RT-3DE测定右室游离壁长轴应变对CHF患者心功能的预测分析

目的：研究实时三维超声心动图(RT-3DE)测定右室游离壁长轴应变(FWLS)对心力衰竭(CHF)患者心功能的预测价值。方法：选取2019年3月-2020年1月我院收治的84例心力衰竭患者,另选取同时段于我院体检健康者为对照组(60例)。所有受试者接受RT-3DE检查,比较两组受试者FWLS以及心功能指标。采用pearson相关分析FWLS与心功能指标的相关性,采用受试者工作特征曲线(ROC曲线)分析FWLS诊断CHF的临床价值。结果：两组血清NT-proBNP水平以及实时三维超声心动图参数比较差异有统计学意义(P<0.05),其中研究组NT-proBNP、RVESV、RVEDV明显高于对照组,而RVSV、RVEF、LVEF、FWLS明显低于对照组(P<0.05)。Pearson相关分析显示,FWLS与RVSV、RVEF、LVEF呈正相关性(r=0.484、0.491、0.533, P<0.001 ) ,而与RVESV、RVEDV无明显相关性(P>0.05)。Logistic回归分析显示,NT-proBNP(OR=4.679；95%CI=1.580~13.858)、RVSV(OR=2.601；95%CI=1.245~5.436)、RVEF(OR=2.241；95%CI=1.305~3.850)、LVEF(OR=1.790；95%CI=1.318~2.430)以及FWLS(OR=2.000；95%CI=1.315~3.042)均是CHF发生的危险因素(P<0.05)。ROC曲线分析显示,FWLS诊断CHF曲线下面积为0.866(95%CI=0.792~0.920),敏感度、特异性分别为81.70%、77.40%,NT-proBNP诊断CHF曲线下面积为0.803(95%CI=0.730~0.876),敏感度、特异性分别为79.80%、73.30%,其中FWLS的曲线下面积高于NT-proBNP(P<0.05)。结论：RT-3DE可准确反映CHF患者的右心室异常状态,其中FWLS 是CHF患者的独立危险因素,在评估CHF患者心功能方面具有优势。

The prediction of FWLS by RT-3DE on the heart function of CHF patientsWang Xiangzhu 1 Sun Lan 2 Wang Lin 1 Yu Zexing 3 * * 1. Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing 1007002 Beijing Chao-yang Hospital, Beijing 1000203 Beijing Chao-yang Hospital, Beijing 100020

Objective: To study the prediction of FWLS by RT-3DE on the heart function of CHF patients. Methods: 84 patients with heart failure admitted to our hospital from March 2019 to January 2020 were selected, and healthy patients who were undergoing physical examination in our hospital during the same period were selected as the control group (60 cases). All subjects underwent RT-3DE examination and compared the FWLS and cardiac function indexes of the two groups of subjects. All subjects underwent RT-3DE examination, and the FWLS and cardiac function indexes of the two groups were compared. Pearson correlation analysis was used to analyze the correlation between FWLS and cardiac function indexes, and the ROC curve was used to analyze the clinical value of FWLS in the diagnosis of CHF. Results: There were significant differences in serum NT proBNP level and real-time three-dimensional echocardiography parameters between the two groups (P < 0.05). NT proBNP, RVESV, RVEDV in the study group were significantly higher than those in the control group, while RVSV, RVEF, LVEF, FWLS in the study group were significantly lower than those in the control group (P<0.05). Pearson correlation analysis showed that FWLS was positively correlated with RVSV, RVEF, and LVEF (r=0.484, 0.491, 0.533, P<0.001), but there was no significant correlation with RVESV and RVEDV(P>0.05). Logistic regression analysis showed that NT-proBNP (OR=4.679; 95%CI=1.580~13.858), RVSV (OR=2.601; 95%CI=1.245~5.436), RVEF (OR=2.241; 95%CI=1.305~3.850), LVEF (OR=1.790; 95%CI=1.318~2.430) and FWLS (OR=2.000; 95%CI=1.315~3.042) are risk factors for CHF (P<0.05). ROC curve analysis showed that the area under the curve for FWLS diagnosis of CHF was 0.866 (95%CI=0.792~0.920), the sensitivity and specificity were 81.70% and 77.40%, respectively, and the area under the curve for NT-proBNP diagnosis of CHF was 0.803 (95%CI=0.730~0.876), the sensitivity and specificity were 79.80% and 73.30%, respectively. The area under the curve of FWLS was higher than that of NT-proBNP (P<0.05). Conclusion: RT-3DE can accurately reflect the abnormal state of the right ventricle in patients with CHF. The FWLS is an independent risk factor for CHF patients, which has advantages in evaluating the cardiac function of CHF patients.