斑点追踪技术评价心衰患者预后预测价值的研究

Research on Speckle Tracking Assessment Prognostic Value in Patients with Heart Failure

目的评价斑点追踪技术对心衰患者预后的预测价值。方法选取心力衰竭患者86例,根据治疗三个月后左心室射血分数(LVEF)是否大于50%,分为恢复组(A组,56例)和未恢复组(B组,30例)。比较患者病程初诊时、3个月后常规二维超声心动图参数的差别,两组患者初诊时斑点追踪参数的差别,分别计算初诊时基底部、心尖部及左心室整体斑点追踪参数与治疗3个月后常规二维超声心动图参数LVEF的相关性;常规超声数据测量后记录左室心尖三腔观、四腔观、二腔观二维动态灰阶图像,上述各切面得到理想图像后,将连续3个心动周期的动态图像存入CD-R光盘待后分析。结果治疗三个月后LVEF、SV、CO、E/A值高于初诊时[(58.56±4.18)%vs(45.16±3.35)%;(79.68±3.01)ml/beat vs(65.70±3.10)ml/beat;(4.06±0.22)L/min vs(3.10±0.2)L/min;(1.00±0.09)vs(0.65±0.07)],而LVDd、LVDs值则低于初诊时[(52.10±5.51)mm vs(58.77±6.27)mm;(30.00±2.43)mm vs(34.23±2.81)mm],差异有统计学意义(P<0.05)。恢复组心尖部旋转角度峰值、旋转达峰时间、旋转速度正向峰值、旋转速度负向峰值以及整体旋转角度峰值、旋转速度正向峰值、旋转速度负向峰值大于未恢复组[(6.38±1.21)°vs(5.43±1.32)°;(84.17±7.17)%vs(70.98±6.32)%;(76.55±6.80)°/s vs(62.18±4.91)°/s;(-45.04±3.28)°/s vs(-53.29±3.20)°/s;(17.56±2.14)°vs(6.67±0.86)°;(115.48±8.10)°/s vs(99.98±6.02)°/s;(-77.83±5.29)°/s vs(-83.48±7.17)°/s],差异有统计学意义(P<0.05)。LVEF与心尖部旋转角度峰值、旋转达峰时间、旋转速度正向峰值、旋转速度负向峰值以及整体旋转角度峰值呈正相关(P<0.05);用斑点追踪技术和双平面Simpson's法测量的左室整体收缩功能相关性良好;可重复性研究表明同一观察者不同时间及两观察者间对左室心肌二维应变值的测量相关性良好。结论斑点追踪技术参数对心衰患者的预后具有预测价值,测定心力衰竭患者左室局部和整体心肌应变,其中以心尖部参数的预测价值更加明显。

Objective To investigate the value of evaluating prognosis of chronic heart failure（CHF） by Speckle Tracking Imaging echocardiography. Methods Eighty-six patients with CHF were divided into 2 groups according to the LVEF after 3 months：Restored（LVEF≥50%,n = 56） and No Restored（LVEF 50%,n = 30）. The parameters of two-dimensional echocardiography（TDE） of first visit and that of after 3 months were compared. The Speckle-tracking echocardiography parameters were compared between two groups. The correlations between parameters of STE of first visit and LVEF after 3 months were analyzed. After conventional ultrasonic measurement data recording of left ventricular apical three-chamber view,four-chamber view,two-chamber view two-dimensional dynamic gray-scale image,each of the section gets the ideal image,and the moving image three consecutive cardiac cycles are stored in CD-R discs after analyzing pending. Results LVEF、SV、CO、E/A after 3 months was significantly higher than those of first visit [（58. 56 ± 4. 18） % vs（45. 16 ± 3. 35） %;（79. 68 ± 3. 01） ml/beat vs（65. 70 ± 3. 10） ml/beat;（4. 06 ± 0. 22） L/min vs（3. 10 ± 0. 21） L/min;（1. 00 ± 0. 09） vs（0. 65 ± 0. 07） ]. The differences were statistically significant（P〈 0. 05）. The LVDd、LVDs after 3 months were significantly lower than those of the first visit（52. 10 ± 5. 51） mm vs（58. 77 ± 6. 27） mm;（30. 00 ± 2. 43）mm vs（34. 23 ± 2. 81） mm. The differences were statistically significant（P 〈0. 05）. Peak rotation on apical plane（AP-Prot）,time to AP-Prot,positive peak of rotation speed,negative peak of rotation speed and peak twist（Ptw）,time to Ptw,positive peak of rotation speed,negative peak of rotation speed in group A were higher than those in Group B [（6. 38 ± 1. 21） ° vs（5. 43 ± 1. 32） °;（84. 17 ± 7. 17） % vs（70. 98 ± 6. 32） %;（76. 55 ± 6. 80） °/s vs（62. 18 ± 4. 91） °/s;（-45. 04 ± 3. 28） °/s vs（-53. 29 ± 3. 20） °/s;（17. 56 ± 2. 14） °vs（6. 67 ± 0. 86） °;（115. 48 ± 8. 10） °/s vs（99. 98 ± 6. 02） °/s;（-77. 83 ± 5. 29） °/s vs（-83. 48 ± 7. 1） 7°/s]. The differences were statistically significant（P〈 0. 05）. There were good correlations between AP-Prot,time to AP-Prot,positive peak of rotation speed,negative peak of rotation speed,peak twist（Ptw） and LVEF（P〈 0. 05）. The GLS-Avg correlated significantly with LVEF. The same observer at different times and two observers＇ left ventricular strain measurements has a good correlation. Conclusion The parameters of speckle-tracking echocardiography parameters can preliminary forecast the prognosis,particularly the parameters of apical plane.