三维超声心动图诊断射血分数保留慢性心力衰竭的价值

The value of three-dimensional echocardiography in the diagnosis of chronic heart failure with preserved ejection fraction

目的探讨实时三维超声心动图对射血分数保留的慢性心力衰竭(HFpEF)患者左心房功能的评估价值。方法回顾性分析100例2021年1月~2021年6月我院收治的慢性心力衰竭(CHF)患者的临床资料,根据临床及影像检查结果将其分为HFpEF组(35例)、射血分数中间值的心衰组(HFmrEF组,30例)和射血分数降低的心衰组(HFrEF组,35例),另选35例同期健康体检者作为对照组。所有入组对象均行实时二维、三维超声心动图检查及血清N-末端脑钠肽前体(NT-ProBNP)水平检测,比较四组超声参数情况及血清NT-ProBNP水平,并分析超声参数与血清NT-ProBNP水平的相关性。结果HFrEF组左室射血分数(LVEF)、二维左房射血分数(2D-LAEF)、三维左房射血分数(3D-LAEF)均低于HFmrEF组、HFpEF组和对照组(P<0.05),HFmrEF组各指标均低于HFpEF组和对照组(P<0.05),HFpEF组各指标均低于对照组(P<0.05);HFrEF组左室收缩末径(LVIDs)、左室舒张末径(LVIDd)、二尖瓣口前向瞬时最大血流速度/二尖瓣环峰值血流速度(E/E′)、二维左房最小容积(2D-LAVmin)、二维左房最大容积(2D-LAVmax)、二维左房最大容积指数(2D-LAVImax)、三维左房最小容积(3D-LAVmin)、三维左房最大容积(3D-LAVmax)、三维左房最大容积指数(2D-LAVImax)及血清N-末端脑钠肽前体(NT-ProBNP)水平均高于HFmrEF组、HFpEF组和对照组(P<0.05),HFmrEF组各指标均高于HFpEF组和对照组(P<0.05),HFpEF组各指标均高于对照组(P<0.05)。Pearson相关性分析结果显示,E/E′、2D-LAVImax、3D-LAVImax与血清NT-ProBNP水平呈正相关(P<0.05),而2D-LAEF、3D-LAEF与血清NT-ProBNP水平呈负相关(P<0.05),且3D-LAVImax、3D-LAEF与血清NT-ProBNP水平的相关值高于2D-LAVImax、2D-LAEF与血清NT-ProBNP水平的相关值。结论实时三维超声心动图可更为准确地评估HFpEF患者左心房结构和功能,且HFpEF患者左心房结构和功能变化与血清NT-ProBNP水平密切相关。

Objective To investigate the evaluation value of real-time three-dimensional echocardiography of left atrium function in patients with chronic heart failure with preserved ejection fraction(HFpEF).Methods The clinical data of 100 patients with chronic heart failure(CHF)admitted to our hospital from January 2021 to June 2021 were retrospectively analyzed,and divide them into the HFpEF group(35 cases)and the heart failure with mid-range ejection fraction(HFmrEF group,30 cases)and the heart failure reduced ejection fraction(HFrEF group,35 cases)according to the clinical and imaging examination results of the selected patients,another 35 healthy subjects were selected as the control group.The real-time two-dimensional echocardiography,real-time three-dimensional echocardiography,and the level of serum N-terminal pro-brain natriuretic peptide(NT-ProBNP)of all subjects were underwented and detected.The four groups of ultrasound parameters and serum level of NT-ProBNP were compared,and the correlation between ultrasound parameters and levels of serum NT-ProBNP were analyzed.Results The left ventricular ejection fraction(LVEF),two-dimensional left atrial ejection fraction(2D-LAEF),and three-dimensional left atrial ejection fraction(3D-LAEF)of the HFrEF group were lower than those of the HFmrEF group,the HFpEF group,and the control group(P<0.05),the all indicators of the HFmrEF group were lower than those in the HFpEF group and the control group(P<0.05),the all indicators of the HFpEF group were lower than those in the control group(P<0.05);the left ventricular end systolic diameter(LVIDs),left ventricular end diastolic diameter(LVIDd),mitral valve orifice forward instantaneous maximum blood flow velocity/mitral annulus peak blood flow velocity(E/E′),two-dimensional left minimum volume of atrium(2D-LAVmin),two-dimensional left maximum volume of atrium(2D-LAVmax),two-dimensional left atrium maximum volume index(2D-LAVImax),three-dimensional left minimum volume of atrium(3D-LAVmin),three-dimensional left maximum volume of atrium(3D-LAVmax),three-dimensional left atrium maximum volume index(2D-LAVImax)and level of serum N-terminal brain natriuretic peptide precursor(NT-ProBNP)were higher than the HFmrEF group,the HFpEF group and the control group(P<0.05),the all indicators of the HFmrEF group were higher than the HFpEF group and the control group(P<0.05),the all indicators of the HFpEF group were higher than control group(P<0.05).Pearson correlation analysis results showed that E/E′,2D-LAVImax,3D-LAVImax were positively correlated with serum level of NT-ProBNP(P<0.05),while 2D-LAEF and 3D-LAEF were negatively correlated with serum level of NT-ProBNP(P<0.05),and the correlation value of 3D-LAVImax,3D-LAEF and level of serum NT-ProBNP was higher than the correlation value of 2D-LAVImax,2D-LAEF and level of serum NT-ProBNP.Conclusion Real-time three-dimensional echocardiography could accurately evaluated the structure and function of the left atrium in patients with HFpEF,and the changes in the structure and function of the left atrium in patients with HFpEF were closely related to the level of serum NT-ProBNP.