三维斑点追踪成像对慢性心力衰竭患者左心室功能的评估价值

Evaluation of left ventricular function in patients with chronic heart failure by three-dimensional speckle tracking imaging

目的研究超声心动图三维斑点追踪成像(3D-STI)对慢性心力衰竭(CHF)患者左心室功能的评估价值。方法选取CHF患者64例(CHF组),同期健康体检者42例(对照组),两组均行常规超声检查,并采集左心室三维全容积实时图像,应用斑点追踪分析软件测量左心室心肌整体纵向峰值应变(GLS)、环向峰值应变(GCS)和径向峰值应变(GRS)。应用受试者工作特征(ROC)曲线评估GLS、GCS和GRS对左心室收缩功能不全的诊断价值。结果CHF组左心室射血分数(LVEF)明显低于对照组,而左心室舒张期末容积(LVEDV)和左心室收缩期末容积(LVESV)明显高于对照组,舒张早期左室充盈峰值流速(E)/舒张早期运动速度峰值(Ea)也明显高于对照组(P<0.05)。CHF组左心室三维应变参数GLS、GCS和GRS明显高于对照组(P<0.05);GLS、GCS和GRS分别与LVEF呈正相关,与LVEDV呈负相关(P<0.05)。GLS诊断左心室收缩功能不全的ROC曲线下面积(AUC)分别高于GCS和GRS(P<0.05),GCS和GRS诊断AUC差异无显著性(P>0.05)。结论3D-STI三维整体应变参数GLS、GCS和GRS是评价左心室心肌功能的可靠指标,可以从多维度评估左心室收缩功能,其中以GLS诊断效能最高。

Aim To study the value of three-dimensional speckle tracking echocardiography(3d-sti)in evaluating left ventricular function in patients with chronic heart failure(CHF).Methods 64 Patients with CHF(CHF group)and 42 healthy subjects(control group)were selected.Both groups underwent routine ultrasound examination,and 3D full volume real-time images of left ventricle were collected.The global longitudinal peak strain(GLS),circumferential peak strain(GCS)and radial peak strain(GRS)of left ventricle were measured by speckle tracking analysis software.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of GLS,GCS and GRS for left ventricular systolic dysfunction.Results The left ventricular ejection fraction(LVEF)in CHF group was significantly lower than that in control group,while the left ventricular end diastolic volume(LVEDV)and left ventricular end systolic volume(LVESV)in CHF group were significantly higher than those in control group,and the peak velocity of early diastolic filling(E)/peak velocity of early diastolic movement(EA)in CHF group were also significantly higher than those in control group(P<0.05).The absolute value of GLS,GCS and GRS in CHF group was significantly higher than those in control group(P<0.05);GLS,GCS and GRS were positively correlated with LVEF and negatively correlated with LVEDV(P<0.05).The area under ROC curve(AUC)of GLS was higher than that of GCS and GRS(P<0.05),but there was no significant difference between GCS and GRS(P>0.05).Conclusion 3D-STI three-dimensional global strain parameters GLS,GCS and GRS are reliable indexes for evaluating left ventricular myocardial function,which can evaluate left ventricular systolic function from multiple dimensions,and GLS has the highest diagnostic efficiency.