斑点追踪超声心动图评估新生儿左心室纵向应变的可行性研究

Feasibility of left ventricular longitudinal strain measurement by speckle-tracking echocardiography in infants

目的探讨斑点追踪超声心动图(STE)评估新生儿左室纵向应变的临床可行性及应用方法。方法选取2019年6月至2020年2月于广州医科大学附属第三医院出生的1周内新生儿110例,收集其基本资料,由两位有5年以上工作经验的医师进行STE采集,再分别由有5年工作经验和2年工作经验医师进行同一患者图像分析,并比较两医师间分析结果的差异及相关性;由5年工作经验医师对同一患者图像进行两次分析,并比较医师内两次分析结果的差异及相关性;按照新生儿体重进行分组,比较医师间及医师内的相关性;STE分析指标主要包括整体平均左室纵向应变(Glps-avg)、四腔心左室纵向应变(Glps-A4C)、三腔心左室纵向应变(Glps-A3C)、两腔心左室纵向应变(Glps-A2C)、左室前壁纵向应变(Glps-a)、前室间隔纵向应变(Glps-ais)、后室间隔纵向应变(Glps-pis)、左室下壁纵向应变(Glps-i)、左室后壁纵向应变(Glps-p)、左室侧壁纵向应变(Glps-l)、左室基底段纵向应变(Glps-bs)、左室中段纵向应变(Glps-ms)、左室心尖段纵向应变(Glps-as),共13个指标,差异性分析采用配对t检验,相关性采用组内相关性系数(ICC)进行统计学分析。结果根据纳入及排除标准,纳入95例新生儿。两医师间分析结果比较:除Glps-pis外,其余指标差异有统计学意义(均P<0.05),ICC为0.38~0.72(均P<0.01);医师内两次分析结果比较:Glps-ais和Glps-i差异有统计学意义(均P<0.05),其余指标差异无统计学意义(均P>0.05),ICC为0.31~0.76(均P<0.05);Glps-avg、Glps-bs、Glps-ms医师间及医师内ICC分别为0.68/0.75、0.72/0.66、0.65/0.76。按新生儿体重进行分组比较显示:极低体重儿组,医师间ICC为0.82~0.93(均P<0.05),医师内ICC为0.80~0.95(均P<0.05);低体重儿组,医师间ICC为0.65~0.94(均P<0.05),医师内ICC为0.69~0.93(均P<0.01);正常体重儿组,医师间ICC为0.06~0.68,除Glps-A3C外,其余指标差异有统计学意义(均P<0.05),医师内ICC为0.36~0.59(均P<0.05);超体重儿组,医师间ICC差异无统计学意义(均P>0.05),医师内ICC,Glps-bs和Glps-ms分别为0.63、0.77(均P<0.05),其余指标差异无统计学意义(均P>0.05)。结论STE在新生儿左室纵向应变的评估中具有较好的重复性,医师内的一致性高于医师间,其中Glps-avg一致性最佳,其次为Glps-bs、Glps-ms;STE在低体重儿和极低体重儿的重复性较正常体重儿及超体重儿更好。

Objective To explore the clinical feasibility and application method of speckle-tracking echocardiography(STE)in assessing left ventricular longitudinal strain in infants.Methods One hundred and ten infants within one week of birth were randomly selected in the Third Affiliated Hospital of Guangzhou Medical University from June 2019 to February 2020,and the basic data were collected.STE was performed by two physicians with more than 5 years′experience.Images of the same infant were analyzed by physicians with 5 years′experience and 2 years′experience,respectively,and the difference and correlation of the results between the two doctors were analyzed.The images of the same infant were analyzed twice by the doctor with 5 years′experience,and the differences and correlations between the results were analyzed.The infants were divided into different groups according to weight to compare the correlations between inter-physicians and intra-physician.STE analysis indicators included global left ventricular longitudinal peak strain(Glps-avg),four-chamber left ventricular longitudinal strain(Glps-A4C),three-chamber left ventricular longitudinal strain(Glps-A3C),two-chamber left ventricular longitudinal strain(Glps-A2C),left ventricular anterior wall longitudinal strain(Glps-a),anterior interventricular septum longitudinal strain(Glps-ais),posterior interventricular septum longitudinal strain(Glps-pis),inferior wall of left ventricle longitudinal strain(Glps-i),posterior wall of left ventricle longitudinal strain(Glps-p),lateral wall of left ventricle longitudinal strain(Glps-l),left ventricular basal section longitudinal strain(Glps-bs),left ventricular middle section longitudinal strain(Glps-ms)and left ventricular apex section longitudinal strain(Glps-as),a total of 13 indicators.The differences were analyzed by paired t test,and the correlations were determined by intra-group correlation coefficient(ICC).Results According to the inclusion and exclusion criteria,95 patients were included.For the 13 STE indicators,inter-physicians comparison:the differences between the two physicians were statistically significant(all P<0.05)except for Glps-pis,and the ICC were 0.38-0.72(all P<0.01).Intra-physician comparison:the differences of these indicators between two measurements were not statistically significant(all P>0.05)except for Glps-ais and Glps-I,ICC were 0.31-0.76(all P<0.05).Among them,inter-physicians and Intra-physician ICC of Glps-avg,Glps-bs,Glps-ms were 0.68/0.75,0.72/0.66 and 0.65/0.76 respectively.The group comparison by infants′weight showed that:In very low weight infants group,the ICC of inter-physicians and intra-physician ranged 0.82-0.93(all P<0.05)and 0.80-0.95(all P<0.05).In low weight infants group,the ICC of inter-physicians and intra-physician ranged 0.65-0.94(all P<0.05)and 0.69-0.93(all P<0.01).In the normal weight infants group,ICC of inter-physicians ranged 0.06-0.68,with statistical significance except for Glps-A3C(all P<0.05);ICC of intra-physician ranged 0.36-0.59(all P<0.05).In overweight infants group,there was no statistical significance in ICC of inter-physicians(all P>0.05),the ICC of intra-physician,Glps-bs and Glps-ms groups were 0.63 and 0.77(all P<0.05),with no statistical significance in other indicators(all P>0.05).Conclusions Left ventricular longitudinal strain by STE in infants has better repeatability,and the consistency of intra-physician is higher than inter-physicians,among which the Glps-avg consistency is the best,followed by Glps-bs and Glps-ms.STE is more reproducible in low and very low weight infants than in normal and overweight infants.