超声目测法评价左心室室壁运动的准确性

Accuracy of visual assessment of left ventricular wall motion abnormalities by echocardiography

目的前瞻性评价超声目测法检出左心室室壁运动异常的准确性。方法１１４例胸痛患者在冠状动脉造影前１小时行二维超声心动图检查，将左室前壁和后壁区域的运动分级为正常、减低、消失或反常，并分别计分为１～４。冠状动脉造影后立即做左室造影，对左室前壁和后壁区域的运动进行上述分级和计分。结果在左室造影的患者中，超声检出前壁运动异常的敏感性为７７％，特异性９７％，准确性９３％；检出下壁运动异常的敏感性为５０％，特异性９３％，准确性８１％。Ｓｐｅａｒｍａｎ等级相关分析法显示，超声与造影评价左室前壁及下壁区域运动异常程度的相关性均良好（相关系数分别为０．７７和０．５０，Ｐ＜０．０００１）。结论超声目测法能准确检出和分级室壁、特别是前壁区域运动异常。

Objective To compare the accuracy of visual evaluation of wall motion abnormalities(WMA) by two dimensional echocardiography (2DE) with contrast left ventriculography (LVG) in a prospective and blinded study. Methods The study group consisted of 114 patients undergoing elective coronary angiography and LVG. Echocardiograms were recorded one hour before angiography and were visually analyzed in 16 segments. Each segment was assigned to either anterior or inferior regions. Segmental wall motion was graded as normal, hypokinetic, akinetic or dyskinetic. Anterior and inferior wall motions were assessed from LVG using the same grading system as that of 2DE.Results Compared with the results of LVG, the sensitivity, specificity and accuracy of 2DE for detecting anterior WMA were 77%, 97% and 93% and for inferior WMA, 50%, 93% and 81%, respectively. Spearman′s rank correlation coefficient was calculated showing that there was a good correlation between 2DE and LVG grading results for both anterior and inferior wall motion ( r =0.77 and 0.50, respectively; both P < 0.0001). Conclusion 2DE visual assessment is accurate for detecting and grading the severity of WMA, especially for the anterior wall.