心脏磁共振成像评价实时三维超声测定冠心病患者左心室容量及功能的准确性

Accuracy of measurement of left ventricular volume and function in coronary heart disease with real-time three- dimensional echocardiography

目的采用心脏磁共振成像（CMRI）评估实时三维超声（RT-3DE）技术测定冠心病患者左心室容量及功能的准确性。方法应用RT-3DE测量37例冠心病患者及30例正常对照者左室舒张期末容量（EDV）、左室收缩期末容量（ESV）、左室射血分数（EF），并与CMRI结果对照，利用受试者操作特征（ROC）曲线评估RT-3DE测定左室容积的诊断价值。结果正常对照组RT-3DE与cMRI所测EDV、ESV、EF数值较近似，两种方法测量的数值之间差异无统计学意义（P〉0．05）；其EDV、ESV的R0c曲线下面积分别为0．912和0．944，诊断价值较高。冠心病组RT-3DE的EDV测值较CMRI低，二者平均相差（10．95±31．26）ml，差异有统计学意义（P〈0．05）；冠心病组RT-3DE的ESV测值较CMRI低，二者平均相差（3．17±16．42）ml，差异无统计学意义（P〉0．05）；冠心病组RT3DE的EF值与CMRI测定值较接近，二者平均相差（1．54±11．85）％，差异无统计学意义（P〉0．05）。冠心病组EDV、ESV的ROC曲线下面积分别为0．832和0．861，诊断价值中等。结论RT-3DE测定正常人左室容量及功能的诊断价值较高；在冠心病心室重构的情况下，RT-3DE可能会低估左室容量。

Objective To evaluate the accuracy of measurement of left ventricular（LV） volume and function in coronary heart disease（CHD） by real-time three-dimensional eehocardiography（RT 3DE） using cardiac magnetic resonance imaging （CMRI）. Methods LV end diastolic volume （EDV）, LV end systolic volume（ESV） and LV ejection fraction（EF） were measured with RT-3DE in patients with CHD （ n = 37） and in the control （ n = 30）. The results measured by RT-3DE were compared with those of CMRI. The diagnostic value of RT 3DE was evaluated using receiver operating characteristic（ROC） curve. Results Compared with that measured by CMRI,EDV,ESV and EF by RT-3DE（ P ：〉0.05） were almost similar as that in the control. Area under ROC curve of in EDV and ESV were 0. 912 and 0. 944 in the control. However,EDV determined by RT 3DE was smaller than that by CMRI（P 〈0.05） in CHD group. A difference （10.95 ± 31.26 ml） was existed in EDV between the two methods. ESV measured by RT-3DE was smaller than that calculated by CMRI（ P 〉0.05） with a mean differance of （3.17 ± 16.42）ml in CHD group. EF by RT-3DE（P 〉0.05）was ahnost as same as that by CMRI in CHD group, with a mean difference of （1.54 ± 11.85）%. The area under ROC curve of EDV and ESV were 0. 834 and 0. 873 in CHD group and their diagnostic performance was moderate. Conclusions Measurment of LV volume and function by RT 3DE in control was more acurrate than that in CHD. In the cases of LV remodeling in patients with CHD,RT-3DE would underestimate the LV volume.