自动心肌运动定量与三维定量分析技术在评估左室收缩功能中的对比研究

Comparative study of aCMQ and 3D QA technique in assessing left ventricular systolic function

目的:对比分析超声心动图自动心肌运动定量(aCMQ)与三维定量(3DQA)分析技术评测左心室收缩功能的相关性。方法:选取在医院接受超声心动图检查的266例左室收缩功能减低的患者,将左心室射血分数(LVEF)<50%的患者纳入观察组(108例),LVEF≥50%的患者纳入对照组(158例)。收集两组患者左室长轴两腔心观(AP2)、三腔心观(AP3)及四腔心观AP4动态图像;aCMQ测量两腔心纵向应变(AP2LS)、三腔心纵向应变(AP3LS)、四腔心纵向应变(AP4LS)及左心室整体纵向应变(LVGLS);对两组患者左室舒张末期容量(LVEDV)、左室收缩末期容量(LAESV)及LVEF的水平进行计算比较,探讨aCMQ和3DQA两种技术在评估左心室收缩功能方面的相关性。结果:aCMQ技术测量后,观察组LVEF水平明显低于对照组,差异有统计学意义(t=31.059,P<0.01);观察组AP2LS、AP3LS、AP4LS及LVGLS绝对值均明显低于对照组,差异具有统计学意义(t=21.136,t=17.853,t=21.929,t=16.670;P<0.01);对照组中,aCMQ测量的LVEF值与3DQA技术测量的LVEF值呈显著正相关(r=0.73,P<0.01);观察组aCMQ和3DQA技术分别测量的LVEF呈显著正相关(r=0.91,P<0.01);aCMQ测量的LVGLS与3DQA检测的LVEF呈显著负相关(r=-0.815,P<0.05)。重复测量中,同一观察者采用3DQA前后检测LVEF的变异系数为2.81%,不同观察者间的变异系数为3.98%;同一观察者采用aCMQ前后检测LVEF的变异系数为5.28%,不同观察者间的变异系数为4.84%;同一观察者采用aCMQ前后检测LVGLS的变异系数为3.89%,不同观察者间的变异系数为5.97%。结论:aCMQ分析技术可重复性较高,其测量的LVEF值及LVGLS值与3DQA技术检测的结果具有显著相关性,可作为临床评估左心收缩功能的新方法。

Objective:To compare and analyze the correlation of between automated cardiac motion quantitation(aCMQ)by echocardiography and three-dimensional quantitative analysis(3DQA)technique in assessing left ventricular systolic function.Methods:266 patients with reduced left ventricular systolic function who underwent echocardiographic examination were selected.And 108 patients whose left ventricular ejection fractions were less than 50%(LVEF<50%)were divided into observation group,and 158 patients whose those were larger or equal 50%(LVEF≥50%)were divided into control group.The dynamic images of left ventricular long-axis two-chamber view(AP2),three-chamber view(AP3)and four-chamber view(AP3)were collected.Two-chamber longitudinal strain(AP2LS),three-chamber longitudinal strain(AP3LS),four-chamber longitudinal strain(AP4LS)and left ventricle global longitudinal strain(LVGLS)of left ventricular were measured by using aCMQ.Left ventricular end-diastolic volume(LVEDV),left atrial end-systolic volume(LAESV)and LVEF of two groups were calculated and compared.And then,the correlation of aCMQ and 3DQA in assessing left ventricular systolic function was explored.Results:After aCMQ measurement was implemented,the level of LVEF in observation group was significantly lower than that of control group(t=31.059,P<0.01),and the absolute values of AP2LS,AP3LS,AP4LS and LVGLS of observation group were significantly lower than those of control group(t=21.136,t=17.853,t=21.929,t=16.670,P<0.01).In the control group,there was significantly positive correlation between aCMQ and 3DQA techniques for LVEF values(r=0.73,P<0.01).And in observation group,there was significantly positive correlation between aCMQ and 3DQA techniques for LVEF values(r=0.91,P<0.01),while there was significantly negative correlation between the LVGLS values of aCMQ and the LVEF values of 3DQA(r=-0.815,P<0.05).In repeated measures,the coefficient of variation(CV)of detecting LVEF value before and after same observer adopted 3DQA was 2.81%,while that among different observers was 3.98%.And that before and after same observer adopted aCMQ was 5.28%,and that among different observers was 4.84%.And that of detecting LVGLS before and after same observer adopted aCMQ was 3.89%,and that among different observers was 5.97%.Conclusion:The repeatability of aCMQ is higher,and its measured LVEF values and LVGLS values have significantly correlation with the results of 3DQA,and it can be used as a new method of clinical assessment of left ventricular systolic function.