TS.

Nguyn th thu hoI

nh gi chc nng
tht tri bng siu m
Doppler tim

M u

Ri lon chc nng tht tri: bin

chng thng gp cc bn TM.

Hu qu: Suy tim, RL nhp tim, t vong.

Siu m tim l phng php thm d

hu ch nh gi CNTT, gip cho
chn on v tin lng bnh c chnh
xc.

 1955 - Inge Edler: ln u tin nghin cu

nh gi chc nng tht tri bng siu
m A-mode v M-mode.
1966 - Harvey Feigenbaum: o chc
nng tht tri trn siu m M-mode vi
cc tn hiu t vch lin tht.

 1976 - Harvey Feigenbaum: nh gi

CNTT trn siu m M-mode vi thi gian
thc (real-time).
KQ thu c t phng php ny c tng
quan cht ch vi phng php chp
bung tht tri.
Hn ch: siu m M-mode ch gip kho st kch thc ngang ca tht tri, khng kho st c chnh
xc dc theo chiu di ca tm tht.

 1974 1978: u d siu m c ci tin

nhiu -> gip quan st h/ siu m 2D theo
thi gian thc vi gc 90 -> quan st c kh y cc cu trc ca tim.
-> tnh ton c CNTT trn siu m TM.

Nhc im: Siu m M-mode khng nh gi c

chnh xc th tch ca bung tht, nht l trong trung
hp TT b bin dng (NMCT).

 Nhng nm 1980: Ra i cc phng

php tnh th tch tht tri theo thit
din v chiu di: Simpson, Cubed

chnh xc cao khi so snh vi cc

phng php tiu chun vng: chp
bung tim, x hnh c tim

Siu m Doppler
Hiu ng Doppler:
1884 - Johan Christian Doppler
Phng trnh
ng hc
cht lng
Bernoullie:
chnh lch
p lc gia 2
v tr cn
quan st.
(J Am Coll Cardiol 2006;48: 201225)

Siu m Doppler
nh gi CN tm thu TT: CO, PET, ET,
IVCT, VTI (LVOT)

nh gi CN tm trng TT: dng chy

VHL, dng chy TMP, IVRT...

Siu m Doppler m c tim

1989- Isaac: Siu m Doppler m xung
c tim.

1994- Surtherland: SA Doppler m mu

M-mode v 2D
2000- JDhood: Doppler sc cng c
tim (strain v strain rate)
Speckle tracking imaging- STI

nh gi chc nng
tm thu tht tri

nh gi CN tm thu TT
trn siu m TM
-Khong cch E-VLT
-% co ngn si c:
Dd Ds

%D=

Dd

-Phn s tng mu EF
Vd Vs

EF =

Vd

V= 7D3/(2,4+D)

nh gi CN tm thu TT
trn siu m TM

nh gi CN tm thu TT
trn siu m TM

nh gi CN tm thu TT
trn siu m TM

nh gi CN tm thu TT

PHng php simpson

20
V= (h d2/4)
1
V: Th tch TT
h: Chiu cao ca
mt khi nh.
d: K ca mt
khi nh

Nguyn l: Th tch hnh ln bng tng th tch ca

cc hnh nh c chia ra t hnh ln theo trc dc.
Bung TT c chia thnh nhng hnh tr (vng thn
tht tri), vng mm c coi nh hnh ellip.

PHng php simpson

PHng php simpson

Siu m 3D
Nguyn l ban u: tI to hnh nh
da trn cc hnh 2D thnh phn.
Siu m 3D thi gian thc: cng mt
lc, u d ( > 3000 tinh th) thu nhn c cc d liu 3 chiu, vi hnh nh tim
ang co bp, t bt c gc qut no.

Siu m 3D

Am Heart J;130: 812-22Am Heart J;130: 812-22

Siu m 3D

Circulation 2005 112: 1161 - 1170

Cung lng tim

CO = VTImc x (d/2)2 x x tn s tim
Hoc

CO = SV x tn s tim
CO: lng mu bm vo h thng TH
trong 1 v thi gian.
nh gi CN tm thu TT : bnh van tim,
bnh c tim, bnh mch vnh, RL huyt
ng.

Cc thi khong tm thu

Thi gian tin tng mu

PET

Cc yu t nh hng:

TS tim, AL tm trng MC, dn truyn in

hc trong tht.

Cc thi khong tm thu

Thi gian tng mu

herkules.oulun.fi

Cc yu t nh hng:
TS tim, tin gnh, hu gnh

Tc tng p lc tht trI ti a

(+dP/dt)
+dP/dt > 1200 mmHg/s: CNTTTT bnh thng

+dP/dt 800 1200 mmHg/s: CNTTTT gim nh n va

+dP/dt < 800 mmHg/s: CNTTTT gim nng

Circulation 1989;80;1287-1292

ECHOCARDIOGRAPHY Vol. 24, No. 5, 2007

Siu m Doppler m c tim

V(S): phn nh CN tm thu TT

BT: V(S) > 9cm/s

V(S) gim: RLCN tm thu TT, tui

cao.
C mi tng quan tuyn tnh cht
ch vi EF, +dP/dt

V(S) gim I khi c

thiu mu c tim cc
b, tng ln sau tI t i m u M V
Am J Cardiol 1989; 64: 66-75

nh gi chc nng tm thu

tng vng tht tri

Phn vng tht trI theo hi Siu m Hoa k

S phn vng t-i mu ca cc nhnh MV chnh

TP

Trc di cnh c

Trc ngn cnh c

7
7

14

15

TT

TP

TT

12

10

M lin tht tr-c

11
10

M m
13

M vnh phi

15

16

14

Thnh sau

12

Thnh tr-c
11

M l.th.tr-c + phi
TP

TT
6

M l.th.tr-c + m
NP

TT
3

NT

Bn bung tim t mm

NT

Hai bung tim t mm

Siu m cn m

European Heart Journal 2008; 29: 299-314

Siu m Doppler xung m c tim

Pulsed TDI

A
E

theo di vn ng m c tim
(Tissue tracking - TT)

S phn b mu cho thy thnh bn tht tri co bp mun ( thi

gian c xc nh da vo cc thi im ng van MC v VHL)

to hnh nh ng b m c tim

(Tissue Synchronyzation Imaging -TSI)

TSI

TT

Thnh bn TT c thi gian at vn tc ti a ko di

4D Tissue Synchronyzation Imaging -TSI

Vng trc vch () co bp mun

Strain Rate imaging

Bnh thng

Mt ng b

Bax et al JACC 2004 44 1

Siu m Doppler m c m ho mu (color coded TDI) mc co
bp tng vng c tim.
T ng tnh ton chnh lch v vn tc gia cc vng c tim, biu
din theo TG.

Theo di vn ng m c tim dng m

(Speckle tracking imaging -STI)

(J Am Coll Cardiol 2006;48:201225)

Theo di vn ng m c tim dng m 3D

(3d Speckle tracking imaging 3DSTI)

Echocardiography, Volume 25, November 2008 p 1167-71

nh gi chc nng
tm trng tht tri

nh gi chc nng tm trng

tht tri
Siu m TM
Thi gian gin ng th tch
Vn ng trong th tm trng ca thnh
sau MC
Dc tm trng ca van hai l (dc EF)

Khong cch AC cui tm trng khi van

hai l ng

nh gi chc nng tm trng

tht tri
Siu m TM

Siu m doppler dng chy vhl

T l E/A
Thi gian gim tc sng A

Thi gian gin ng th tch

Siu m Doppler dng chy VHL

nh E

Thi gian gim tc

sng E

nh A

Thi gian
sngA

dng chy qua VHl

Bnh thng

Hn ch

Gim n hi

Dng chy tnh mch phi

Sng tm thu.
Sng tm trng.
Dng tro ngc ca nh tri.

Dng chy TM phi

S

Khi vn tc sng S < 40% vn tc sng D

-> c tng p lc nh tri.
Khng p dng c BN rung nh.

Tc lan truyn ca dng y u

tm trng (Vp)

Siu m Doppler m c tim

Samer J. Khouri,
(J Am Soc Echocardiogr
2004;17:290-7.)

nh gi chc nng
ton b tht trI

Ch s Tei ( Tei - index )

Chuwa Tei - nm 1995
Ch s Tei (Tei index), ch s chc nng c
tim (Index of Myocardial Performance)
Phng php o:

TG gin ng th tch + TG co ng th tch

Ch s Tei =
Thi gian tng mu

nh gi chc nng ton b tht tri

bng ch s Tei

Kt lun

Cng vi s pht trin ca cc k thut

thm d SA v k thut vi x l, SA Doppler
tim ngy cng chng t l mt phng php
c tin cy cao, khng xm nhp, nh
gi chnh xc tnh trng huyt ng, chc
nng tm thu v tm trng tht tri ton b
v tng vng cc bnh nhn tim mch.