立体三维超声心动图评价心肌病患者左心室收缩功能的应用价值

目的 探讨立体三维超声心动图(stereo three-dimensional echocardiography,S3DE)评估扩张型心肌病(DGM)及肥厚型心肌病(HCM)患者左心室收缩功能的准确性及其应用价值.方法 应用M型超声心动图(ME)、二维超声心动图(2DE)及S3DE测量DCM患者(20例)、HCM患者(20例)及正常对照者(20例)的左室舒张末期容积(EDV)、左室收缩末期容积(ESV)、每搏输出量(SV)及左室射血分数(EF),比较三组间及同组不同检测方法间的测量结果.结果 ①三组的S3DE同ME相比,EDV、ESV及SV差异均有统计学意义(P<0.01),S3DE同2DE相比,上述测值差异均无统计学意义(P>0.05);S3DE同ME、S3DE同2DE相比,EF测值仅在正常对照组(P<0.01)和HCM组(P<0.05)差异有统计学意义,DCM组三种方法所测EF差异均无统计学意义.②三组间S3DE各项指标的比较:与对照组相比,DCM组EDV、ESV均显著增加,EF显著减低(P均<0.01),而SV差异无统计学意义(P>0.05);HCM组仅SV明显增高(P<0.01),EDV、ESV及EF差异均无统计学意义(P>0.05).③S3DE所测EDV、ESV及EF同2DE相关性及拟合优度均好(r=0.778,0.876,0.932;R2=0.605,0.767,0.869;均P<0.01).④HCM组在控制了心率变量的影响后,心输出量同SV高度相关(r＝0.987,P<0.01).结论 S3DE能实时显示心脏立体结构,准确可靠地评估左室收缩功能,优于传统ME和2DE检测方法;EDV、ESV及EF仍是临床评估左室收缩功能较为有效的指标;S3DE所测SV有望成为评估心肌病患者早期左室收缩功能更为敏感、准确的指标.

Evaluation of left ventricular systolic function of cardiomyopathy patients with stereo three-dimensional echocardiography

Objective To evaluate the accuracy and value of measurement of left ventricular systolic function in dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) patients with stereo three-dimensional echocardiography (S3 DE). Methods End-diastolic volume (EDV), end-systolic volume (ESV),stroke volume(SV) and ejection fraction(EF) of the left ventricle were measured with M-mode echocardiography(ME),two-dimensional echocardiography(2DE) and S3DE in DCM patientsC20 cases). HCM patients(20 cases),and normal controls(20 cases). The different results among the three groups or three methods were analyzed. Results (①In all the three groups,the results of EDV,ESV,and SV obtained with ME were significantly higher than those obtained with S3DE( P <0. 01). Only in normal group( P <0. 01) and HCM group ( P <0. 05) ,the results of EF obtained with ME and 2DE were significantly higher than that obtained with S3DE. ②By S3DE,compared with normal group,EDV,ESV were increased and EF was decreased obviously in DCM group (all P <0. 01); while in HCM group, only SV was significantly higher( P < 0. 01). ③EDV, ESV, and EF measured by S3DE were correlated and fit well with those measured by 2DE(r = 0.778,0.876, 0.932;R2 =0.605,0.767,0.869;all P <0.01). ④Within HCM group,excluding the impact of heart rate,cardiac output (CO) was highly correlated with SV( r = 0. 987,P < 0. 01). Conclusions S3DE can real-time display the stereo structure of the heart, and accurately and reliably assess the left ventricular systolic function, with a priority over traditional ME and 2DE methods. EDV,ESV, and EF are still effective indicators for the clinical assessment of left ventricular systolic function. SV obtained with S3DE will be expected to be the more sensitive and accurate value in assessing left ventricular systolic function in patients with early-stage cardiomyopathy.