| 司 同,朱家宝,顾星星,陈 明,汤丽群,吴 静.基于三维超声心动图对比分析扩张型心肌病与二尖瓣关闭不全左室构型和收缩功能的研究[J].,2022,(13):2564-2569 |
| 基于三维超声心动图对比分析扩张型心肌病与二尖瓣关闭不全左室构型和收缩功能的研究 |
| Comparative Analysis of Left Ventricular Configuration and Systolic Function in Dilated Cardiomyopathy and Mitral Insufficiency Based on Three-Dimensional Echocardiography |
| 投稿时间：2022-01-05 修订日期：2022-01-28 |
| DOI：10.13241/j.cnki.pmb.2022.13.032 |
| 中文关键词: 三维超声心动图 扩张型心肌病 二尖瓣关闭不全 左室构型 收缩功能 |
| 英文关键词: Three-dimensional echocardiography Dilated cardiomyopathy Mitral insufficiency Left ventricular configuration Function of contraction |
| 基金项目:江苏省医学创新团队与领军人才项目（CXTDB2016007） |
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| 中文摘要: |
| 摘要 目的：基于三维超声心动图对比分析扩张型心肌病（DCM）与二尖瓣关闭不全（MI）左室构型和收缩功能的研究。方法：收集我院2018年1月至2021年7月就诊患有左心室（LV）扩张的患者100例，其中DCM患者57例，MI患者43例。LV大小大致相仿，DCM组（43±5）mm/m2，MI组（42±5）mm/m2。另选取同时期50例健康受试者作为对照组。所有患者均进行常规超声心动图及三维超声心动图检查，测量指标主要包括左室大小（LVID）、左室后壁厚度（PWT）、左室舒张末期内径（LVEDD）、左室舒张末期室间间隔厚度（IVS）、左室舒张末期容积（LVEDV）、收缩末期容积（LVESV）、相对室壁厚度（RWT）、LV质量指数（LVMI）、三维左室射血分数（3D-LVEF）、三维舒张末期血流速度（3D-EDV）、二维或三维超声心动图球形指数（2D-SI/3D-SI）。结果：DCM组和MI组LVEDD均大于对照组，差异有统计学意义（P＜0.05）。DCM组比MI组患者心功能分级III/IV和心力衰竭的发生率更高，差异有统计学意义（P＜0.05）。DCM组和MI组患者的LVEDD、LVEDD指数、LVEDV、LVEDV指数、3D-EDV、3D-EDV指数均高于对照组，差异有统计学意义（P＜0.05）；但DCM组和MI组对比差异无统计学意义（P＞0.05）。DCM组和MI组患者的LV长度、LV长度指数、LVMI均高于对照组，差异有统计学意义（P＜0.05）；且MI组高于DCM组，差异有统计学意义（P＜0.05）。DCM组和MI组患者的LVESV、LVESV指数、2D-SI、3D-SI均高于对照组，差异有统计学意义（P＜0.05）；且DCM组高于MI组，差异有统计学意义（P＜0.05）。DCM组3D-LVEF、RWT均低于对照组和MI组，差异有统计学意义（P＜0.05）。ROC分析显示，3D-SI在评估左室扩大患者的左室重构方面优于其他变量，3D-SI的ROC曲线下面积为0.875，95%CI为0.816-0.920，3D-SI>0.62对于DCM和MI区分左室构型的特异性（81.66%）和敏感性（92.09%）较高。DCM和MI患者的3D-LVEF和3D-SI均呈线性负相关（r=-0.719，P=0.000；r=-0.682，P=0.000）。DCM和MI患者3D-SI检测心力衰竭的ROC曲线下面积均大于3D-LVEF的ROC曲线下面积，差异有统计学意义（P=0.000）。结论：与MI患者相比，尽管LV大小大致相仿，但DCM患者的左室几何形状更接近球形，且收缩功能更差。收缩功能与3D-SI显著相关，3D-SI较好地描述了左室重构，可能是LV扩张患者心力衰竭的较强指标。 |
| 英文摘要: |
| ABSTRACT Objective: Comparative analysis of left ventricular architecture and systolic function in dilated cardiomyopathy (DCM) and mitral insufficiency (MI) based on three-dimensional echocardiography. Methods: A total of 100 patients with left ventricular (LV) dilation admitted to our hospital from January 2018 to July 2021 were collected, of which 57 cases were DCM and 43 cases were MI. The size of LV was approximately similar in DCM group and MI group,respectively (43±5) mm/m2 and (42±5) mm/m2. Another 50 health volunteer of the same period were selected as the control group. All patients underwent routine echocardiography and three-dimensional echocardiography. Measurements including left ventricular size (LVID), left ventricular posterior wall thickness (PWT), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic interval between thickness (IVS), left ventricular end-diastolic volume (LVEDV), end systolic volume (LVESV), relative wall thickness (RWT), LV mass index (LVMI), 3D left ventricular ejection fraction (3D-LVEF), the three dimensional end-diastolic blood flow velocity (3D-EDV), two-dimensional or three-dimensional echocardiography spherical index - SI (2D / 3D- SI). Results: LVEDD in DCM group and MI group was higher than that in control group, and the difference was statistically significant (P<0.05). The incidence of heart function grade III/IV and heart failure was higher in DCM group than in MI group, and the difference was statistically significant(P<0.05). LVEDD, LVEDD index, LVEDV, LVEDV index, 3D-EDV and 3D-EDV index in DCM group and MI group were higher than those in control group, with statistical significance (P<0.05). However, there was no significant difference between DCM group and MI group (P>0.05). LV length, LV length index and LVMI in DCM group and MI group were higher than those in control group, with statistical significance(P<0.05). MI group was higher than DCM group, and the difference was statistically significant(P<0.05). LVESV, LVESV index, 2D-SI and 3D-SI in DCM group and MI group were higher than those in control group, and the differences were statistically significant (P<0.05).DCM group was higher than MI group, and the difference was statistically significant(P<0.05). 3D-LVEF and RWT in DCM group were lower than those in control group and MI group, the differences were statistically significant(P<0.05). ROC analysis showed that 3D-SI was superior to other variables in evaluating left ventricular remodeling in patients with left ventricular enlargement. The area under the ROC curve of 3D-SI was 0.875, 95%CI was 0.816-0.920, and 3D-SI>0.62 had a high specificity(81.66%) and sensitivity(92.09%) for DCM and MI to distinguish left ventricular configuration. The 3D-LVEF and 3D-SI in both DCM and MI patients were linearly negatively correlated (r=-0.719, P=0.000; r=-0.682, P=0.000). The area under the ROC curve of heart failure detected by 3D-SI in both DCM and MI patients was greater than that of 3D-LVEF, and the difference was statistically significant(P=0.000). Conclusion: Compared with MI, patients with DCM had more spherical left ventricular geometry and poorer systolic function, although the LV was roughly the same size. Systolic function was significantly correlated with 3D-SI, which better describes left ventricular remodeling and may be a strong indicator of heart failure in patients with LV dilatation. |
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