三维斑点追踪技术联合E/e'在脓毒症心肌功能障碍诊断中的应用价值

Diagnostic Value of Three-dimensional Speckle Tracking Imaging Combined with E/e’for Sepsis Induced Myocardial Dysfunction

目的:探讨三维斑点追踪技术(3D-STI)联合舒张早期二尖瓣血流峰值速度/舒张早期二尖瓣瓣环峰值速度(E/e’)在脓毒症心肌功能障碍(SIMD)诊断中的应用价值。方法:选取2020年1月-2021年12月广东省中西医结合医院收治的90例脓毒症患者,根据是否出现SIMD将其分为SIMD组57例和非SIMD组33例,另选取同期于本院行超声心动图检查的45例健康体检者(health control,HC)纳入HC组,均接受心脏超声心动图检查。比较SIMD组、非SIMD组和HC组左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、E/e’和左心室总体纵向应变(LVGLS)、左心室总体圆应变(LVGCS)、左心室总体径向应变(LVGRS)和左心室总体面积应变(LVGAS);受试者操作特性(ROC)曲线分析3D-STI、E/e’及联合检查诊断脓毒症SIMD的价值。结果:SIMD组、非SIMD的LVEDV、LVESV及E/e’均高于HC组,LVEF均低于HC组(P<0.05);SIMD组LVEDV、LVESV和E/e’均明显高于非SIMD组,LVEF明显低于非SIMD组(P<0.05);SIMD组、非SIMD组和HC组LVGLS、LVGCS、LVGRS和LVGAS等3D-STI指标绝对值差异均有统计学意义(P<0.05),SIMD组LVGLS、LVGCS、LVGRS和LVGAS绝对值均明显低于非SIMD组和HC组(P<0.05);ROC分析结果显示,3D-STI参数联合E/e’诊断脓毒症SIMD的AUC为0.905,敏感度、特异度分别为94.74%和75.80%。结论:3D-STI联合E/e’可准确评估脓毒症患者左室舒缩功能,对脓毒症SIMD具有较好的诊断价值。

Objective:To explore the diagnostic value of three-dimensional speckle tracking imaging(3D-STI)combined with ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity(E/e’)for sepsis induced myocardial dysfunction(SIMD).Method:A total of 90 patients with sepsis admitted to Guangdong Hospital of Integrated Traditional Chinese and Western Medicine were enrolled from January 2020 to December 2021.According to presence or absence of SIMD,they were divided into SIMD group(57 cases)and nonSIMD group(33 cases).A total of 45 health controls(HC)undergoing ultrasonic cardiogram during the same period were enrolled as HC group.The left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),E/e’,left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),left ventricular global radial stain(LVGRS)and left ventricular global area stain(LVGAS)in different groups were compared.The diagnostic value of 3D-STI,E/e’and combined detection for sepsis induced SIMD was analyzed by receiver operating characteristic(ROC)curves.Result:LVEDV,LVESV and E/e’in SIMD group and non-SIMD group were higher than those in HC group,while LVEF was lower than that in HC group(P<0.05).LVEDV,LVESV and E/e’in SIMD group were significantly higher than those in non-SIMD group,while LVEF was significantly lower than that in non-SIMD group(P<0.05).There were significant differences in absolute values of 3D-STI indexes(LVGLS,LVGCS,LVGRS,LVGAS)among SIMD group,nonSIMD group and HC group(P<0.05),which were significant lower in SIMD group than those in non-SIMD group and HC group(P<0.05).The results of ROC curves analysis showed that AUC,sensitivity and specificity of 3D-STI parameters combined with E/e’in the diagnosis of SIMD was 0.905,94.74%and 75.80%,respectively.Conclusion:3D-STI combined with E/e’can accurately assess left ventricular diastolic and systolic function in sepsis patients,which has good diagnostic value for SIMD.