心脏超声造影测量肺循环时间评估心力衰竭患者左心室充盈压升高的价值  

Pulmonary Transit Time Measured by Contrast Echocardiography in Evaluating Elevated Left Ventricular Filling Pressure of Patients with Heart Failure

作　　者：王淑华[1] 张梅青[1] 王秋霜[1] 朱斐 姬冬冬[1] 李敏[1] 刘丹[1] 杨菲菲[2] 张岱 WANG Shuhua;ZHANG Meiqing;WANG Qiushuang;ZHU Fei;JI Dongdong;LI Min;LIU Dan;YANG Feifei;ZHANG Dai(Department of Health Medicine,Fourth Medical Center of PLA General Hospital,Beijing 100048,China;不详)

机构地区：[1]解放军总医院第四医学中心健康医学科,北京100048 [2]解放军总医院第六医学中心心血管学部,北京100486

出　　处：《中国医学影像学杂志》2023年第4期338-343,共6页Chinese Journal of Medical Imaging

摘　　要：目的探讨应用心脏超声造影测量肺循环时间(PTT)及肺血量(PBV)评估心力衰竭患者左心室充盈压升高的价值。资料与方法回顾性分析2019年2月—2021年10月解放军总医院第四医学中心心内科收治的慢性心力衰竭患者76例,根据左心室舒张功能评估指南分为左心室充盈压正常组(n=41)和左心室充盈压升高组(n=35),同时选择健康对照30例,所有受检者行常规超声和心脏超声造影,测量左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)、左心房容积指数(LAVI)、三尖瓣反流速度及压差、左心室舒张早期充盈速率(E)、组织多普勒二尖瓣环舒张早期运动峰值速度(e')等,测定对比剂PTT并计算PBV。比较3组超声参数、PTT及PBV的差异。分析PTT、PBV与各参数的相关性;采用受试者工作特征曲线评价PTT、PBV预测左心室充盈压升高的效能。结果对照组、左心室充盈压正常组、左心室充盈压升高组间比较,PTT依次延长,PBV增多,LVEF减低,LVEDV、LVEDD、LAVI、E/e'增大(F=22.93、12.01、103.85、23.15、51.40、35.04、48.94,P均<0.05),肺动脉瓣反流舒张晚期压差增加(F=4.15,P<0.05),B型钠尿肽增高(H=44.44,P<0.01)。PTT和PBV与LVEDV(r=0.455、0.591)、LVEDD(r=0.393、0.621)、LAVI(r=0.453、0.581)、三尖瓣反流压差(r=0.254、0.396)、肺动脉瓣反流舒张晚期压差(r=0.630、0.487)、E/e'(r=0.514、0.526)及B型钠尿肽(r=0.471、0.621)均呈正相关(P均<0.05),与LVEF呈负相关(r=−0.692、−0.363,P<0.05)。PTT和PBV预测左心室充盈压升高的曲线下面积分别为0.802和0.760,PTT>8.6 s和PBV>438.9 ml判断左心室充盈压升高的敏感度分别为68.5%、71.9%,特异度分别为82.7%、61.3%。结论心力衰竭患者的PTT和PBV随左心室充盈压升高而延长和增多,超声造影测得的PTT和PBV用于评估心力衰竭左心室充盈压升高有一定临床价值。Purpose To explore the clinical significant value of pulmonary transit time(PTT)and pulmonary blood volume(PBV)measured by contrast echocardiography to predict elevated left ventricular filling pressure in patients with heart failure.Materials and Methods Seventy-six patients with chronic heart failure admitted in Department of Cardiology,Fourth Medical Center of PLA General Hospital from February 2019 to October 2021 were enrolled in this study,and were divided into normal group(n=41)and elevated left ventricular filling pressure group(n=35)according to the recommendations for the evaluation of left ventricular diastolic function.At the same time,30 healthy patients were selected as the control group.All subjects underwent both conventional and contrast-enhanced echocardiography,and measured parameters including left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV),left ventricular end diastolic diameter(LVEDD),left atrial volume index(LAVI),peak velocity of tricuspid regurgitation and pressure gradient,early diastolic filling velocity(E),mitral annulus early diastolic velocity(e'),PTT and PBV.The differences in ultrasound parameters,PTT and PBV among three groups were compared,and the correlation between PTT,PBV and each parameter was analyzed.Receiver operating characteristic curve was plotted for PTT and PBV in predicting elevated left ventricular filling pressure.Results Compared with the control group,the normal left ventricular filling pressure group and the elevated left ventricular filling pressure group,PTT was successively prolonged,PBV was increased,and LVEF was decreased.LVEDV,LVEDD,LAVI,E/e'increased(F=22.93,12.01,103.85,23.15,51.40,35.04,48.94,all P<0.05),and late diastolic pressure increased(F=4.15,P<0.05).B-type natriuretic peptide increased(H=44.44,P<0.01).PTT and PBV were negatively associated with LVEF(r=−0.692,−0.363,P<0.05)and were positively associated with LVEDV(r=0.455,0.591),LVEDD(r=0.393,0.621),LAVI(r=0.453,0.581),tricuspid regurgitation pressure grad

关 键 词：心力衰竭 肺循环时间 肺血量 心脏超声造影 左心室充盈压 

分 类 号：R54[医药卫生—心血管疾病] R445.1[医药卫生—内科学]