三维动态心脏模型评估射血分数保留的心力衰竭患者左心房容积和功能的价值  

Value of Three-dimensional Dynamic Heart Model in Quantifying the Left Atrial Volume and Function of Patients With Heart Failure and Preserved Ejection Fraction

作　　者：蔡雨琪 何健 林静茹 陶瑾 赵莹 陶佳 王浩[1] 朱振辉 陆敏杰 吴伟春 CAI Yuqi;HE Jian;LIN Jingru;TAO Jin;ZHAO Ying;TAO Jia;WANG Hao;ZHU Zhenhui;LU Minjie;WU Weichun(Echocardiography Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院超声影像中心,北京市100037 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院磁共振影像科,北京市100037

出　　处：《中国循环杂志》2023年第2期176-181,共6页Chinese Circulation Journal

基　　金：中国医学科学院心血管影像重点实验室(培育)建设项目(2019PT310025)。

摘　　要：目的:以心脏磁共振成像(CMR)为金标准,探讨三维动态心脏模型(DHM)评估射血分数保留的心力衰竭(HFpEF)患者左心房容积和功能的价值。方法:前瞻性选取2020年9月至2021年11月因气促、胸闷、乏力、运动耐量下降就诊于中国医学科学院阜外医院患者96例,并根据HFA-PEFF评分分为HFpEF组(HFA-PEFF≥5分,n=36)与对照组(HFA-PEFF评分≤4分,n=60)。使用二维超声心动图(2DE)、DHM、CMR检查两组患者左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房射血分数(LAEF)三个参数,并比较2DE、DHM单个心动周期测值(DHM_s)和DHM自动测量的多个心动周期测值的均值(DHM_ave)与CMR所测上述参数的差异,及相关性和一致性,并评价DHM技术的重复性。结果:HFpEF组和对照组2DE所测的LAVmax、LAVmin均低于同组CMR测值,2DE所测的LAEF均高于同组CMR测值,DHM所测的LAVmin均低于同组CMR的测值,差异具有统计学意义(P均<0.01)。在对照组,DHM与CMR所测的LAVmax、LAVmin中度相关(r值0.706~0.764,P均<0.01),在HFpEF组高度相关(r值0.834~0.914,P均<0.01)。HFpEF组DHM_s与DHM_ave比CMR所测的LAVmax分别平均低估3.67 ml、2.94 ml,一致性界限(LOA)分别为-35.14~42.47 ml、-33.96~39.85 ml;DHM_ave与CMR所测的LAEF中度相关(r值为0.546,P<0.01),LOA为-24.22%~21.38%。DHM获得的左心房容积和LAEF重复性较好(组内相关系数为0.951~0.983,P均<0.05)。结论:DHM可准确快速测量左心房容积和功能,对HFpEF患者的心脏形态和功能的评估提供了新的方法。Objectives:To explore the application value of three-dimensional dynamic heart model(DHM)in evaluating left atrial(LA)volume and function in patients with heart failure and preserved ejection fraction(HFpEF),with cardiac magnetic resonance imaging results as the gold standard.Methods:Thirty-six HFpEF patients,who were diagnosed according to the Heart Failure Association Pre-test assessment,Echocardiography&natriuretic peptide,Functional testing,Final aetiology(HFA-PEFF)score(≥5 points)at Fuwai Hospital from September 2020 to November 2021,were prospectively enrolled.Sixty patients with HFA-PEFF score of less than 4points in the same period were collected as the control group.Then two-dimensional echocardiography(2DE),DHM and CMR were used to automatically measure left atrial volume and functional parameters,including maximum left atrial volume(LAVmax),minimum left atrial volume(LAVmin),and left atrial ejection fraction(LAEF).The results derived from 2DE,DHM and CMR were compared.The correlation and consistency of the LA measurements derived from CMR were compared with 2DE,single cardiac cycle mearsurements in dynamic heart model(DHM_s)and mean value of multiple cardiac cycle mearsurements in dynamic heart model(DHM_ave).Finally,we evaluated the intra-observer and inter-observer repeatability of DHM in measuring LA volume and function.Results:In the HFpEF group and the control group,the left atrial volume measured by 2DE was lower than that measured by CMR in the same group,while LAEF measured by 2DE was higher than that measured by CMR in the same group,and the LAVmin measured by DHM was also lower than that measured by CMR in the same group(all P<0.01).In the control group,there was a moderate correlation between LAVmax and LAVmin measured by DHM and CMR(r=0.706-0.764,both P<0.01),and the correlation was excellent in HFpEF group(r=0.834-0.914,both P<0.01).In the HFpEF group,The measured LAVmax value of DHM was 2.94 ml and 3.67 ml lower than those measured by CMR,the limits of agreement(LOA)were-35.14 ml to 42.

关 键 词：动态心脏模型 心脏磁共振成像 左心房容积 斑点追踪 射血分数保留的心力衰竭 

分 类 号：R54[医药卫生—心血管疾病]