实时三维超声参数在评价稳定性冠心病患者左心室舒张功能中的作用  

Study of Left Ventricular Diastolic Function in Stable Coronary Patients by Real-time Three-dimensional Echocardiography

作　　者：林琼雯[1] 王吴刚[1] 吴伟春[1] 王浩[1] 

机构地区：[1]北京协和医学院 中国医学科学院 阜外心血管病医院 超声科,北京市100037

出　　处：《中国分子心脏病学杂志》2013年第5期662-666,共5页Molecular Cardiology of China

摘　　要：目的探讨实时三维超声心动图（real—timethree—dimensional echocardiography，RT-3DE）技术在稳定性冠心病患者左心室舒张功能评价中的应用价值。方法将65例稳定性冠心病患者根据造影检查所示冠状动脉狭窄程度分组。应用RT-3DE技术获取患者左心室容积-时间曲线（volume—timecurve，VTC），观察整体及各节段VTC形态，计算舒张早期峰值充盈率（peak filling rate，PFR）、平均充盈率（meanfillingrate，MFR）、1，3充盈分数（I／3 filling fraction，1／3 FF）等参数，比较组间差异，选择有效参数进行相关性分析，并计算ROC曲线下面积。结果RT-3DE所测左心室容积、射血分数、峰值射血率（peak ejection rate，PER）及MFR在各组患者中无明显差异。PFR、1／3 FF随着冠状动脉狭窄程度的加重逐渐降低．冠状动脉明显狭窄者与造影结果正常者相比较，差异具有统计学意义（P均〈0．05）。PFR、1／3 FF与E／E’比值及NT—proBNP浓度均呈负相关，1/3 FF相关性优于PFR（与E／E’比值，r=-0．751．P〈0．01；与NT—proBNP浓度，r=0．612，P〈0．01）。以1/3FF判断无显著冠状动脉狭窄（即狭窄程度〈70％）的曲线下面积为0．772（P=0．001）．95％置信区间为0．633—0．911。1/3 FF≥36．75％判断冠状动脉狭窄程度〈70％的敏感性为73％，特异性为76％。氨基末端脑钠肽前体（N—terminal pro—B—type natriuretic peptide，NT—proBNP）。结论RT-3DE可定性、定量反映稳定性冠心病患者左心室舒张功能的变化，1／3FF可在一定程度上检测此类患者初期出现的以舒张早期心肌弛缓异常为主的轻度舒张功能受损。Objective To explore the value of real-time three-dimensional echocardiography （RT-3DE） derived parameters in thc assessment of LV diastolic function in patients with coronary artery disease （CAD）. Methods Sixty-five stable CAD patients were enrolled and were divided into 3 groups according to the degree of coronary stenosis. Left ventricular volume-time curves （VTCs） were acquired using RT-3DE, and then peak filling rate （PFR）, mean filling rate （MFR） and 1/3 filling fraction （1/3 FF） were measured to evaluate the LV diastolic function. The correlations of RT3DE-derived LV diastolic parameters with E/E＇ and plasma NT-proBNP levels were analyzed, respectively. The ROC curve of RT3DE-dcrived parameter was analyzed to identify the predictive value for coronary stenosis. N-terminal pro-B-type natriuretic peptide （NT-proBNP）. Results With the worsening of coronary stenosis, PFR and 1/3 FF decreased gradually. PFR and 1/3 FF in patients with obviously coronary stenosis were significantly lower than those in the normal control group （P 〈0.05）, and while MFR showed no differences between each two groups. PFR and 1/3 FF both inversely correlated with E/E＇ and NT-proBNP level, respectively, with 1/3 FF presenting higher correlation coefficients （for E/E, r =- 0.751, P 〈0.01; for NT-proBNP level, r ~0.612, P 〈0.01 ）. By the ROC curve, the area under the curve of 1/3 FF was 0.772 （P 0.001）, with 95% confidence interval at 0.633-0.911. The sensitivity and specificity of 1/3 FF 〉_36.75% for coronary stenosis 〈70% were 73% and 76%, respectively. Conclusions It is suggested that the VTC by RT-3DE can bc used to assess LV diastolic function in stable CAD patients with different degrees of coronary stcnosis qualitativcly and quantitatively. To a certain degree, 1/3 FF could detect mild diastolic dysfunction characterized by myocardial relaxation abnormalities in these patients at the early times.

关 键 词：实时三维超声心动图 左心室舒张功能 冠状动脉狭窄 容积-时间曲线 

分 类 号：R541.4[医药卫生—心血管疾病]