三维超声全自动动态容积定量技术对双心室收缩功能的评估

Evaluation of biventricular systolic function by three-dimensional fully automated dynamic volumetric quantification technique

目的:探讨三维超声全自动动态容积定量技术测量双心室容积和射血分数的可行性及相关影响因素。方法:回顾性纳入2020年1月至2020年12月于中国医科大学附属第一医院经冠状动脉造影确诊为冠心病的患者55例。所有患者均行心脏超声和CMR检查。采用三维超声全自动动态容积定量技术(左心室采用DHM软件,右心室采用3D RVauto软件)测量左、右心室舒张末期容积(LVEDV、RVEDV)、收缩末期容积(LVESV,RVESV)和射血分数(LVEF,RVEF),对部分心内膜边界自动识别不符合实际边界者进行手动调整(DHME,3D RVE)。DHM和DHME测值、3D RVauto和3D RVE测值分别与CMR测值进行一致性检验,并将患者按图像质量、心率、左心室有无节段运动异常、左心室有无形态改变以及RVEDV、RVEF大小进行分组,探讨三维超声全自动动态容积定量技术测量的准确性及相关影响因素。结果:DHM、DHME与CMR的LVEF、LVEDV、LVESV测值差异均无统计学意义(P均>0.05),测量LVEF时DHME较DHM与CMR的相关性提高(r=0.94 vs 0.80),但DHM测量LVEF的准确性已在临床可接受范围内(Percentage error<30%)。图像质量不佳、心率>63次/分、左心室有节段运动异常和形态有改变的患者DHM测量LVEF的准确性降低(Percentage error:24.56%vs 13.84%,28.01%vs 19.14%,27.29%vs 18.83%,24.15%vs 23.80%),但均在临床可接受范围内。3D RVauto与CMR的RVEF测值差异无统计学意义(P=0.06),手动调整后3D RVE与CMR测值的相关性提高(r=0.95 vs 0.49)。图像质量不佳、HR>63次/分、RVEDV增大和RVEF减低的患者3D RVauto测量RVEF的准确性降低(Percentage error:44.50%vs 32.47%,41.07%vs 39.48%,46.24%vs 38.08%,41.42%vs 31.16%),手动调整后均可提高至临床可接受范围(Percentage error:12.36%、13.31%、13.40%、11.29%)。结论:三维超声全自动动态容积定量技术测量左心室收缩功能的准确性较高,但其测量右心室收缩功能准确性一般。对于图像质量不佳、心率>63次/分、左心室有节段运动异常、左心室形态有改变、RVEDV增大和RVEF减低的患者,可通过手动调整心内膜边界提高测量准确性。

Objective To investigate the feasibility and influencing factors of three-dimensional(3D)fully automated dynamic volumetric quantification technique for the measurement of biventricular volume and ejection fraction.Methods Fifty-five patients with coronary heart disease confirmed by coronary angiography at the First Hospital of China Medical University from January to December 2020 were examined by 3D fully automated dynamic volumetric quantification technique(left ventricle:DHM;right ventricle:3D RVauto)and cardiac magnetic resonance(CMR).The left and right ventricular end-diastolic volume(LVEDV and RVEDV),end-systolic volume(LVESV and RVESV),and ejection fraction(LVEF and RVEF)were measured,and manual adjustment(DHME and 3D RVE)was performed for some cases in which endocardial boundary automatic recognition did not conform to the actual boundary.Consistency test was conducted between the measured results and CMR values.The patients were further divided into subgroups according to image quality,heart rate(HR),left ventricular segmental movement abnormalities,left ventricular morphological changes,RVEDV,and RVEF to investigate the accuracy and influencing factors of 3D fully automated dynamic volume quantification technique.Results There was no significant difference in LVEF values measured by DHM,DHME,and CMR(P>0.05).LVEF values measured by DHME showed a highly positive correlation with those measured by DHM(r=0.94 vs 0.80),while the accuracy of DHM in LVEF measurement was within the clinically acceptable range(percentage error<30%).Consistency between values measured by DHM and CMR was significantly decreased in patients with poor image quality,HR>63 beats per minute(bpm),segmental wall motion abnormality,and left ventricular morphological changes(percentage error:24.56%vs 13.84%,28.01%vs 19.14%,27.29%vs 18.83%,and 24.15%vs 23.80%,respectively),but all the percentage errors were within the clinically acceptable range.There was no significant difference in RVEF values measured by 3D RVauto and CMR(P=0.06).The correlation of values measured between 3D RVE and CMR increased(r=0.95 vs 0.49).Consistency between values measured by 3D RVauto and CMR was significantly decreased in patients with poor image quality,HR>63 bpm,increased RVEDV,and decreased RVEF(percentage error:44.50%vs 32.47%,39.48%vs 41.07%,46.24%vs 38.08%,and 41.42%vs 31.16%,respectively),and the consistency was significantly improved after manual adjustment(percentage error:12.36%,13.31%and 13.40%and 11.29%,respectively).Conclusion 3D fully automated dynamic volumetric quantification technique has a high accuracy in measuring left ventricular systolic function,and can be recommended for extensive clinical application.However,its accuracy in measuring RV systolic function is generally low.For patients with poor image quality,HR>63bpm,segmental wall motion abnormality,left ventricular morphological changes,increased RVEDV,and decreased RVEF,the measurement accuracy can be improved by manual adjustment of endocardial boundary.