实时三平面超声心动图评价心肌梗死患者左心室总体收缩功能的研究

摘要

目的 探讨实时三平面超声心动图(RT-3PE)测量心肌梗死患者左心室总体收缩功能的可行性、准确性和重复性.方法 同期应用RT-3PE和二维超声心动图(2DE)双平面Simpson法测量30例心肌梗死患者左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)和左心室射血分数(LVEF),并与单光子发射计算机断层成像术(SPECT)测值进行对比研究,同期由同一和不同的检查者应用RT-3PE进行重复测量并将测量结果进行比较.结果 (1)RT-3PE和2DE Simpson法所测LVEDV分别为(86.67±37.64)、(86.43±38.25)ml,LVESV分别为(42.13±37.42)、(41.06±32.47)ml,SPECT测量的LVEDV和LVESV分别为(108.70±66.27)、(55.90±61.68)ml,RT-3PE和2DE Simpson法测得LVEDV和LVESV分别与SPECT比较差异有统计学意义(t=3.63、2.76、3.37、2.54,P均＜0.01或0.05);3种方法所测LVEF值之间差异无统计学意义(P＞0.05).(2)RT-3PE测得LVEDV、LVESV和LVEF与SPECT相应的测量值密切相关(r=0.943、0.965、0.816,P均＜0.01);2DE Simpson法测得LVEDV、LVESV和LVEF与SPECT相应的测量值相关性较好(r=0.896、0.957、0.721,P均＜0.01).Altman-Bland一致性分析显示RT-3PE所测左心室容积和收缩功能与SPECT测值的一致性高于2DE Simpson法.(3)同一和不同的检查者采用RT-3PE重复测量结果之间差异无统计学意义(P＞0.05),且有良好的相关性,同一检查者采用RT-3PE两次测量LVEDV、LVESV和LVEF的相关性良好(r=0.968、0.984、0.883,P均＜0.01);不同检查者采用RT-3PE测量LVEDV、LVESV和LVEF的相关性也很好(r=0.948、0.970、0.899,P均＜0.01).结论 RT-3PE是一种能够快速、准确测量心肌梗死患者左心室总体收缩功能的影像技术.%Objective To investigate the feasibility, accuracy and reproducibility of real-time tri-plane echocardiography ( RT-3PE ) for measuring the global left ventricular systolic function in patients with myocardial infarction. Methods In the total of 30 patients with myocardial infarction, left ventricular end-diastolic volume( LVEDV ),left ventricular end-systolic volume( LVESV )and left ventricular ejection fraction( LVEF ) were measured through RT-3PE and two-dimensional echocardiography ( 2DE ) bi-plane Simpson s method. The measured values were compared with those obtained through SPECT. Intra-and interobserver reliabilities were also assessed for the measurement of RT-3PE. Results ( 1 )The values of LVEDV measured through RT-3PE and 2DE Simpson' s method were( 86.67 ± 37. 64 )ml and( 86.43 ± 38. 25 )ml respectively,and those of LVESV were( 42. 13 ± 37. 42 )ml and( 41. 06 ± 32. 47 )ml respectively. While the values of LVEDV and LVESV measured by SPECT were( 108. 70 ± 66. 27 )ml and( 55. 90 ± 61. 68 ) ml respectively. There were significant differences between the values measured by SPECT and RT-3PE,and also between those measured by SPECT and 2DE Simpson's method( t =3.63,2.76,3.37,2.54,P<0.01 or<0.05); There was no significant difference among the values of LVEF measured by the three ways. ( 2 )For the measurementof LVEDV,LVESV and LVEF, there was correlation between RT-3PE and SPECT( r respectively: 0. 943, 0. 965,0. 816, P < 0.01 ),as well as between 2DE Simpsons method and SPECT( r respectively :0. 896, 0. 957 ,0. 721 ,P <0. 01 ). Altman-Bland analysis showed a good consistency between RT-3PE and SPECT in the measurement of left ventricular volume and systolic function. ( 3 ) There was no significant difference between the measurements obtained by the same or different examiners with RT-3PE( P > 0.05 ), and there was a good correlation for both intra-( r respectively: 0. 968, 0. 984, 0. 883, P < 0. 01 ) and interobserver ( r respectively:0.948,0. 970,0. 899,P <0. 01 ). Conclusions RT-3PE is a quick and accurate ultrasonic technology for the measurement of global left ventricular systolic function in patients with myocardial infarction