掌上心脏彩色超声在老年心血管病患者中的应用价值

Application of hand-held echocardiography in elderly cardiovascular disease patients

目的评价掌上心脏彩色超声在老年心血管病患者临床应用中的可行性和准确性。方法连续选取老年心血管病患者共200例,进行掌上心脏彩色超声(Vscan GE掌上心脏彩色超声机)及常规心脏超声(Sequoia 512彩色超声机)检查,并记录检查时间。掌上心脏彩色超声对房室腔大小、室壁厚度、心脏收缩功能及节段性室壁运动情况、瓣膜反流或狭窄程度、心包积液进行定性或者半定量诊断,并与常规心脏超声进行比较,用Kappa值判断两者诊断的一致性。结果掌上心脏彩色超声检查图像质量整体评分(3.7±0.6)分,常规超声图像质量整体评分(3.8±0.7)分,差异无统计学意义(P>0.05),掌上心脏彩色超声检查平均用时(150±41)s。掌上心脏彩色超声与常规超声诊断一致性较高,尤其在心包积液(κ=0.97)、心脏扩大(κ=0.94)、下腔静脉增宽(κ=0.90)以及左心室收缩功能减低(κ=0.87)、节段性室壁运动障碍(κ=0.88)的定性和半定量评价上具有非常好的一致性。掌上心脏彩色超声筛查心肌梗死的敏感性89.6%,特异性100.0%,准确性93.6%。结论掌上心脏彩色超声体积小巧,检查快捷,图像质量良好,能够准确地对老年心血管病患者的心脏情况进行定性或半定量诊断。

Objective To study the application of hand-held echocardiography in elderly cardiovascular disease patients.Methods Two hundred elderly cardiovascular disease patients who underwent hand-held and conventional echocardiography were included in this study.Semi-qualitative or semi-quantitative diagnosis of atrial and ventricle dimensions,left ventricle wall thickness,heart contraction function and segmental ventricle wall motion,valve reflux and stenosis,pericardial effusion was compared with that of conventional echocardiography.Their consistency was assessed according to the Kappa value.Results No significant difference was found in the mean image quality score of hand-held echocardiography and conventional echocardiography（3.7±0.6and3.8±0.7,P〈0.05）.The mean time of hand-held echocardiography was 150±41s.The diagnosis consistency of hand-held echocardiography and conventional echocardiography was good,especially in semi-qualitative or semi-quantitative diagnosis of pericardial effusion（κ=0.97）,cardiaectasis（κ=0.94）,widened inferior vena cava（κ=0.90）and LV contraction function（κ=0.87）,segmental ventricle wall dyskinesia（κ=0.88）.The sensitivity and specificity of hand-held echocardiography in diagnosis of myocardial infarction were 89.6% and 100.0% respectively.ConclusionHand-held echocardiography can be used in qualitative or quantitative diagnosis of cardiovascular diseases in elderly patients due to its short scanning time and good image quality.