心音频谱图在二尖瓣反流患者左心室功能监测中的作用  

The role of heart sound spectrograms in monitoring left ventricular function in patients with mitral regurgitation

作　　者：张文俐[1] 屈雪蒸 宋蓓[1] 张瑞岩[1] Zhang Wenli;Qu Xuezheng;Song Bei;Zhang Ruiyan(Department of Cardiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院心内科,上海200025

出　　处：《心脑血管病防治》2024年第1期9-12,20,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探求使用可穿戴设备获取心音频谱图,观察不同程度二尖瓣反流(MR)患者心音频谱特征在左心室功能监测中的作用。方法入选2020年6月至2021年5月因心血管疾病入住上海交通大学医学院附属瑞金医院的102例MR患者,根据心脏超声MR反流束面积/左心房面积比值超过20%将其分为轻度MR组72例和中度及以上MR组30例。基于心音频谱图对心音持续时间、最大声强、最大心音振幅进行分析,并与心脏超声测定的左心室射血分数(LVEF)进行相关性分析。结果心音频谱图第一心音持续时间与收缩期持续时间比值(S11-S12/S11-S21)与LVEF呈线性负相关(r=-0.535,P<0.01),S11-S12/S11-S21用于判定LVEF降低(LVEF<50%)曲线下面积为0.840(95%CI=0.756~0.924,P<0.01),截断值是55.50%,敏感度78.6%,特异度83.3%。结论心音频谱图提示,MR患者心脏收缩期第一心音持续时间占比与LVEF呈负相关性,在二尖瓣病患的心功能居家监测中存在潜在的应用价值。Objective To investigate the role of heart sound spectrograms obtained through wearable devices in monitoring left ventricular function in patients with different degrees of mitral regurgitation(MR).Methods A total of 102 MR patients admitted to Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,from June 2020 to May 2021 due to cardiovascular diseases were included.Patients were categorized into mild MR(72 cases)and moderate-to-severe MR groups(30 cases)based on whether the mitral regurgitation flow area/left atrial area ratio exceeded 20%.Duration of heart sound,maximum heart sound intensity,and maximum heart sound amplitude were analyzed based on heart sound spectrogram,and correlation analysis was conducted with left ventricular ejection fraction(LVEF)measured by echocardiography.Results The ratio of duration of the first heart sound to systolic duration(S11-S12/S11-S21)in heart sound spectrograms showed a linear correlation with LVEF(r=-0.535,P<0.01).The area under the curve(AUC)for using S11-S12/S11-S21 to determine reduced LVEF(LVEF<50%)was 0.840(95%CI=0.756-0.924,P<0.01),with a threshold of 55.50%,sensitivity of 78.6%,and specificity of 83.3%.Conclusion Heart sound spectrograms suggest a negative correlation between the proportion of the first heart sound duration during cardiac systolic period and LVEF in MR patients.There is potential value in utilizing heart sound spectrograms for at-home monitoring of cardiac function in patients with mitral valve diseases.

关 键 词：二尖瓣反流 心音频谱图 收缩期持续时间 左心室射血分数 

分 类 号：R542.51[医药卫生—心血管疾病]