血流向量成像技术评价慢性肾脏病合并舒张功能不全患者左心室能量损耗  

Evaluation of left ventricular energy loss by vector flow mapping in patients with chronic kidney disease with diastolic dysfunction

作　　者：王伟[1] 王岳恒[1] 白晖[1] 周金玲[1] 常青 Wang Wei;Wang Yueheng;Bai Hui;Zhou Jinling;Chang Qing(Department of Cardiac Ultrasound,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心脏超声科,石家庄050000

出　　处：《中华医学超声杂志（电子版）》2021年第4期361-367,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：河北省卫生健康委青年科技课题(20210496)。

摘　　要：目的应用血流向量成像(VFM)技术分析慢性肾脏病(CKD)合并舒张功能不全患者左心室能量损耗(EL)的变化特点,探讨其在评估CKD患者左心室舒张功能中的临床价值。方法选取2017年2月至2018年11月在河北医科大学第二医院治疗的58例CKD患者,依据舒张功能不全严重程度,将其分为左心房压力正常的Ⅰ级舒张功能障碍组(DD1组),左心房压力升高的Ⅱ、Ⅲ级舒张功能障碍组(DD2组),另收集同期38例健康成人作为对照组。计算左心室充盈早期、左心房收缩期、整个舒张期及收缩期的平均EL,即E-EL-ave、A-EL-ave、D-EL-ave及S-EL-ave,充盈早期及左心房收缩期平均EL比值(E/A-EL),比较3组间各参数的差异。结果DD1组的A-EL-ave、S-EL-ave高于对照组(均P<0.01)。DD2组的各个时相平均EL均高于对照组(均P<0.01);E/A-EL对左心室舒张功能障碍伴正常左心房压CKD患者具有良好的诊断效能,其最佳截断值为<1.27[曲线下面积(AUC)=0.900,P<0.01],E/A-EL和E/e'二者联合对左心室舒张功能障碍伴左心房压升高CKD患者具有良好的诊断效能,其联合因子最佳截断值为1.28(AUC=0.945,P<0.01)。E-wave、E/e'和Awave、心脏指数(CI)、左心房最大容积指数(LAVImax)分别与E-EL-ave和A-EL-ave有独立相关性(校正R^(2)=0.546、0.613,均P<0.01)。结论VFM技术可从血流动力学角度反映CKD患者左心室舒张功能受损程度,EL与评价左心室舒张功能的指标相关。Objective To analyze the characteristics of changes in left ventricular energy loss(EL)in patients with chronic kidney disease(CKD)with diastolic dysfunction by vector flow mapping(VFM)technique and explore the clinical value of EL in evaluating left ventricular diastolic function in patients with CKD.Methods Fifty-eight CKD patients were divided into two groups according to diastolic dysfunction:patients with GradeⅠdiastolic dysfunction with normal left atrial pressure(DD1 group)and those with GradeⅡorⅢdiastolic dysfunction with increased left atrial pressure(DD2 group).Thirty-eight healthy adults were enrolled as a control group.VFM analysis was executed to calculate the average left ventricular EL during the early filling phase(E-EL-ave),atrial filling phase(A-EL-ave),diastole phase(D-EL-ave),and systolic phase(S-EL-ave).The rate of average EL during early filling and atrial filling is expressed as E/AEL,and the difference among the three groups were compared.Results A-EL-ave and S-EL-ave in the DD1 group were significantly higher than those of the control group(P<0.01for both).Average energy loss in different phases in the DD2 group were all higher than those in the control group(P<0.05 for all).E/A-EL had excellent diagnostic efficacy for CKD patients with normal left atrial pressure with a cut-off value of<1.27(area under the curve[AUC]=0.900,P<0.01);the combination of E/A-EL and E/e'had excellent diagnostic efficacy for CKD patients with increased left atrial pressure with a cut-off value of 1.28(AUC=0.945,P<0.01).E wave,A wave,E/e',LAVImax,and cardiac index were independently correlated with E-ELave and A-EL-ave(adjusted R^(2)=0.546,0.613,P<0.01 for both),respectively.Conclusion VFM technology can reflect the impaired left ventricular diastolic function in CKD patients from the perspective of hemodynamics,and the energy loss is related to the indicators for evaluating left ventricular diastolic function.

关 键 词：心室功能 左 慢性肾脏病 能量损耗 血流向量成像 

分 类 号：R692[医药卫生—泌尿科学]