单心动周期实时三维超声心动图对慢性肾脏病患者左心功能的早期评估

Evaluation of left ventricle function in patients with chronic kidney disease at early stage by single beat real-time three-dimensional echocardiography

目的采用单心动周期实时三维超声心动图技术(s RT-3DE)对慢性肾脏病(CKD)患者左心结构及功能进行评估,并与传统二维超声心动图参数进行比较,探讨s RT-3DE在观察CKD患者早期心脏结构及功能细微变化中的价值。方法选取我院门诊及住院治疗的CKD患者43例(CKD组),健康对照组30例,进行常规超声心动图及s RT-3DE检查,对左心房容积(LAV)、左心房容积指数(LAVI)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)、左室心肌质量(LVM)及质量指数(LVMI)进行比较分析。结果 s RT-3DE所测指标LAV、LAVI、LVEDV、LVM、LVMI与对照组比较差异具有统计学意义(P<0.05),LVESV、LVEF两组间比较无统计学差异(P>0.05),常规二维超声心动图双平面Simpson法、s RT-3DE所测得LAV、LAVI、LVESV、LVEF差异无统计学意义(P>0.05),s RT-3DE法所测得LVEDV、LVM、LVMI小于常规二维超声心动图,差异均具有统计学意义(P<0.05),但与2DE测值高度相关。两种方法图像采集及处理所需时间比较,差异具有统计学意义(P<0.05)。结论单心动周期实时三维超声心动图可早期发现CKD患者左心结构变化,与常规二维超声比较采集数据快速、结果准确可靠,可用于早期评价左心功能及患者随访。

Objective To compare single beat real-time three-dimensional （sRT-3DE） and conventional two-dimensional （2D）eehoeardiographie parameters with left ventrieular （LV）and left atrium （LA）indexes in patients with chronic kidney disease, and investigate the value of sRT-3DE in evaluating the structure and function of left heart at early stage of CKD. Methods Forty-three patients from in and out-patients with CKD （CKD group） were collected, thirty healthy subjeets served as eontrols（eontrol group）. All the patients were manipulated by standard 2D and sRT-3DE. Compared left atrium volume（LAV）, left atrium volume index（LAVI）, left ventrieular diastolic volume（LVEDV）, left ventrieular systolic volume（LVESV）, left ventrieular ejection fraetion（LVEF）, left ventrieular mass（LVM） and left ventrieular mass idex（LVMI） obtained by conventional 2D and sRT-3DE. Results There were significant differences between CKD group and control group for LAV, LAVI, LVEDV, LVM, LVMI by sRT-3DE（P〈0.05）, there were no significant differences for LVESV and LVEF between two groups （P〉0.05）. There was no significant difference between real-time three-dimensional eehoeardiography and biplane Simpson＇s method for LAV, LAVI, LVESV, LVEF（P〉0.05）. 3D-LVEDV, and 3D-LVM, 3D-LVMI were smaller than 2D-LVEDV, 2D-LVM and 2D-LVMI（P〈0.05）, sRT-3DE technique could result in better correlation with conventional 2DE. There were significant differences between the two methods for the time of acquiring image and analyzing image（P〈0.05）. Conclusion sRT-3DE can detect the structural and functional changes of LV and LA for patients with CKD at early stage, and have a unique advantage in sampling mode and analyzing image, sRT-3DE can quantify left ventrieular and left atrium volume and contractive function rapidly and accurately, provide a reliable method to deteet and follow-up in early ehange in patients with CKD.