三维斑点追踪技术测定左心房容积与功能在评价糖尿病患者左心室舒张功能障碍中的应用

Application of three-dimensional speckle tracking imaging in evaluation of left atrial volume and function to reflect left ventricular diastolic dysfunction in diabetic patients

目的:通过三维斑点追踪技术(3D-STI)测定左心房容积与功能,评价其诊断糖尿病患者左心室舒张功能障碍的价值。方法:对78例左心室射血分数正常的糖尿病患者行超声心动图检查,依据超声心动图评定的左心室舒张功能简化流程,分为舒张功能正常组和舒张功能障碍组各39例;另纳入健康志愿者40例作为对照组。应用GE Vivid E95的3D-STI左心房容积及心肌应变自动定量软件获得左心房容积及功能参数,包括左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房收缩前容积(LAVpreA)、左心房最大容积指数(LAVImax)、左心房排空分数(LAEF)、左心房存储期应变(LASr)、左心房管道期应变(LAScd)及左心房收缩期应变(LASct)。比较3组间的左心房参数差异。结果:LAVmin、LAVmax及LAVpreA在舒张功能障碍组中较舒张功能正常组显著增大(均P<0.001)。LAVmax经体表面积校正后,舒张功能障碍组仍较舒张功能正常组增大(P<0.001)。LASr及LAScd在对照组、舒张功能正常组、舒张功能障碍组依次递减,舒张功能正常组及舒张功能障碍组均低于对照组(均P<0.001),且舒张功能障碍组均低于舒张功能正常组(均P<0.001)。3组LASct比较,差异无统计学意义(P>0.05)。LAVpreA较其他左心房容积参数在评估左心室舒张功能障碍上有较好的诊断效能(截断值43.50 mL,敏感度89.7%,特异度93.5%,AUC 0.96)。LAScd与LASr有较好的左心室舒张功能障碍的排除价值(LASr:截断值-22.5%,敏感度84.8%,特异度76.9%,AUC 0.90;LAScd:截断值-11.5%,敏感度89.1%,特异度94.5%,AUC 0.98)。结论:3D-STI获得的左心房容积及功能参数对糖尿病患者左心室舒张功能障碍的判定有一定价值。

Objective:To explore the value of three-dimensional speckle tracking imaging(3D-STI)in evaluation of left ventricular diastolic function in diabetic patients by analyzing left atrial volume and function.Methods:Echocardiography was performed in 78 diabetes patients with normal left ventricular ejection fraction.According to the simplified assessment method of left ventricular diastolic function,the patients were divided into a diastolic dysfunction group(39 cases)and a normal diastolic function group(39 cases).The control group consisted of 40 healthy volunteers.3D-STI of left atrial volume and myocardial strain automatic quantitative software of GE vivid E95 was used to obtain the left atrial volume and function data,including maximum left atrial volume(LAVmax),minimum volume of left atrium(LAVmin),left atrial volume before the P wave on electrocardiogram(LAVpreA),maximum volume index of left atrium(LAVImax),left atrial emptying fraction(LAEF)left atrium reservoir strain(LASr),left atrium conduit strain(LAScd)and left atrium contraction strain(LASct).The left atrial parameters were compared between the three groups.Results:LAVmin,LAVmax and LAVpreA in the diastolic dysfunction group were significantly higher than those in the normal diastolic function group(all P<0.001).After correction of body surface area,LAVmax in the diastolic dysfunction group was still higher than that in the normal diastolic function group(P<0.001).LASr and LAScd decreased in turn in the control group,the normal diastolic function group and the diastolic dysfunction group.Compared with the control group,LASr and LAScd in both the diastolic normal group and the diastolic dysfunction group were significantly lower(all P<0.001),and those in the diastolic dysfunction group were also significantly lower than those in the normal diastolic function group(both P<0.001).LASct had no statistical difference in three groups(P>0.05).LAVpreA had a good diagnostic value for left ventricle diastolic function compared with other left atrial volume parameters with the cutoff value of 43.50 mL,sensitivity of 89.7%,specificity of 93.5%,AUC of 0.96.LASr and LAScd had a better exclusion value for diastolic dysfunctionin with the cutoff value,sensitivity,specificity,AUC of LASr of-22.5%,84.8%,76.9%,0.90,respectively,and those of LAScd of-11.5%,89.1%,94.5%,0.98,respectively.Conclusions:3D-STI technology of left atrial volume and function parameters is valuable for the determination of left ventricular diastolic dysfunction in patients with diabetes.