三维全自动左心定量技术评价左心房和左心室重构容积变化的初步研究

Preliminary study on evaluating volume changes in left atrial remodeling and left ventricular remodeling by three-dimensional echocardiography with automatic quantification

目的探讨三维超声心动图全自动左心定量技术（3D-HM）评价左房重构和左室重构患者左心容量及左室功能的可行性与重复性。方法在HMACQ成像模式下采集156例受试者三维图像。共分为3组：①对照组（A组），70例；②急性心肌梗死后左室重构组（B组），17例；③高血压左房重构组（C组），69例。使用3D-HM方法定量左心室舒张末容积（LVEDV）、左室收缩末容积（LVESV）、左心房收缩末容积（LAESV）及左室射血分数（LVEF），并与传统三维超声心动图手动测量（3D-manual）结果进行比较。评价3D-HM方法组内及组间的重复性。结果不同组别各参数3D-HM测值间差异均有统计学意义（均P〈0．05），其中B组LVEDV、LVESV、LAESV均高于A组和C组（均P〈0．05），LVEF低于A组和C组（均P〈0．05），C组LAESV高于A组（P〈0．05）。B组LVEDV和LVESV两种方法的测值差值大于A组和C组（均P〈0．05），C组LAESV两种方法的测值差值大于A组（P=0．03）；3D-HM法的LVEDV、LVESV、LAESV及LVEF测值与3D-manual法测值之间分别存在较高的相关性（r=0．94，0．97，0．91，0．90）。3D-HM数据后处理时间明显短于3D-manual法（P〈0．05）；3D-HM法测值在观察者内及观察者间的差异均无统计学意义（均P〉0．05）。结论313-HM是一项快速、可行的技术，对左房重构和左室重构患者的左心定量具有高度的可重复性。

Objective To discuss the feasibility and reproducibility of left ventricular volume and function of patients with left atrial remodeling and left ventricular remodeling by 3-dimensional echocardiography HeartModel （3D-HM）. Methods Three-dimensional images of 156 subjects were collected under HMACQ imaging mode. They were assigned into three groups：① control group （group A, n = 70） ; ② group of left ventricular remodeling after , acute myocardial infarction （group B, n =17） ; ③ group of hypertension left atrial remodeling （group C, n = 69）. 3D-HM method was used for quantifying left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, left atrial end-systolic volume （LAESV） and left ventrieular ejection fraction （LVEF）, and the results were compared with conventional 3D-manual results. The reproducibility of the 3D-HM method within one group and among different groups was evaluated. Results There was a significant difference in all the parameters measured with the 3D-HM method in different groups（ P 〈0.05）. LVEDV, LVESV, and LAESV in group B were higher than those in group A and group C（ P 〈0.05）, and LVEF was lower than that in group A and group C（ P 〈0.05）,LAESV of group C was higher than that of group A（ P 〈0.05）. The difference in the measurements of LVEDV and LVESV between the two methods was greatest in group B compared with group C and group A（ P 〈0.05）. In group C, the measured value difference of LAESV between two methods was greater than that of group A （ P = 0.03）. There was closer correlation among LVEDV, LVESV, LAESV and LVEF measured values of 3D-HM method as well as measured values of the 3D-manual method （r = 0.94, 0.97, （1.91 and 0.90）, The data post-processing time of 3D-HM was significantly shorter than that of 3D-manual （ P 〈0.05）. The inter-observer and intra-observer difference of measured values of 3D-HM method had no statistical significance （ P 〉0.05）. Conclusions 3D-HM is a fast and feasible technique with high reproducibility for quantifying the left ventricular volume and function in patients with left atrial remodeling and left ventricular remodeling.