依国人最新超声心动图数据判定左心房大小的方法学比较

Methodological comparison of left atrium classification according to the latest echocardiographic data from Chinese adults

目的根据最新的大样本国人超声心动图数据正常值,分析比较超声心动图两种测量方法——径线法和容积法对于左房大小判定的一致性。方法回顾性分析1067例门诊患者的超声心动图数据,分别根据二维径线法测量左房前后径(LAD)和Simpson双平面法测定的左房容积(LAV)将左房大小分为正常组或扩大组。结果①所有人群中有299例(28.0%)LAD扩大,449例(42.1%)LAV扩大。②LAD与LAV呈显著线性相关(r=0.642,P=0.000),但依据LAD和LAV判定左房大小的一致性并不理想(Kappa=0.392,P=0.000)。LAD判定左房扩大的患者中大多数(74.6%)都存在LAV的扩大;而LAV扩大的患者中,50.3%的患者LAD在正常范围。③若以LAV为参照标准,男性患者中,LAD>3.7cm判断左房扩大的敏感性76.8%,特异性66.8%,LAD>4.0cm判断左房重度扩大的敏感性75.5%,特异性78.7%。女性患者中,LAD>3.4cm判断左房扩大的敏感性74.9%,特异性70.6%,LAD>3.7cm判断左房重度扩大的敏感性84.2%,特异性75.8%。结论采用径线法对左房大小的判定存在局限性,与LAV法的一致性不佳,依据LAD判定容易低估左房的大小。当LAD>4.0cm(男)/3.7cm(女)时判断左房扩大的准确性较好。

Objective To analyze and compare the classification of left atrial size by different echocardiographic measurements based on the latest large sample of normal Chinese adults′echocardiographic data. Methods The echocardiography data of 1 067 unselected adult outpatients were retrospectively analyzed.The outpatients were divided into normal or enlarged groups according to the left atrial antero-posterior diameter (LAD) and left atrial volume (LAV),respectively. Results ①LAD and LAV enlargement were found in 299 (28.0%) patients and 449 (42.1%) patients of the total population,respectively.②There was a good positive linear correlation between LAD and LAV (r=0.642,P=0.000),but the agreement for the classification of left atrial size by LAD and LAV was not ideal (Kappa=0.392,P=0.000).The majority of the patients (74.6%) with abnormal LAD had abnormal LAV.Conversely,among the patients with abnormal LAV(50.3%) had normal LAD.③The sensitivity and specificity of judging left atrial enlargement were 76.8% and 66.8% for LAD>3.7 cm in male,and 74.9% and 70.6% for LAD>3.4 cm in female,respectively.The sensitivity and specificity of judging severely left atrial enlargement were 75.5% and 78.7% for LAD>4.0 cm in male,and 84.2% and 75.8% for LAD>3.7 cm in female,respectively. Conclusions The agreement of the classification of left atrial size by LAD and LAV is limited.LAD-based assessment may result in an underestimation of left atrial size.When LAD is larger than 4.0 cm for male or 3.7 cm for female,the accuracy of LAD in the diagnosis of left atrial enlargement is better.