四维超声对慢性缺血性心力衰竭患者左心室重塑及短期预后的定量评价

The quantitative evaluation of four-dimensional strain imaging on the prediction of left ventricular remodeling and short-term prognosis in patients with chronic ischemic heart failure

目的:探讨四维超声定量技术评估慢性缺血性心力衰竭(CIHF)患者心室重塑水平及短期预后的临床价值。方法:选择110例本院住院治疗的CIHF患者,按照临床指南予以规范性治疗6个月,治疗前后应用左室四维应变技术(4D-SI)对左室舒张末期容积(LVEDV)、室间隔厚度(IVST)、左室后壁舒张末期厚度(LVPWT)、室壁运动积分指数(WMSI)、左室射血分数(LVEF)、四维整体峰值长轴应变(GLPS)、环向应变(GCPS)、面积应变(GAPS)及径向应变(GRPS)参数进行测定并评估左室构型,比较治疗前后各指标差异;比较不同左室构型的四维参数差异。随访3年,根据患者预后生存情况分为生存组与死亡组,比较两组超声参数的差异;比较3种构型预后差异。应用多元Logistic回归分析各超声参数与随访3年CIHF患者生存的相关危险程度。绘制单参数受试者工作特征曲线(ROC)检测四维超声各参数对随访3年CIHF患者预后的评估价值。结果:与治疗前相比,治疗后患者的LVEDV、IVST、LVPWT及WMSI显著降低(均P<0.05),而LVEF、GLPS、GCPS、GAPS及GRPS显著升高(均P<0.05)。治疗前3种左室构型四维超声数值均存在差异,向心性肥厚型最高,离心性肥厚型次之,正常构型最低(均P<0.05)。与死亡组相比,生存组患者LVEDV、IVST、LVPWT及WMSI无差异(均P>0.05),而LVEF、GLPS、GCPS、GAPS及GRPS较高(均P<0.05)。3种构型预后无差异(χ~2=2.728,P=0.256)。多元Logistic回归分析显示,WMSI为随访3年CIHF患者生存危险因素(OR=2.872,P=0.020),而GLPS及GAPS为保护性因素(OR=0.482,P=0.028;OR=0.319,P=0.011)。ROC曲线显示,GAPS截断值为-21.5%,预测CIHF患者不良的AUC最大为0.914,敏感度为93.5%,特异度为90.3%。结论:四维超声定量技术能较准确评估CIHF患者左室重塑情况,其中GAPS能够作为患者短期预后结局的独立预测指标。

Objective:To evaluate the clinical application value of the four-dimensional strain imaging(4 D-SI)on the prediction of left ventricular remodeling and short-term prognosis in patients with chronic ischemic heart failure(CIHF).Method:The 110 patients with CIHF in our hospital were collected to perspective study.All patients were received the regular therapy based on the clinical index and the course of therapy was 6 months.The indexes of left ventricular end diastolic volume(LVEDV),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),wall motion score index(WMSI),left ventricular ejection fraction(LVEF),global longitudinal peak strain(GLPS),global circumferential peak strain(GCPS),global area peak strain(GAPS),global radial peak strain(GRPS)were assessed by 4 D-SI at pre-and post-therapy respectively,and above indexes were compared between pre-and post-therapy.The left ventricular patterns were analyzed and compared by4 D-SI at pre-therapy.Follow-up 3 years,all patients were divided into two groups according to the prognosis,which were survival group and death group.The above indexes were compared between two groups.The prognoses of three left ventricular patterns were analyzed.The risk factors of 3 years follow-up survival rate of patients with CIHF were confirmed by multivariate Logistic analysis.The diagnostic value of the levels of above indexes of 4 D-SI to the 3 years follow-up prognosis of the patients with CIHF were analyzed by receiver operating characteristic curves(ROC).Result:Compared to pre-therapy,the levels of LVEDV,IVST,LVPWT and WMSI at post-therapy were lower(all P<0.05),but the levels of LVEF,GLPS,GCPS,GAPS and GRPS at post-therapy were higher(all P<0.05).The 4 D-SI indexes of concentric hypertrophy were highest,and the normal pattern were lowest(all P<0.05).Compared to death group,the levels of LVEDV,IVST,LVPWT and WMSI at survival group were no different(all P>0.05),but the levels of LVEF,GLPS,GCPS,GAPS and GRPS at survival group were higher(all P<0.05).The prognoses of three left ventricular patterns were no different(χ2=2.728,P=0.256).Multivariate Logistic analysis showed that the WMSI was independent risk factors to the 3 years follow-up survive of patients with CIHF(OR=2.872,P=0.020),but the GLPS and GAPS were independent protective factors(OR=0.482,P=0.028;OR=0.319,P=0.011).When the cut-off point of GAPS level was-21.5%,the AUC of predictions to the poor prognosis in patients with CIHF was 0.914 and the sensitivity was 93.5%as well as specificity was90.3%.Conclusion:The indexes of 4 D-SI can evaluate the levels of left ventricular remodeling in patients with CIHF,and the index of GAPS can act as independent predictors to short-term prognosis.