实时三维超声心动图对中晚期肝硬化患者左心室容积及收缩功能的评价

Quantitative assessment of left ventricular volume and systolic function using real-time three-dimensional echocardiography in late-stage liver cirrhosis

目的:探讨实时三维超声心动图(RT-3DE)定量评价中晚期肝硬化患者左心室容积及收缩功能的临床应用价值。方法:检测中晚期肝硬化患者32例,正常对照组20例,对所有研究对象进行实时三维超声心动图全容积图像采集,应用Qlab定量分析软件,得到17节段时间-容积曲线、左室舒张末容积(EDV)、收缩末容积(ESV)和左室射血分数(LVEF),分别显示16、12、6个节段达到收缩末最小容积的时间的标准差(Tmsv16-SD、Tmsv12-SD、Tmsv6-SD)及16、12、6个节段达到收缩末最小容积的时间的最大差值(Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)。以上参数用心率校正后,分别为Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%及Tmsv6-Dif%,结果与正常对照组进行比较。结果:EDV、ESV和LVEF两组间比较无显著性差异(P>0.05),Tmsv16-SD、Tmsv12-SD、Tmsv16-Dif、Tmsv12-Dif高于正常对照组(P<0.05),Tmsv16-SD%、Tmsv12-SD%、Tmsv16-Dif%、Tmsv12-Dif%两组间比较有显著性差异(P<0.05)。而Tmsv6-SD、Tmsv6-Dif、Tmsv6-SD%、Tmsv6-Dif%两组间比较无显著性差异(P>0.05)。结论:RT-3DE技术可用于评价中晚期肝硬化患者左心室容积及整体与局部的收缩功能,是简便、实用的检测方法。

Objective： To explore the value of real-time three-dimensional echocardiography （RT-3DE） in evaluating left ventricular volume and systolic function in late-stage liver cirrhosis. Methods： Thirty-two patients with late-stage liver cirrhosis and twenty healthy volunteers were enrolled in this study. Full volume RT-3DE was performed. The 17-segmental time-volume curves and left ventricular end-diastolic volume （EDV）, end-systolic volume （ESV） and ejection fraction （EF） were obtained by the online Qlab software. The time to minimal systolic volume in each segment （Tmsv） was taken to derive the following indexes： Tmsv16-SD, Tmsv12-SD, Tmsv6-SD, Tmsv16-Dif, Tmsv12-Dif and Tmsv6-Dif, which meant the standard deviation or the maximal difference of Tmsv among the 16, 12 and 6 segments of the left ventricle respectively. The software also provided with each of the above parameters as a percentage of the cardiac cycle： Tmsv6-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-Dif%, Tmsv12- Dif% and Tmsv6-Dif%. Results： EDV, ESV and EF of left ventricle： there were no significant differences between the two groups （P〉0.05）, Tmsv16-SD, Tmsv12-SD, Tmsv16-Dif, Tmsv12-Dif, Tmsv16-SD%, Tmsv12-SD%, Tmsv16-Dif%, Tmsv12-Dif%： were significantly higher in late-stage liver cirrhosis than those in the control group （P〈0.05）, Tmsv6-SD, Tmsv6-Dif, Tmsv6-SD%, Tmsv6-Dif%： there were no significant differences between the two groups （P〉0.05）. Conclusions： RT-3DE can be used to access left ventricular volume and systolic function changes of late-stage cirrhosis and it is a convenient, practical method to evaluate left ventricular volume and systolic function.