冠状动脉粥样硬化性心脏病心功能分级与心脏超声指标的相关性分析

Correlation analysis between cardiac function classification of NYHA and echocardiography paramerers in coronary heart disease

目的探讨冠状动脉粥样硬化性心脏病(以下简称冠心病)患者心功能分级与心脏超声指标的关系。方法根据美国纽约心脏病协会(NYHA)心功能分级标准将我院166例确诊的冠心病患者分为心功能Ⅰ级48例(A组)、心功能Ⅱ级45例(B组)、心功能Ⅲ级40例(C组)和心功能Ⅳ级33例(D组),另选同期50例健康体检者作为对照组;比较各组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、二尖瓣舒张早期峰值流速与二尖瓣环舒张早期峰值流速比值(E/Ea)。受试者工作特征曲线评价各指标在冠心病中的诊断价值;分析心功能分级与LVESD、LVEDD、LVEF、E/Ea的关系。结果与对照组比较,冠心病各组LVESD、LVEDD、E/Ea明显升高,LVEF明显降低,且随着心功能分级的发展,LVESD、LVEDD、E/Ea显著升高,LVEF显著降低,各组比较差异均有统计学意义(均P<0.05);受试者工作特征曲线分析表明,LVESD、LVEDD、LVEF、E/Ea诊断冠心病的曲线下面积分别为0.888、0.753、0.123、0.770;心功能分级与LVESD、LVEDD、E/Ea均呈正相关(r=0.609、0.484、0.414,均P<0.01),与LVEF呈负相关(r=-0.758,P<0.01)。结论冠心病患者心功能分级与心脏超声指标LVESD、LVEDD、LVEF、E/Ea均显著相关,可用于评价冠心病患者心功能变化。

Objective To explore the correlation between cardiac function classification of NYHA and echocardiography paramerers in coronary heart disease（CHD）.Methods The echocardiography was applied to measure the left ventricular end systolic diameter（LVESD）,left ventricular end diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF）,peak flow velocity of mitral valve in early diastole to peak flow velocity of mitral annulus in early diastole（E/Ea）in 166 cases of CHD,who were divided into 4 groups by cardiac function classification of New York Heart Association（NYHA）：NYHA class Ⅰ group（group A,48 cases）,NYHA class Ⅱ group（group B,45 cases）,NYHA class Ⅲ group（group C,40 cases）,NYHA class Ⅳ group（group D,33 cases）,the results were compared with those of 50 normal subjects（NC group）.The receiver operating characteristic（ROC）curves were figured,and the area under ROC curves（AUCs）were calculated to evaluate the diagnostic value of these items. The correlation between cardiac function classification of NYHA and LVESD,LVEDD,LVEF,E/Ea were analyzed.Results Compared with NC group,the level of LVESD,LVEDD,E/Ea were increased and LVEF was decreased in CHD patients.With the cardiac function classification of NYHA processed,LVESD,LVEDD,E/Ea increased significantly and LVEF decreased obviously（all P〈0. 05）. The AUCs of LVESD,LVEDD,LVEF,E/Ea were 0. 888,0. 753,0. 123,0. 770,respectively. There was a significant positive correlation between cardiac function classification of NYHA and LVESD,LVEDD,E/Ea,but a negative correlation with LVEF（r=0.609,0.484,0.414,-0.758,all P〈0.01）.Conclusion Cardiac function classification of NYHA in patients with CHD is significantly correlated to LVESD,LVEDD,LVEF,E/Ea by echocardiography,which can be used to assess the changes of cardiac function in CHD.