实时三维超声心动图检测左室质量指数评价主动脉瓣置换术后左心室重构的改善情况

Evaluation of left ventricular mass index by real-time three-dimensional echocardiography in the evaluation of left ventricular remodeling after aortic valve replacement

目的探索实时三维超声心动图(RT-3DE)计算左室质量指数(LVMI)评估主动脉瓣置换(AVR)前后主动脉瓣病变患者左室重构(LVH)的改善情况。方法选择行AVR 的主动脉瓣疾病患者并定义为病例组(n=68),其中主动脉瓣狭窄(AS)33例,主动脉瓣关闭不全(AI)35例。同期选择健康体检人群作为对照组(n=70)。分别于AVR 前,治疗后1 周、1 个月和6 个月进行超声心动图检查并计算2D-LVMI 和3D-LVMI。所有检查均由2 名超声医师采用单盲独立测量。采用重复测量方差分析比较AS和AI患者2D-LVMI和3D-LVMI的变化差异。采用Bland-Altman 分析和组内相关系数(ICC)对2D-LVMI和3D-LVMI进行重复性检验。结果AS与AI患者的3D-LVMI和2D-LVMI在整个AVR治疗周期中均呈下降趋势,在不同时间段的变化差异有统计学意义(P<0.001)。组间比较发现,AS患者2D-LVMI大于3D-LVMI,差异有统计学意义(P=0.043)。AI与AS患者在AVR术后1周时3D-LVMI低于2D-LVMI,差异有统计学意义(P<0.05)。3D-LVMI在观察者之间ICC结果为0.966;2D-LVMI的ICC结果为0.757,低于3D-LVMI的一致性。结论RT-3DE能够通过LVMI精确评估主动脉瓣病变患者AVR前后LVH的改善情况。

Objective To investigate the improvement of left ventricular remodeling(LVH)in patients with aortic valve disease before and after aortic valve replacement(AVR)by real-time three-dimensional echocardiography(RT-3DE).Methods Patients with aortic valve disease underwent AVR were enrolled and defined as the patient group(n = 68),including 33 cases of aortic stenosis(AS)and 35 cases of aortic regurgitation(AI).Meanwhile,the healthy population was enrolled as the control group(n = 70).Echocardiography was performed and 2D-LVMI and 3D-LVMI were calculated before AVR,1st week,1st month,and 6nd months after AVR.All examinations were performed by two sonographers using a single blind independent measurement.Differences in 2D-LVMI and 3D-LVMI between AS and AI patients were compared using repeated measures analysis of variance.Repeatability tests were performed on 2D-LVMI and 3D-LVMI using Bland-Altman analysis and intra-group correlation coefficient(ICC).Results The 3D-LVMI and 2D-LVMI of AS and AI patients showed a downward trend during the whole AVR treatment cycle.The difference of the changes in different time periods were statistically significant (AS:Fwithin group = 30.337,Pwithin group = 0.000;AI:Fwithin group = 66.318,Pwithin group = 0.000).The comparison between groups showed that the 2D-LVMI of AS patients was greater than that of 3D-LVMI,and the difference was statistically significant(Fbetween group = 4.270,Pbetween group = 0.043).The 3D-LVMI of AI and AS patients was lower than 2D-LVMI at 1st week after AVR,and the difference was statistically significant(AS:t = 2.950,P = 0.004;AI:t = 2.197,P = 0.032).The ICC results for the 3D-LVMI between the observers were 0.966.The ICC results for the 2D-LVMI were 0.757,which was lower than 3D-LVMI.Conclusion RT-3DE can accurately assess the improvement of LVH utlizing LVMI before and after AVR in patients with aortic valve disease.