摘要
目的探讨三维斑点追踪(3D-STI)技术评估缺血性二尖瓣反流(IMR)患者左心功能的临床应用价值。方法选取104例冠状动脉粥样硬化性心脏病(以下简称冠心病)患者,根据其有无继发于二尖瓣反流分为单纯冠心病组40例和IMR组64例(其中23例轻度反流,22例中度反流,19例重度反流),另选健康志愿者42例为对照组,各组均行常规超声心动图和3D-STI检查。比较常规超声心动图指标:左室收缩、舒张末期内径(LVIDS、LVIDD)、收缩末期左房前后径(LAD)、左室舒张早期与晚期二尖瓣环运动峰值的比值(Em/Am)、血流速度比(E/A)、左室射血分数(LVEF),以及3D-STI指标:左房最大、最小、收缩前容积(LAVmax、LAVmin、LAVp)、左房总射血分数(LAEF)、被动排空分数(LApEF)、主动射血分数(LAaEF)、左房整体纵向应变(GLS)、圆周应变(GCS)、径向应变(GRS)及各应变达峰时间标准差(TLS-SD、TCS-SD、TRS-SD);分析IMR患者3D-STI指标与LAEF的相关性。绘制受试者工作特征(ROC)曲线分析TLS-SD、TCSSD、TRS-SD评估左房功能改变的效能。结果各组常规超声心动图指标LVIDS、LVIDD、LAD、Em/Am、LVEF比较,差异均有统计学意义(均P<0.05);LVIDS、LVEF各组间两两比较,差异均有统计学意义(均P<0.05)。各组3D-STI指标LAVmin、LAVp、LAEF、LAaEF、GLS、GCS、GRS、TLS-SD、TCS-SD、TRS-SD比较,差异均有统计学意义(均P<0.05);LAVmin、LAEF、LApEF、LAaEF、GLS、GCS、GRS、TLS-SD、TRS-SD各组间两两比较,差异均有统计学意义(均P<0.05)。IMR患者GLS、GCS、GRS与LAEF均呈正相关(r=0.210、0.383、0.381,均P<0.05)。TLS-SD、TCS-SD、TRS-SD截断值分别为53.9 ms、139.3 ms、89.2 ms时,其评估左房功能改变的曲线下面积分别为0.862、0.841、0.924,敏感性分别为70.3%、65.6%、78.1%,特异性分别为100%、90.5%、100%。结论3D-STI技术可准确、客观地评估IMR患者左房功能变化,具有较高的临床应用价值。
Objective To investigate the clinical application value of three-dimensional speckle tracking imaging(3D-STI)technology in evaluating left ventricular function in patients with ischemic mitral regurgitation(IMR).Methods A total of 104 patients with coronary atherosclerotic heart disease(hereinafter referred to as coronary heart disease)were selected.According to whether they were secondary to mitral valve shunt,they were divided into 40 cases in simple coronary heart disease group and 64 cases in IMR group(23 cases of mild reflux,22 cases of moderate reflux,19 cases of severe reflux),another 42 healthy volunteers were selected as the control group,routine echocardiography and 3D-STI were performed in each group.The indicators of conventional echocardiography among the groups were compared,including the left ventricular systolic/late diastolic diameter(LVIDS,LVIDD),left anterior and posterior atrial diameter(LAD),ratio of left ventricular early and late diastolic peak motion ratio(Em/Am),blood flow ratio(E/A),left ventricular ejection fraction(LVEF).The parameters of 3D-STI were compared among the groups,including left atrial maximum/minimum/precontractile volume(LAVmax,LAVmin,LAVp),left atrial total ejection fraction(LAEF),passive emptying fraction(LApEF),active ejection fraction(LAaEF),left atrial overall longitudinal strain(GLS),circumferential strain(GCS),radial strain(GRS),peak time standard deviation[longitudinal(TLSSD),circumferential(TCS-SD),radial(TRS-SD)].The correlation between 3D-STI parameters of IMR patients and LAEF were analyzed.The ROC curve was drawn to analyze the efficiency of TLS-SD,TCS-SD,TRS-SD in evaluating the left atrial function changes.Results The conventional echocardiographic indexes LVIDD,LVIDS,LAD,Em/Am and LVEF were significantly different(all P<0.05).The difference of LVIDS and LVEF between IMR patients and the other two groups were statistically significant(all P<0.05).There were significant differences in LAVmin,LAVp,LAEF,LAaEF,GLS,GCS,GRS,TLS-SD,TRS-SD among the three groups(al
作者
杨道玲
王戏丹
吴玉莲
陈静婉
YANG Daoling;WANG Xidan;WU Yulian;CHEN Jingwan(Department of Ultrasound,Jinhua Hospital,Zhejiang University School of Medicine,Zhejiang 321000,China)
出处
《临床超声医学杂志》
CSCD
2021年第6期432-436,共5页
Journal of Clinical Ultrasound in Medicine
基金
浙江省卫生厅面上项目(2020KY1012)
金华市科技局基金项目(2019-4-010)。
关键词
斑点追踪
三维
二尖瓣反流
缺血性
心房功能
左
Speckle tracking imaging,three-dimensional
Mitral regurgitation,ischemic
Atrial function,left
