超声识别冠心病患者下壁室壁运动异常假阳性的探索性研究

Exploratory study to investigate the false positive status of inferior wall regional wall motion abnormality identified by ultrasound in patients with coronary heart disease

目的探讨基层医院利用常规超声识别冠心病患者下壁局限性室壁运动异常(RWMA)假阳性情况。方法选取2020年1—12月北京市昌平区医院超声疑似诊断下壁RWMA的45例冠心病患者作为研究对象。分析超声诊断结果,比较诊断真阳性与诊断假阳性患者合并症情况、超声参数及二尖瓣反流情况。结果45例超声疑似诊断左心室下壁RWMA患者中,诊断真阳性34例,诊断假阳性11例,诊断假阳性率为24.44%。诊断真阳性患者合并下侧壁RWMA比例高于诊断假阳性患者,差异有统计学意义(P<0.05);诊断真阳性与诊断假阳性患者合并前侧壁RWMA、存在二尖瓣反流比例比较差异无统计学意义。诊断真阳性与诊断假阳性患者室间隔、左心室后壁、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)比较差异无统计学意义;诊断真阳性患者右心室前后径、右心房左右径均大于诊断假阳性患者,差异有统计学意义(P<0.05)。结论超声诊断下壁RWMA可能存在诊断假阳性的情况,结合一些超声影像特点可能会减少误诊。

Objective To investigate the false positive status of regional wall motion abnormality(RWMA)in patients with coronary heart dis-ease by conventional ultrasound in primary hospitals.Methods 45 patients with coronary heart disease suspected inferior wall RWMA diagnosed by ultrasound in Changping District Hospital of Beijing from January to December 2020 were selected as the study subjects,the results of ultrasonic di-agnosis were analyzed,and the complications,ultrasonic parameters and mitral regurgitation were compared between the patients with true positive and false positive.Results Among 45 cases of suspected left ventricular inferior wall RWMA diagnosed by ultrasound,34 cases were true positive,11 cases were false positive,and the false positive rate was 24.44%.The proportion of lower lateral wall RWMAin patients with true positive diagno-sis was higher than that in patients with false positive diagnosis,and the difference was statistically significant(P<0.05);there were no significant differences in the proportion of anterior lateral wall RWMA and mitral regurgitation between the patients with true positive and false positive.There were no significant differences in ventricular septum,left ventricular posterior wall,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF)between the patients wtihe true positive and false positive;the anteropos-terior and anteroposterior diameters of right ventricle and right atrium in patients diagnosed with true positive were larger than those diagnosed with false positive,and the difference was statistically significant(P<0.05).Conclusion There may be false positives in inferior wall RWMA diagnosed by ultrasound,and combining with some ultrasonic image characteristics may reduce misdiagnosis.