心脏声学造影对冠状动脉粥样硬化性心脏病并发症的诊断及心功能的评估  

Clinical value of contrast echocardiography in diagnosing complications and assessing cardiac function in patients with coronary heart disease

作　　者：包道日娜 梁思颖 朱天刚[1] Bao Daorina;Liang Siying;Zhu Tiangang(Cardiac Center,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心脏中心心血管内科,100044

出　　处：《中华医学超声杂志（电子版）》2021年第5期482-486,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的通过左心声学造影(LVO)观察冠状动脉粥样硬化性心脏病(冠心病)患者室壁运动、左心室容量及并发症,综合讨论LVO在冠心病诊治中的应用价值。方法回顾性研究2016年5月至2018年12月北京大学人民医院65例冠心病患者,采用双平面Simpson法测量收缩末期容积(ESV)、舒张末期容积(EDV)及左心室射血分数(LVEF),观察心室结构及室壁运动,通过配对t检验、χ^(2)检验比较经胸超声心动图(TTE)与LVO 2种检查方法的上述检测内容的差异性,通过线性回归分析室壁运动积分指数(WMSI)与LVEF的相关性。结果(1)TTE测得EDV和ESV为(90.77±35.17)ml,(49.20±29.56)ml,LVO测得EDV和ESV分别为(126.86±41.74)ml和(68.89±36.25)ml,2种方法测得的EDV和ESV值差异均具有统计学意义(t=-14.589,-8.780,P均<0.001);TTE和LVO所测LVEF值按≥50%,40%~49%和<40%进行分组,2种检查方法分组比较差异具有统计学意义(χ^(2)=28.685,P<0.001)。(2)TTE发现心尖血栓11例,其中8例被LVO证实,另外诊断心尖血栓5例;LVO诊断室壁瘤20例,11例与TTE一致,其中9例为TTE漏诊;LVO诊断冠心病并发症心尖部血栓和室壁瘤时,与TTE比较,差异均具有统计学意义(χ^(2)=19.211、22.234,P均<0.001)。(3)通过LVO、TTE分别计算出WMSI值为(1.68±0.43)和(1.50±0.24),均与所测LVEF值[(48.50±13.49)%和(48.94±13.27)%]呈负相关关系(r=-0.630、-0.625,P均<0.01)。结论LVO通过显影心内膜边界,能更好地观察心室壁节段,准确地评估冠心病患者左心室收缩功能及诊断并发症。Objective To observe wall motion,left ventricle volume,and complications in coronary heart disease(CHD)patients by left ventricular opacification(LVO)and assess the value of LVO examination in the diagnosis and treatment of CHD.Methods The differences of TTE and LVO were compared by the results of ESV,EDV,and LVEF,which were measured through biplane Simpson’s method in65 patients with CHD at Peking University People’s Hospital from May 2016 to December 2018,using paired-samples t test and Chi-square test.We also observed the left ventricular structure and wall motion and analyzed the relationship between wall motion score index(WMSI)and LVEF through linear regression.Results Left ventricular EDV and ESV measured by TTE were(90.77±35.17)ml and(49.20±29.56)ml,respectively;the corresponding values measured by LVO were(126.86±41.74)ml and(68.89±36.25)ml.There were significant differences in the values measured by TTE and LVO(t=-14.589,-8.780;P<0.001).LVEF measured by TTE and LVO was classified into different groups,respectively(LVEF≥50%;LVEF=40%-49%;LVEF<40%),and there was a significant difference in the composition of groups between them(χ^(2)=28.685,P<0.001).TTE suggested 11 cases of suspected left ventricular mural thrombosis,of which eight were confirmed by LVO,and another five cases were diagnosed by LVO.Twenty cases of left ventricular aneurysm were diagnosed by LVO,of which 11 were confirmed and 9 were missed by TTE.There was a significant difference between LVO and TTE in the diagnosis of CHD complications,apical thrombosis,and ventricular aneurysm(χ^(2)=19.211,22.234;P<0.001).WMSI calculated by LVO and TTE was(1.68±0.43)and(1.50±0.24),respectively,and they both had a negative correlation with LVEF results[(48.50±13.49)%and(48.94±13.27)%;r=-0.630,-0.625;P<0.01).Conclusion LVO allows to observe ventricular wall segment clearly,assessing left ventricular systolic function more accurately,and diagnose apical thrombosis and ventricular aneurysm more sensitively by visualizing left ventricular endo

关 键 词：左心声学造影 冠状动脉粥样硬化性心脏病 心功能评估 血栓 室壁瘤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]