心音图在慢性收缩性心力衰竭中的诊断价值  

Diagnostic value of acoustic cardiography in chronic systolic heart failure

作　　者：许逸飞[1] 周颖[2] 鲍敏芳 林海燕[2] 张文波[2] 徐耕[2] 

机构地区：[1]浙江省中医院心血管内科,杭州310006 [2]浙江大学医学院附属第二医院心血管内科

出　　处：《中华心律失常学杂志》2014年第4期304-308,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 探讨心音图在慢性心力衰竭诊断中的临床应用价值.方法 2012年3月至2013年9月入住浙江大学医学院附属第二医院心内科的患者共243例,其中慢性心力衰竭组128例,对照组115例.利用心音图技术分别测定两组电-机械激动时间（electromechanical activation time,EMAT）、左心室收缩时间（left ventricular systolic time,LVST）及第三心音（S3）强度,比较两组平均EMAT、LVST及S3强度的差异,分析EMAT及S3在诊断慢性心力衰竭中的敏感性与特异性.结果 慢性心力衰竭组平均EMAT较对照组明显延长（121±17）ms对（88±15）ms,（P＜0.001）,平均LVST明显缩短（311±39）ms对（340±22） ms,（P＜0.05）,S3强度明显增高（4.22±2.30对3.01±0.66,P＜0.05）,慢性心力衰竭组S3存在率32.0％,高于对照组11.3％ （P＜0.05）.EMAT诊断慢性心力衰竭的敏感性及特异性分别为96.1％、87.0％,对脑钠肽（BNP）处于灰区（100～400 ng/L）的慢性心力衰竭患者,EMAT诊断心力衰竭的敏感性及特异性分别为95.3％、72.4％.结论 心音图参数EMAT、LVST、S3强度均有助于快速诊断心力衰竭,尤其EMAT诊断慢性心力衰竭的临床价值较血浆BNP更高.Objective To investigate the diagnostic value of acoustic cardiography in patients with chronic systolic heart failure. Methods Between March 2012 and September 2013,243 patients from our department were enrolled in the study, including 128 patients with chronic heart failure and 115 patients with normal heart function. We measured and compared the acoustic cardiography parameters between the two groups including the eleetromechanical activation time （EMAT） , left ventricular systolic time （LVST） and the S3 strength.And the sensitivity and specificity of these parameters were compared with serum brain natriuretic peptide （ BNP ） value in patients with chronic systolic heart failure. Results In chronic systolic heart failure group, E MAT was much longer than that in the control group （ 121 ± 17 ）ms vs. （88 ± 15 ）ms, （P〈0. 001 ） , LVST was obviously shortened （311 ±39 ）ms vs. （340±22） ms, （P〈O. 05 ） , the S3 strength was significantly increased （4.22± 2.30 vs. 3. O1 ±0.66, P〈0.05 ） and the detection rate of the S3 was higher （32.0% vs. 11.3% ,P〈0.05 ）.Sensitivity and specificity of EMAT for chronic systolic heart failure were 96. 1% and 87.0%.Sensitivity and specificity of EMAT for BNP in patients with BNP value ranging from 100 to 400 ng/L were 95.3% and 72.4%. Conclusions Acoustic cardiography parameters inclu- ding EMAT, LVST and the S3 strength were efficient in diagnosis of chronic systolic heart failure.The diag- nostic value of EMAT（ ≥ 90 ms） was much better than that of BNP in patients with BNP value ranging from 100 to 400 ng/L.

关 键 词：慢性收缩性心力衰竭 心音图 电-机械活动时间 脑钠肽 

分 类 号：R541.6[医药卫生—心血管疾病]