实时三维经食管超声心动图测定左心耳功能的临床研究

目的 评价实时三维经食管超声心动图(TEE)测定左心耳机械功能的可行性和准确性.方法 对42例心房颤动患者行实时三维TEE检查.分别应用二维面积法、三维面积法和三维容积法测定左心耳排空分数,并与多普勒测定的最大排空速度(PEV)进行相关性分析.检验三种方法的变异性.结果 二维面积法测定的左心耳排空分数高于三维面积法和三维容积法,差异有统计学意义[(62.84±17.27)%对(45.39±16.58)%,P=0.000和(62.84±17.27)%对(48.35±19.37)%,P=0.001],与PEV无显著相关性(r=0.529,P=0.130).三维面积法与三维容积法测定的左心耳排空分数差异无统计学意义[(45.39±16.58)%对(48.35±19.37)%,P=0.158],与PEV有相关关系,r值分别为0.604(P=0.048)和0.662(P=0.036).三种方法的变异性在观察者间和观察者内差异均无统计学意义(P均＞0.05).结论 实时三维TEE测定左心耳排空分数准确可行,优于常规二维面积法,可用于评价左心耳机械功能.

Assessment of left atrial appendage function by real-time three-dimensional transesophageal echocardiography

Objective To evaluate the feasibility and accuracy of real-time three-dimensional transesophageal echocardiography(TEE) in assessment of left atrial appendage(LAA) function. Methods Forty-two atrial fibrillation patients underwent real-time three-dimensional TEE. LAA ejection fraction based on two-dimensional area measurements(EFA-2D), three-dimensional area measurements(EFA-3D) and three-dimensional volume measurements(EFv-3D) were calculated and related to LAA peak empty velocity (PEV). The variability within observer and interobserver were tested. Results EFA-2D was significantly higher than EFA-3D[(62.84 ± 17.27)% vs (45.39 ± 16.58)%, P = 0.000] and EFv-3D [( 62.84 ±17.27) % vs (48.35 ± 19.37) %, P = 0.001 ], whereas EFA-3D and EFv-3D had no significant difference ( P = 0.158). In a simple linear correlation,the degree of association between EFv-3D and PEV was higher as between EFA-3D and PEV ( r = 0.662 vs 0.604,both P ＜0.05). No significant correlation was observed between EFA-2D and PEV ( r = 0.529, P = 0.130). Variabilities within observer and interobserver were no significant differences by the three methods( P ＞0.05). Conclusions LAA ejection fraction calculation by real-time three-dimensional TEE is feasible and more accurate than by 2D TEE.