d liu ca my hng khc.

VN NG XOAY VN XON THT

u tm thu

Gia tm thu

Gia tm thu nhn t mm

Vn ng xoay, vn xon tht (ASE 2011)

Trc kia chi nh gi c nh MRI
C vai tr quan trng trong chc nng tht tm thu

v tm trng C th dng TDI mu phn gii cao nh gi nhng 2D STE d s dng hn vi a s bnh nhn Bnh thng gc xoay 7,73,5 Gi tr bnh thng thay i theo tui (tng theo tui)

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

Xon
Suy tim

Nh xon

T-nh nh xon
Tr
Tr

EF bo tn
EF gim Bnh mch vnh NMCT di ni tm mc NMCT xuyn thnh Ph i tht trai Tng huyt p BCT ph i Hp ng mch ch BCT gin Bnh mng ngoi tim

BT hoc tng
Gim

BT hoc tng
Gim

BT Gim

BT Gim

Tr Tr

BT hoc tng Thay i Gim Gim Gim

Gim Thay i BT hoc tng Gim Gim

Tr Tr Tr Tr Cha r

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

nh gi hnh thi chc nng tht phi

o ng knh v chiu dy c tht phi
o p lc ng mch phi t dng chy h van ba l v h phi Trong tc ng mch phi, hi chng t qu h hp cp c th

thy vch lin tht y sang tri. Nu c thm gin tht phi c th gy gim huyt p v cung lng tim. Khuyn co ASE/EAE 2010 nh gi chc nng tm thu v tm trng tht phi ch yu da vo TAPSE, Doppler m.

TAPSE & bnh c tim gin

c im Nhm chng (n=30) 46,03 3,96 26,10 2,66 28,75 2,35 Nhm bnh (n=61) 63,35 5,83 33,20 8,15 37,35 8,27 p

LVDd (mm) RVDd (mm) ng knh nh phi (mm)

<0,001 <0,001 <0,001

RVDd/LVDd EF (%) FS (%) TAPSE

0,57 0,07 69,90 7,48 39,43 6,42 23,57 1,60

0,53 0,12 28,26 8,51 13,67 4,37 13,93 2,78

<0,05 <0,001 <0,001 <0,001

Nguyn Lin Nht , Nguyn Anh V

TAPSE & TDI anh gia chc nng tht phi

o Sa trn Doppler m

o TAPSE

Kt lun
- Siu m Doppler co th giup xc nh nhanh chng nguyn nhn suy tim. - Co th s dng k thut nay nh gi tt chc nng tm thu va tm trng ca cc tht. - Giup o p lc ng mch phi va nh gi p lc mao mch phi. - Cng c hng dn iu tr: chi nh truyn dch, li tiu, thuc tng co c tim, thuc gian mch, thuc vn mch cng nh giup chinh cc thng s th my.