实时三维超声心动图和二维斑点追踪技术对心力衰竭的诊断价值  

Value of real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging in the diagnosis of heart failure

作　　者：王湘竹 孙兰兰[2] 王琳 吴江[3] 于泽兴 WANG Xiangzhu;SUN Lanlan;WANG Lin;WU Jiang;YU Zexing(Department of Function,the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学第三附属医院功能科,北京市100029 [2]首都医科大学附属北京朝阳医院心脏超声科 [3]首都医科大学附属北京安贞医院超声科

出　　处：《临床超声医学杂志》2021年第10期756-760,共5页Journal of Clinical Ultrasound in Medicine

基　　金：北京中医药大学基本科研业务费项目(2018-JYBZZ-JS083)。

摘　　要：目的探讨实时三维超声心动图(RT-3DE)和二维斑点追踪技术对心力衰竭患者心功能的预测价值。方法选取我院收治的84例心力衰竭患者为研究组,另选取同期60例健康体检者为对照组,均行RT-3DE检查获得右室收缩末期容积(RVESV)、右室舒张末期容积(RVEDV)、右室每搏输出量(RVSV)、右室射血分数(RVEF)、左室射血分数(LVEF);二维斑点追踪技术检查获得右室游离壁长轴应变(FWLS)。比较两组上述心功能指标和N末端B型利尿钠肽原(NT-proBNP)水平的差异。分析FWLS与心功能指标的相关性,Logistic回归分析心力衰竭的危险因素,绘制受试者工作特征(ROC)曲线分析FWLS诊断心力衰竭的临床价值。结果研究组NT-proBNP、RVESV、RVEDV均高于对照组,而RVSV、RVEF、LVEF、FWLS均低于对照组,差异均有统计学意义(均P<0.05)。相关性分析显示,FWLS与RVSV、RVEF、LVEF均呈正相关(r=0.484、0.491、0.533,均P<0.001),与RVESV、RVEDV无明显相关性。Logistic回归分析显示,NT-proBNP、RVSV、RVEF、LVEF及FWLS均为心力衰竭发生的危险因素(OR=4.679、2.601、2.241、1.790、2.000,均P<0.05)。ROC曲线分析显示,FWLS诊断心力衰竭的曲线下面积为0.866(95%可信区间0.792~0.920),敏感性、特异性分别为81.70%、77.40%;NT-proBNP诊断心力衰竭的曲线下面积为0.803(95%可信区间0.730~0.876),敏感性、特异性分别为79.80%、73.30%,FWLS的曲线下面积高于NT-proBNP,差异有统计学意义(P<0.05)。结论RT-3DE可准确反映心力衰竭患者右室异常状态,其右心参数及FWLS均为预测心力衰竭发生的独立危险因素,RT-3DE和二维斑点追踪技术对心力衰竭均有一定的诊断价值。Objective To explore the value of real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging in predicting the heart function in patients with heart failure.Methods A total of 84 patients with heart failure treated in our hospital were selected as the study group,and 60 healthy subjects during the same period were selected as the control group.RT-3DE was performed to obtain right ventricular end systolic volume(RVESV),right ventricular end diastolic volume(RVEDV),right ventricular stroke output(RVSV),right ventricular ejection fraction(RVEF)and left ventricular ejection fraction(LVEF).The long axial strain(FWLS)of the right ventricular free wall was obtained by two-dimensional speckle tracking imaging.The differences of the above cardiac function indexes and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between FWLS and cardiac function indexes,Logistic regression analysis was used to indentify the risk factors of heart failure,and the receiver operating characteristic(ROC)curve was drawn to analyze the clinical value of FWLS in diagnosing heart failure.Results NT-proBNP,RVESV,and RVEDV in the study group were higher than those in the control group,while RVSV,RVEF,LVEF and FWLS were lower than those in the control group,and the differences were statistically significant(all P<0.05).Correlation analysis showed that FWLS was positively correlated with RVSV,RVEF,and LVEF(r=0.484,0.491,0.533,P<0.001),and there was no significant correlation with RVESV and RVEDV.Logistic regression analysis showed that NT-proBNP,RVSV,RVEF,LVEF and FWLS were risk factors for heart failure(OR=4.679,2.601,2.241,1.790,2.000,all P<0.05).ROC curve analysis showed that the area under the curve for the diagnosis of heart failure by FWLS was 0.866(95%confidence interval 0.792~0.920),and the sensitivity and specificity were 81.70%and 77.40%,respectively.The area under the curve for the diagnosis of he

关 键 词：超声心动描记术 三维 实时 斑点追踪技术 二维 N末端B型利尿钠肽原 心室功能 右 心力衰竭 

分 类 号：R540.45[医药卫生—心血管疾病]