超声心动图诊断左心室扩大和收缩功能减低

Echocardiography for diagnosing left ventricular dilatation and systolic dysfunction

目的 评价M型、二维及三维超声心动图技术诊断左室扩大和收缩功能减低的准确性。方法 在3 7例冠心病和高血压患者中 ,以心导管左室造影的诊断为标准 ,对比了应用Teichholtz公式的M型超声、双平面Simpson公式的二维超声以及多平面经食管三维超声技术诊断左室舒张和收缩末期容量增大和左室射血分数减低的准确率。结果 ①以左室造影测量的左室舒张末期容量 >110ml/m2 为标准 ,M型、二维及三维超声诊断准确率分别为 73 .0 %、75 .7%和 94.6% ,三维超声的诊断准确率显著高于M型和二维超声 (P <0 .0 5 ) ;②以左室造影测量的左室收缩末期容量 >44ml/m2 为标准 ,M型、二维及三维超声诊断准确率分别为 81.1%、81.1%和97.3 % (P >0 .0 5 ) ;③以左室造影测量的左室射血分数 <5 0 %为标准 ,M型、二维及三维超声诊断准确率分别为60 .0 %、72 .9%和 94.6% ,三维超声的诊断准确率显著高于M型和二维超声 (分别P <0 .0 1和 <0 .0 5 )。结论 三维超声诊断左室扩大和收缩功能减低的准确性与左室造影相似而显著高于目前的M型和二维超声技术 。

Objective To compare the accuracy of M mode (MME) ,two dimensional (2DE) and three dimensional (3DE) echocardiography in the diagnosis of left ventricular dilatation and systolic dysfunction.Methods With quantitative left ventriculography (LVG) as a comparison standard,the accuracy of MME (using Teichholtz formula),2DE (using biplane Simpson formula) and multiplane transesophageal 3DE in detecting increased left ventricular end diastolic(EDV) and end systolic(ESV) volume and decreased left ventricular ejection fraction (LVEF) were compared in 37 patients with coronary artery disease and hypertension.Results ① Using LVG determined EDV>110 ml/m 2 as the diagnostic criteria,the diagnostic accuracies of MME,2DE and 3DE were 73.0% , 75.7% and 94.6% respectively,and the accuracy of 3DE was significantly higher than that of MME and 2DE (P< 0.05 ).② Using LVG determined ESV>44 ml/m 2 as the diagnostic criteria,the diagnostic accuracies of MME,2DE and 3DE were 81.1% , 81.1% and 97.3% respectively (P> 0.05 ).③ Using LVG determined LVEF <50% as the diagnostic criteria,the diagnostic accuracies of MME,2DE and 3DE were 60.0% , 72.9% and 94.6% respectively,and the accuracy of 3DE was significantly higher than that of MME and 2DE (P< 0.01 and P< 0.05 respectively).Conclusions The accuracy of 3DE in detecting left ventricular dilatation and systolic dysfunction is similar to that of LVG while significantly higher than that of MME and 2DE.Consequently,3DE should be regarded as a new standard in the quantitative evaluation of heart failure.