实时三平面超声心动图评价扩张型心肌病、冠心病患者左室容积及收缩功能

Assessment of left ventricular volumes and systolic function by real-time tri-plane echocardiography in patients with dilated cardiomyopathy and coronary artery disease

目的初步探讨实时三平面超声心动图(RT-3PE)评价扩张型心肌病、冠心病患者左室容积及收缩功能的可行性。方法RT-3PE分别测量20例正常人、16例扩张型心肌病和23例心肌梗死患者的左室舒张末期容积(LVEDV)和收缩末期容积(LVESV),计算出左室射血分数(LVEF);并分别与二维超声心动图(2DE)的双平面Simpson法和M型超声心动图的Teichholz法测值进行比较。结果①正常人中LVEDV、LVESV及EF,RT-3PE、2DE的双平面Simpson法和M型超声心动图的Teichholz法的各项测值之间无显著性差异(P>0.05),RT-3PE与2DE所测LVEF较M型超声心动图有更好的相关性(r分别为0.91,0.85,P<0.05)。②在扩张型心肌病和心肌梗死患者中,RT-3PE与2DE的双平面Simp-son法检测LVEF均具有很好的相关性(r分别为0.99,0.98,P<0.05),两者之间无显著性差异(P>0.05),但是2DE的双平面Simpson法所测的LVEDV、LVESV均明显低于RT-3PE测值,两者之间有显著性差异(P<0.05)。而M型测得的LVEDV、LVESV偏大,LVEF存在高估或低估现象。③RT-3PE所测的LVEDV、LVESV及LVEF,同一观察者两次测值间均无显著性差异(P>0.05),且有良好的相关性(r分别为0.98,0.97,0.88,P<0.05)。结论RT-3PE能够快速、无创地测量心室容积及收缩功能,为临床评价节段性室壁运动异常及心腔扩大的心室功能提供了一种实用、简便的方法。

Objective To evaluate the feasibility of real-time tri-plane echocardiography （RT-3PE） for quantifying left ventricular volumes and systolic function in the patients with dilated cardiomyopathy and coronary artery disease. Methods Left ventricular end diastolic volume （LVEDV）, left ventricular end systolic volume （LVESV） and Left ventricular ejection fraction （LVEF） were acquired by RT-3PE in 20 normal controls, 16 patients with dilated cardiomyopathy and 23 patients with coronary artery disease. Meanwhile, these parameters were also measured by M-mode Teichholtz method and two-dimensional echocardiography biplane Simpson method. Results ①In normal controls, there were no significant difference among the LVEDV, LVESV and LVEF measured by RT-3PE, 2DE biplane Simpson method and M-mode Teichholtz method. Furthermore, 2DE had better correlation with RT-3PE than M-mode for LVEF （r= 0.91, 0.85, P〈0.05, respectively）. ②In the patients with dilated cardiomyopathy and coronary artery disease, although the measures of LVEDV and LVESV with RT-3PE were larger than those with 2DE, there was a good correlation （r=0.99, 0. 98, P〈0.05） between RT-3PE and 2DE for LVEF measurement, and there was no significant difference between the two methods. At the same time, there was statistically significant difference between RT-3PE and M-mode for left ventricular volumes, and resulted in less accuracy of LVEF. ③For LVEDV, LVESV and LVEF obtained by RT-3PE, intraobserver repeatabilities were excellent （r= 0. 98, 0.97, 0.88, P〈0.05）. Conclusion RT-3PE is a simple, rapid, and pragmatic method to measure left ventricular volumes and systolic functions in patients with segmental wall motion abnormalities or left ventricular dilation.