心脏超声造影评价恶性肿瘤化疗患者左心室射血分数与左心室容积

目的比较心脏超声造影与常规超声心动图测量恶性肿瘤化疗患者左心室射血分数（LVEF）与左心室容积的可重复性，探讨心脏超声造影评估恶性肿瘤化疗患者左心功能的价值。 方法选择2016年7至12月华中科技大学同济医学院附属同济医院119例接受了常规超声心动图检查的恶性肿瘤化疗患者。其中图像清晰者42例，图像欠佳者77例。采集所有患者的胸骨旁左心室长轴、心尖四腔、二腔、左心长轴观以及三维动态图像，对于图像欠佳组患者还需采集心脏超声造影状态下的胸骨旁左心室长轴、心尖四腔、二腔、左心长轴观以及三维动态图像。两位资历相当的检查者分别运用EchoPac工作站测得所有患者不同测量方法的LVEF与左心室容积。 结果图像清晰组双平面Simpson法与三维全容积法测量的LVEF差异有统计学意义（t=4.224，P<0.01），而左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）差异均无统计学意义；但图像欠佳组双平面Simpson法与三维全容积法测量的LVEF、LVEDV差异均有统计学意义（t=8.650、6.207，P<0.01），而LVESV差异无统计学意义。对于图像清晰组，无论采用双平面Simpson法还是三维全容积法，2位检查者间测量的LVEF、LVEDV、LVESV差异均无统计学意义。而对于图像欠佳组，无论采用双平面Simpson法还是三维全容积法，2位检查者间测量的LVEF、LVEDV差异均有统计学意义（t=4.286、3.645、3.308、4.189，P<0.01），而LVESV差异均无统计学意义；行心脏超声造影后，对于图像欠佳组，无论采用双平面Simpson法还是三维全容积法，2位检查者间测量的LVEF、LVEDV、LVESV差异均无统计学意义。组内相关系数（ICC）显示，图像清晰组、图像欠佳组造影前后双平面Simpson法、三维全容积法测量LVESV的可重复性均较好（ICC=0.901、0.858、0.935、0.920、0.884、0.952）。图像清晰组双平面Simpson法、三维全容积法测量LVEF、LVEDV的可重复性均较好（ICC=0.946、0.895、0.776、0.815）。对于图像欠佳组，双平面Simpson法测量LVEF的可重复性较差（ICC=0.625），但行心脏超声造影后有明显提高（ICC=0.858）；双平面Simpson法、三维全容积法测量LVEDV的可重复性均较差（ICC=0.630、0.712），但行心脏超声造影后均有明显改善（ICC=0.863、0.914）。 结论心脏超声造影能明显改善图像显示欠佳的化疗患者LVEF与左心室容积测量的可重复性。

Measurements of contrast-enhanced echocardiography for left ventricular ejection fraction and left ventricular volume in patients undergoing cancer chemotherapy

ObjectiveTo discuss the value of contrast-enhanced echocardiography in assessing left heart function by comparing the reproducibility of contrast-enhanced echocardiography and conventional echocardiography for measurements of left ventricular ejection fraction (LVEF) and left ventricular volume in patients undergoing cancer chemotherapy. MethodsOne hundred and nineteen patients undergoing cancer chemotherapy were divided into satisfactory image group (42 subjects) and unsatisfactory image group (77 subjects) according to the quality of the recorded images. High frame rate two-dimensional and three-dimensional images were recorded from apical long-axis view, four-chamber view and two-chamber view of left ventricle. Contrast-enhanced echocardiography was performed in the unsatisfactory image group. Two equally experienced examiners measured the LVEF and left ventricular volume in all patients by EchoPac software. ResultsThe difference of LVEF measured by Simpson′s biplane method and 3D full-volume echocardiography in satisfactory image group was statistically significant (t=4.224, P<0.01), while there were no significant differences in the measurements of left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). However, the differences of LVEF and LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography in unsatisfactory image group were both statistically significant (t=8.650, 6.207, both P<0.01). And there was no significant difference in the measurements of LVESV. In satisfactory image group, LVEF, LVEDV and LVESV measured by Simpson′s biplane method or 3D full-volume echocardiography showed no significant differences between two examiners. While in unsatisfactory image group, LVEF and LVEDV measured by Simpson′s biplane method or 3D full-volume echocardiography showed significant differences between two examiners (t=4.286, 3.645, 3.308, 4.189, all P<0.01), except for LVESV. LVEF, LVEDV and LVESV measured by Simpson′s biplane method or 3D full-volume echocardiography showed no significant differences between two examiners in unsatisfactory image group with contrast-enhanced echocardiography. The results of intraclass correlation coefficient (ICC) showed that the reproducibility of LVESV measured by Simpson′s biplane method and 3D full-volume echocardiography was both well in satisfactory image group and unsatisfactory image group without contrast-enhanced echocardiography (ICC=0.901, 0.858, 0.935, 0.920, 0.884, 0.952). The reproducibility of LVEF and LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography was both well in satisfactory image group (ICC=0.946, 0.895, 0.776, 0.815). The reproducibility of LVEF measured by Simpson′s biplane method showed poor results in unsatisfactory image group (ICC=0.625). However, it was improved by performing contrast-enhanced echocardiography (ICC=0.858). The reproducibility of LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography was poor in unsatisfactory image group (ICC=0.630, 0.712). But it was improved by contrast-enhanced echocardiography in both methods (ICC=0.863, 0.914). ConclusionThe reproducibility for measurements of LVEF and left ventricular volume with unsatisfactory images was improved in patients undergoing cancer chemotherapy by using contrast-enhanced echocardiography.