超声心动图对风湿性心脏病二尖瓣狭窄及左房功能的诊断价值

Diagnostic value of echocardiography in evaluating rheumatic mitral stenosis and left atrial function

目的探讨超声心动图评价风湿性心脏病二尖瓣狭窄(MS)及左房功能的诊断价值。方法选取64例MS患者作为病例组,42例同期健康体检者作为对照组;入选者均行超声心动图检查,观察并计算二尖瓣的整体形态及二尖瓣口面积(MVA),使用Kappa检验超声心动图与二尖瓣标本MVA、狭窄程度的一致性;比较两组被检者左心房最大容积指数(LAVmaxI)、左心房最小容积指数(LAVminI)及左心房收缩前容积指数(LAVpreI),左房总射血容量指数(TASVI)、左房被动射血容量指数(PASVI)、左房主动射血容量指数(AASVI)、左房扩张指数(LVEI)、左房整体射血分数(LAEF)、左房被动射血分数(LAEFpassive)及左房主动射血分数(LAEFactive),采用Pearson法分析MVA与LAVmaxI、LAVminI、LAVpreI、TASVI、PASVI、AASVI、LAEF、LAEFpassive及LAEFactive的相关性,采用受试者工作曲线(ROC)下面积(AUC)评估超声心动图对风湿性心脏病的预测价值。结果超声心动图测量MS一致性较好(Kappa=0.840,P=0.063),病例组患者LAVmaxI、LAVminI、LAVpreI及AASVI均高于对照组(P<0.05),TASVI、PASVI、LVEI、LAEF、LAEFpassive、LAEFactive均低于对照组(P<0.05);Pearson相关性分析显示,LAVmaxI、LAVminI、LAVpreI、AASVI与MVA均呈正相关(r=0.840、0.829、0.818、0.675,P<0.05),TASVI、PASVI、LVEI、LAEF、LAEFpassive、LAEFactive均呈显著负相关(r=-0.426、-0.377、-0.609、-0.643、-0.590、-0.646,P<0.05);ROC曲线分析显示,评估风湿性心脏病MS的AUC由高到低分别为LAVminI(0.998)、LAVmaxI(0.982)、LAVpreI(0.982)、LAEF(0.964)、LAEFpassive(0.958)、LAEFactive(0.953)、LVEI(0.948)、TASVI(0.883)、AASVI(0.816)及PASVI(0.783),均具有一定的准确性。结论超声心动图对风湿性心脏病患者MS及左房功能均具有一定的评估价值。

Objective To explore diagnostic value of echocardiography in evaluating rheumatic mitral stenosis(MS)and left atrial(LA)function.Methods A total of 64 patients with MS were selected as case group,and 42 healthy subjects were selected as control group.Two groups underwent echocardiography exam.MS overall shape and the mitral valve area(MVA)were observed and calculated.The consistence of echocardiography with mitral valve specimens,MVA and stenosis degree were examined using Kappa test.LA maximum volume index(LAVmaxI),LA minimum volume index(LAVminI),LA presystolic volume index(LAVpreI),LA total ejection volume index(TASVI),LA passive ejection index(PASVI),LA Active Ejection Volume Index(AASVI),LA expansion Index(LAEI),LA ejection fraction(LAEF),LAEF Passive(LAEFpassive),and LAEF active(LAEFactive)were compared between two groups.Pearson correlation was applied to analyze the correlation of MVA with LAVmaxI,LAVminI,LAVpreI,TASVI,PASVI,AASVI,LAEF,LAEFpassive,and LAEFactive.The area under the receiver operating characteristic(ROC)curve(AUC)was performed to assess diagnostic value of echocardiography in evaluating rheumatic heart disease(RHD).Results Echocardiography had good consistency in measuring MS(Kappa=0.840,P=0.063).Case group had higher LAVmaxI,LAVminI,LAVpreI,and AASVI than control group had,but had lower TASVI,PASVI,LVEI,LAEF,LAEFpassive,and LAEFactive than control group had(P<0.05).Pearson correlation analysis showed that LAVmaxI,LAVminI,LAVpreI,and AASVI were significantly positively correlated with MVA(r=0.840,0.829,0.818,0.675;P<0.05),in contrast,TASVI,PASVI,LVEI,LAEF,LAEFpassive and LAEFactive were negatively associated with MVA(r=-0.426,-0.377,-0.609,-0.643,-0.590,-0.646;P<0.05).ROC curve analysis revealed that the AUC values for evaluating MS of patients with RHD from high to low were LAVminI(0.998),LAVmaxI(0.982),LAVpreI(0.982),LAEF(0.964),LAEFpassive(0.958),LAEFactive(0.953),LVEI(0.948),TASVI(0.883),AASVI(0.816),and PASVI(0.783),indicating that all of them were of certain accuracy.Conclusion Echocardiography has a certain value in evaluating MS and LA function in patients with RHD.