超声心动图多参数评估特发性室颤患者的心肌功能  

Multiparametric Echocardiographic Assessment for Myocardial Function in Idiopathic Ventricular Fibrillation Patients

作　　者：吕函璐[1] 刘英梅[1] LV Hanlu;LIU Yingmei(Department of Cardiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院心血管内科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2024年第4期622-630,共9页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】应用超声心动图多参数评估特发性室颤患者的超声表型特征,为心律失常高危患者的早期预警提供超声影像学的支持。【方法】纳入2019年1月至2023年12月在中山大学孙逸仙纪念医院首次诊断为特发性心室颤动(IVF)的患者,同时纳入年龄和性别匹配的健康个体作为对照。基于二维灰阶、M型、双平面、频谱多普勒、组织多普勒、斑点追踪、压力-应变环等技术,对纳入人群进行超声心动图多参数分析。超声指标包括传统参数、心肌机械运动参数、心肌电-机械活动参数以及心肌做功参数。使用t检验或Mann-Whitney U检验进行两组独立样本之间的比较。进行受试者工作特征(ROC)曲线分析,以评估超声心动图多参数对特发性室颤的诊断价值。使用组内相关系数(ICC)评估各超声参数观察者内部和观察者之间的变异性。【结果】本研究共纳入IVF患者9例,健康对照个体30例。共计702个左室节段和117个右室游离壁节段纳入心肌功能的分析。与健康对照组相比,IVF组左室整体纵向应变(LV-GLS)相对较低【(18.8±2.7)%vs(.21.2±1.9)%,P=0.004】,而左室机械离散度(LV-MD)相对较高【(44±13)ms vs.(36±9)ms,P=0.022】。心肌做功结果显示,IVF组的整体做功指数(GWI)低于健康对照组【(1991±365)mmHg%vs(.2319±408)mmHg%,P=0.037】。ROC曲线显示LV-GLS、LV-MD以及GWI对特发性室颤的诊断性能较好,曲线下面积(AUC)分别为0.748、0.737以及0.722,截断值分别为19.5%、39.5ms以及2049mmHg%。上述三项指标组成的综合诊断体系,其AUC为0.800。超声心动图各参数在观察者内部和观察者之间均呈现出较好的可重复性,ICC值均大于0.75。【结论】特发性室颤患者超声心动图多参数表现出不同程度的左室功能异常。LV-GLS降低、LV-MD增加以及GWI降低,是恶性心律失常高危的超声心动图特征。【Objective】To explore echocardiographic features in idiopathic ventricular fibrillation(IVF)patients by multiparametric echocardiographic assessment,in order to evaluate the feasibility of identifying patients at high risk of ventricular arrhythmia using echocardiography【.Methods】Patients diagnosed with IVF for the first time in Sun Yat-sen Memorial Hospital from January 2019 to December 2023 were included.Age-and sex-matched healthy individuals were included as control.Multiparametric echocardiographic assessment was performed,involving conventional parameters,myocardial mechanical movement parameters,electro-mechanical parameters,and myocardial energetic parameters.Continuous variables were compared using independent samples t-test or Mann-Whitney U test.The receiver operating characteristic(ROC)curves were performed for echocardiographic parameters to assess their diagnostic value for IVF.The intraclass correlation coefficient(ICC)was used to assess the inter-observer and intra-observer variability.【Results】Nine patients with IVF and thirty healthy individuals were included in this study.In total,702 left ventricular segments and 117 right ventricular free wall segments were analyzed for myocardial function.Left ventricular global longitudinal strain(LV-GLS)was lower in IVF group than in the control group[(18.8±2.7)%vs.(21.2±1.9)%,P=0.004].Left ventricular mechanical dispersion(LV-MD)was higher in IVF group than in the control group[(44±13)ms vs.(36±9)ms,P=0.022].Global work index(GWI)was lower in IVF group than in the control group[(1991±365)mmHg%vs.(2319±408)mmHg%,P=0.037].Based on the results of the ROC curve test,LV-GLS,LV-MD and GWI had the better diagnostic performance,with the area under the curve(AUC)of 0.748,0.737 and 0.722,the cutoff value of 19.5%,39.5 ms and 2049 mmHg%,respectively.The combination of three indices had the largest AUC value of 0.800.All echocardiographic parameters had ex‐cellent intra-observer repeatability and inter-observer reproducibility.The ICC for all para

关 键 词：特发性心室颤动 超声心动图 斑点追踪显像 心肌做功 机械离散度 

分 类 号：R54[医药卫生—心血管疾病]