三维和二维超声心动图评估心肌梗死患者左心室功能和心肌梗死范围的比较

doi:10.3969/j.issn.1006-6233.2018.09.033

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摘要 目的: 比较三维和二维超声心动图对心肌梗死患者左心室功能和心肌梗死范围(MIS)的评估价值。 方法: 以42例急性心肌梗死(AMI)患者为研究组,根据MIS分为小MIS组与大MIS组,以32例进行身体检查的健康人为对照组。以单光子发射计算机断层成像(SPECT)检查结果为金标准,用Pearson相关性分析判断二维、三维超声心动图检查左心收缩期末容积(LVESV)、左心舒张末期容积(LVEDV)、左心每搏输出量(LVSV)、左室射血分数(LVEF)对左心室功能的评估价值,及二维整体纵向峰值应变(GLS)、整体径向峰值应变(GRS)、整体圆周峰值应变(GCS)和三维整体面积峰值应变(GAS)对MIS的评估价值,用ROC曲线分别分析二维、三维应变值对大、小MIS的判别价值。 结果: 三维超声心动图和SPECT检查LVESV、LVEDV、LVSV、LVEF相关性高(r=0.596~0.764),均显著优于二维超声心动图和SPECT检查左心室功能参数的相关性(r=0.378~0.512)。二维、三维超声应变值与MIS均有较高的相关性(r=0.569~0.786),其中二维GLS的相关性最高。ROC曲线显示,二维、三维应变值均能判别大小MIS,其中二维GLS具有最大曲线下面积(AUC),诊断阈值为13.06%时,敏感性为79.86%,特异性为94.78%。 结论: 三维超声心动图评估心肌梗死患者左心室功能效果较好,而二维GLS评估MIS大小效果较佳。

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	王伟芳
	郝宏
	丁智超

关键词 ：急性心肌梗死, 三维超声心动图, 二维超声心动图, 左心室功能, 心肌梗死范围

Abstract：Objective: To compare the value of three-dimensional and two-dimensional echocardiography in the evaluation of the left ventricular function and the range of myocardial infarction (MIS) in patients with myocardial infarction. Methods: 42 patients with acute myocardial infarction (AMI) were used as the research group, according to MIS size, they were divided into small MIS group and large MIS group, 32 cases healthy persons taken physical examination were used as the control group. The results of single photon emission computed tomography (SPECT) examination were the gold standard, used the Pearson correlation to analyze the value of two-dimensional and three-dimensional echocardiography in the detection of left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), left heart stroke volume (LVSV) and left ventricular ejection fraction (LVEF) for the left ventricular function evaluation, and the value of two-dimensional global longitudinal peak strain (GLS), the whole radial peak strain (GRS), the whole circumferential peak strain (GCS) and the three dimensional total area peak strain (GAS) for the evaluation of MIS, and the 2-D global longitudinal peak strain (GLS), the whole radial peak strain (GRS), the whole circumferential peak strain (GCS) and the three dimensional total area peak strain (GAS), GLS, GRS and GCS for the MIS evaluation value, the ROC curve is used to analyze the discriminating values of the two-dimensional and three-dimensional strain values to the large and small MIS respectively. Results: The correlations between three-dimensional echocardiography and SPECT in the detection of LVESV, LVEDV, LVSV and LVEF were high (r=0.596~0.764), were significantly better than those between two-dimensional echocardiography and SPECT in the detection of left ventricular function parameters (r=0.378 ~ 0.512). The two-dimensional and three-dimensional ultrasonic strain values had high correlation with MIS (r=0.569~0.786), the correlation of two-dimensional GLS was the highest. The ROC curve showed that both the two-dimensional and three-dimensional strain values could distinguish the MIS size, the two-dimensional GLS had the maximum area under the curve (AUC), when the diagnostic threshold was 13.06%, the sensitivity was 79.86%, the specificity was 94.78%. Conclusion: Three-dimensional echocardiography has better effect on evaluating left ventricular function in patients with myocardial infarction, while two-dimensional GLS has better effect in assessing MIS size.

Key words： Acute myocardial infarction Three dimensional echocardiography Two dimensional echocardiography Left ventricular function range of myocardial infarction

基金资助:河北省承德市科技技术项目,(编号:20132006)

引用本文:

王伟芳, 郝宏, 丁智超. 三维和二维超声心动图评估心肌梗死患者左心室功能和心肌梗死范围的比较[J]. 河北医学, 2018, 24(9): 1532-1536.
WANG Weifang, HAO Hong, DING Zhichao. Comparison of Left Ventricular Function and Myocardial Infarction Range in Patients with Myocardial Infarction by Three-Dimensional and Two-Dimensional Echocardiography. HeBei Med, 2018, 24(9): 1532-1536.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2018.09.033 或 http://www.hbyxzzs.cn/CN/Y2018/V24/I9/1532

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