三维斑点追踪超声心动图对老年心力衰竭患者左心室舒张功能的评估价值

Value of three-dimensional speckle tracking echocardiography in evaluation of left ventricular diastolic function in elderly patients with heart failure

目的分析三维斑点追踪超声心动图(3D-STE)对老年心力衰竭患者左心室舒张功能的评估价值。方法将2018年1月至2019年10月南京大学医学院附属鼓楼医院收治的130例左心室射血分数保留的心力衰竭(HF pEF)老年患者作为研究对象, 均进行常规超声、3D-STE和左心导管检查, 保存其心脏三维全容积动态图, 之后通过三维斑点追踪技术对心脏三维全容积动态图进行分析, 测量其纵向应变(GLS)、径向应变(GRS)、圆周应变(GCS)、面积应变(GAS)。根据检测的左心室舒张末压(LVEDP), 将患者分为左心室舒张功能正常组(LVEDP≤15 mmHg)和左心室舒张功能不全组(LVEDP>15 mmHg), 对比两组GLS、GRS、GCS、GAS, 采用Pearson相关分析GLS、GRS、GCS、GAS与LVEDP水平的相关性, 并绘制ROC曲线分析GLS、GRS、GCS、GAS对左心室舒张功能不全的预测效能。结果左心室舒张功能不全组GLS、GRS、GCS、GAS绝对值均低于左心室舒张功能正常组(P<0.05);GLS、GCS、GAS与LVEDP水平均呈正相关(P<0.05), GRS与LVEDP水平呈负相关(P<0.05);GLS、GRS、GCS、GAS预测左心室舒张功能不全的AUC分别为0.667、0.775、0.762、0.840, 灵敏度分别为79.17%、72.22%、69.44%、80.56%, 特异度分别为48.28%、70.69%、82.76%、77.59%, 准确度分别为65.38%、71.54%、75.38%、79.23%。结论 3D-STE相关应变参数GLS、GRS、GCS、GAS可以作为老年HF pEF患者左心室舒张功能评估的超声指标, 有助于早期发现老年HF患者左心室舒张功能变化。

Objective To analyze the value of three-dimensional speckle tracking echocardiography(3D-STE)in evaluation of left ventricular diastolic function in elderly patients with heart failure(HF).Methods 130 elderly patients with heart failure(HF pEF)with preserved left ventricular ection fraction in Gulou Hospital Affiliated to Medical College of Nanjing University from January 2018 to October 2019 were studied.All of them were examined by conventional ultrasound,3D STE and left-heart catheterization.Their cardiac three-dimensional full-volume dynamic images were collected and then analyzed with three-di-mensional speckle tracking technique.The global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),and global area strain(GAS)were measured.According to the detec-ted left ventricular end diastolie pressure(LVEDP),the patients were divided into the normal left ventricu-lar diastolic function group(LVEDP≤15 mmHg)and the left ventricular diastolic dysfunction group(LVEDP>I5 mmHg).The GLS,GRS,GCS and GAS of the two groups were compared.Pearson correla-tion analysis was performed to analyze the correlation between GLS,GRS,GCS,GAS and LVEDP,and ROC curves were used to analyze efficiencies of GLS,GRS,GCS and GAS in prediction of left ventricular diastolie dysfunction.Results The absolute values of GLS,GRS,GCS and GAS of the left ventricular diastolie dysfunction group were lower than those of the normal left ventricular diastolie function group(P<0.05).The GLS.GCS and GAS were positively correlated with LVEDP(P<0.05),while GRS was nega-tively correlated with LVEDP(P<0.05).The AUC values of GLS.GRS,GCS and GAS for predicting left ventricular diastolic dysfunction were 0.667.0.775,0.762 and 0.840,respectively.The sensitivities were 79.17%,72.22%,69.44%and 80.56%,speeifieities were 48.28%,70.69%,82.76%and 77.59%,aceuracy rates were65.38%,71.54%,75.38%and 79.23%,respectively.Conclusions The 3D-STE-related strain parameters GLS,GRS,GCS and GAS can be used as ultrasound indexes for assessment of left ventricular diastolic function in elderly patients with HF pEF,which is helpful for early detection of changes in left ventricular diastolie function in elderly patients with HF.