实时三维超声心动图左心室重构指数评价冠心病患者左心室重构的研究

Assessment of left ventricular remodeling in coronary heart diseases by real-time three-dimensional echocardiographic left ventricular remodeling index

目的探讨实时三维超声心动图(RT-3DE)测量左心室重构指数(LVRI)评价冠心病患者左心室重构的价值。方法根据冠状动脉造影结果,将病变组分为左旋支或/和右冠支病变组(LCX/RCA组)24例,其中男性18例,女性6例,年龄38～76岁,平均年龄54.2岁;单纯左前降支病变组(LAD组)21例,其中男性16例,女性5例,年龄35～78岁,平均年龄53.5岁;包含LAD病变的双支或多支病变组(多支组)27例,其中男性20例,女性7例,年龄39～80岁,平均年龄56.2岁;正常对照组22例,其中男性17例,女性5例,年龄32～79岁,平均年龄55.2岁。行RT-3DE,应用软件自动测量左心室舒张末期容积(LVEDV)、舒张末期心外膜容积(LVEDVepi)、左心室射血分数(LVEF);再计算左心室质量[LVM=1.05×(LVEDVepi-LVEDV)]、LVRI(LVM/LVEDV),并采用二维超声心动图(2DE)双平面Simpson测量并计算上述各值。比较RT-3DE和2DE测量LVRI在组间的差异、组内的差异和相关性,以及LVRI与LVEDV、LVEF的相关性;并比较观察者间及观察者内两种方法测量LVRI的一致性和重复性。结果正常对照组、LCX/RCA组、LAD组、多支组两种方法测量的LVRI呈显著递减(P<0.05或P<0.01)。前两组两种方法间的LVRI差异无统计学意义(P>0.05),后两组有统计学意义(P<0.05或P<0.01)。相关性分析表明:①除多支组内两种方法间的LVRI无显著相关性(P>0.05)外,余3组内均呈显著相关性(P<0.01);②病变组同种方法测量的LVRI与LVEDV呈显著负相关性、LVEF呈显著正相关性(P<0.01),但正常组内无显著相关性(P>0.05)。RT-3DE测量的LVRI观察者间及观察者内一致性和重复性较2DE好。结论来源于RT-3DE的LVRI优于2DE,更能作为临床评价冠心病患者左心室重构的指标。

Objective To evaluate the effect of left ventricular remodeling index（LVRI） measured by real-time three-dimensional echocardiography（RT-3DE） in patients with coronary heart disease.Methods The lesion groups were divided into 4 groups by results of coronary artery angiography.The left circumflex artery and /or right coronary branch lesion group（LCX/RCA group,n = 24,male 18,female 6,aged 38-76 years old,mean age 54.2 years old）;The left anterior descending coronary artery stenosis group（LAD group,n = 21,male 16,female 5,aged 35-78 years old,mean age 53.5 years old）;The double or triple coronary arteries stenosis contained LAD group（vessels group,n = 27,male 20,female 7,aged 39-80 years old,mean age 56.2 years old） and normal control group（n = 22,male 17,female 5,aged 32-79 years old,mean age 55.2 years old）.The left ventricular end-diastolic volume（LVEDV）,left ventricular end-diastolic epicardial volume（LVEDVepi）,left ventricular ejection fraction（LVEF） of RT-3DE were automatically measured by 4D LV analysis CAP 2.5 software of TomTec company.The left ventricular mass[LVM = 1.05 ×（LVEDVepi-LVEDV）],LVRI（LVM/LVEDV） were calculated.All above parameters were measured and calculated by 2DE Simpson biplane method in the same manner.The inter-group differences of LVRI,intra-group differences,correlations of LVRI and correlations between LVRI and LVEDV or LVEF in all groups were analyzed.Results The RT-3DE and 2DE LVRI significantly decreased in order of normal controls group,LCX /RCA group,LAD group and vessels group,respectively（P 0.05 or P 0.01）;The differences of LVRI between RT-3DE and 2DE were significant in LAD group and vessels group（P 0.05 or P 0.01）,but without significant in normal controls group and LCX/RCA group（P 0.05）.The correlation analysis indicated that： ①There were significant intra-group correlations between RT-3DE LVRI and 2DE LVRI（P 0.01）,but for vessels group（P 0.05）;②There were significant negative correlations between LVRI and LVEDV,significant positive correlations between LVRI and LVEF（P 0.05 or P 0.01） in LCX /RCA group,LAD group and vessels group,respectively;but without significant correlations（P 0.05） in normal controls group.The good agreement and reproducibility of LVRI measured by RT-3DE superior to 2DE were found.Conclusion It is demonstrated that RT-3DE LVRI could take as a new approach for evaluating left ventricular remodeling of coronary artery disease in clinic superior to 2DE.