3D心脏解剖模型成像对不同心脏疾病心脏功能的评估价值
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摘要
目的:初步探讨3D心脏解剖模型成像(heart model, HM)对不同心脏疾病功能的评估价值。方法:选取2016年7月至2016年9月期间阜外医院的住院患者18例,采用三种常用心脏测量功能方法 (M型超声、二维双平面Simpson法、心脏运动定量分析CMQ法)和HM法测量左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)值,并与心脏MRI检查结果进行比较。结果:18例患者中,心肌病患者7例(其中扩张性心肌病2例,围产期心肌病1例,肥厚型心肌病4例),冠心病患者8例,其他疾病3例(心律失常2例,瓣膜病1例)。与MRI金标准相比,四种超声测量左心室心功能指标均有较好的相关性,其中HM法相关性最好,LVEDV与LVEF的R值分别为0.924,0.912,P<0.01,M型超声测量的LVEDV与LVEF的R值最低,分别为0.800和0.743,P=0.210和P=0.009。此外,HM法在不同疾病中的LVEF的测量差异和准确性比较中,它的差异也是最小(P均>0.05),准确性最高。结论:HM法能够准确测量LVEDV及LVEF值,并且重复性好,客观性强,是一种值得推荐的测量心脏功能的新方法。
Objectives: To evaluate the clinical value of heart model(HM), established by a new 3D technology based on AIUS(anatomical intelligent ultrasound), on the evaluation of cardiac function.Methods: Eighteen patients, hospitalized in Fuwai Hospital from July to September 2016, were included in this study. Transthoracic 2D and 3D echocardiography and nuclear magnetic resonance(MRI) examination were performed in these patients. HM was established on all patients. The left ventricular end-diastolic volumes(LVEDV) and ejection fraction(LVEF) were measured by four cardiac function methods [M-mode, Biplane Simpson's method, Cardiac motion quantification(CMQ) and 3D Heart Model] and these results were compared with results obtained from MRI. Results: According to the type of disease, patients were divided into cardiomyopathy group(n =7, 2 dilated cardiomyopathy, 1 perinatal cardiomyopathy, 4 hypertrophic cardiomyopathy), coronary heart disease group(8 cases), other heart diseases group(n=3, 2 arrhythmias, 1 cardiac valvular disease). Compared to gold standard MRI, there were good correlations between LVEDV and LVEF measured by four echocardiographic methods and MRI. Among them, HM showed the best correlation with MRI, the R value was 0.924 and 0.912 respectively(P<0.01), and the M-Mode presented with the lowest correlation with MRI, the R value was 0.800 and 0.743(P=0.210 and P=0.009, respectively). Furthermore, the highest diagnostic accuracy was evidenced by HM method in patients with different cardiac diseases.Conclusions: HM can accurately measure LVEDV and LVEF values with satisfactory repeatability and objectiveness, and should be recommended to the measurement of cardiac function in daily clinical works.
Objectives: To evaluate the clinical value of heart model(HM), established by a new 3D technology based on AIUS(anatomical intelligent ultrasound), on the evaluation of cardiac function.Methods: Eighteen patients, hospitalized in Fuwai Hospital from July to September 2016, were included in this study. Transthoracic 2D and 3D echocardiography and nuclear magnetic resonance(MRI) examination were performed in these patients. HM was established on all patients. The left ventricular end-diastolic volumes(LVEDV) and ejection fraction(LVEF) were measured by four cardiac function methods [M-mode, Biplane Simpson's method, Cardiac motion quantification(CMQ) and 3D Heart Model] and these results were compared with results obtained from MRI. Results: According to the type of disease, patients were divided into cardiomyopathy group(n =7, 2 dilated cardiomyopathy, 1 perinatal cardiomyopathy, 4 hypertrophic cardiomyopathy), coronary heart disease group(8 cases), other heart diseases group(n=3, 2 arrhythmias, 1 cardiac valvular disease). Compared to gold standard MRI, there were good correlations between LVEDV and LVEF measured by four echocardiographic methods and MRI. Among them, HM showed the best correlation with MRI, the R value was 0.924 and 0.912 respectively(P<0.01), and the M-Mode presented with the lowest correlation with MRI, the R value was 0.800 and 0.743(P=0.210 and P=0.009, respectively). Furthermore, the highest diagnostic accuracy was evidenced by HM method in patients with different cardiac diseases.Conclusions: HM can accurately measure LVEDV and LVEF values with satisfactory repeatability and objectiveness, and should be recommended to the measurement of cardiac function in daily clinical works.
引文
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[11]陈立宇,段福建,张岩,等.实时三维超声心动图与磁共振成像对比评价室壁瘤患者左心室容积和功能的可行性和准确性[J].中国循环杂志,2012, 27(2):133-136. DOI:10. 3969/j.issn. 1000-3614.2012.02.017.
[12] Almeida N, Papachristidis A, Pearson P, et al. Left atrial volumetric assessment using a novel automated framework for 3D echocardiography:a multi-centre analysis[J]. Eur Heart J Cardiovasc Imaging, 2017, 18(9):1008-1015. DOI:10.1093/ehjci/jew166.
[2]邬冬梅,汤嘉宁,王慧峰,等.心肌磁共振显像、核素心肌灌注显像、超声心动图与X线左心室造影测定左心室功能的对比研究[J].中国循环杂志,2006, 21(06):449-452. DOI:10. 3321/j. issn:1000-3614.2006. 06.017.
[3]王勇,黄云洲,李冬蓓,等.实时三维超声心动图测量室壁瘤左心室功能的临床应用[J].中华医学超声杂志(电子版),2010, 7(7):1208-1214. DOI:10. 3969/cma. j. issn. 1672-6448. 2010. 07. 022.
[4] Tsang W, Salgo IS, Medvedofsky D, et al. Transthoracic 3D echocardiographic left heart chamber quantification using an automated adaptive analytics algorithm[J]. JACC Cardiovasc Imaging, 2016, 9(7):769-782. DOI:10. 1016/j. jcmg. 2015. 12. 020.
[5]薛丽丽,刘永铭,马苏美,等.射血分数正常心力衰竭心脏结构和功能变化的特点[J].中国超声医学杂志,2015, 31(09):792-794.
[6]陈晓雨,柳茵.超声心动图技术评价心脏功能研究进展[J].河北医药,2010, 32(5):609-611. DOI:10.3969/j.issn.1002-7386.2010.05. 056.
[7]吴伟春,张红菊,孙欣,等.探讨M型超声心动图对存在节段性室壁运动异常的冠心病左心室收缩功能的价值[J].中国超声医学杂,2012, 28(3):225-229. DOI:10. 3969/j. issn. 1002-0101.2012.03. 014.
[8]柴坷,王华,杨杰孚.射血分数保留性心力衰竭的病理生理机制和治疗进展[J].中国循环杂志,2016, 31(09):921-923. DOI:10.3969/j.issn.1000-3614. 2016. 09.022.
[9]智光,崔振双,徐勇,等.一个心动实时全容积三维与二维双平面改良Simpson's法测定左室射血分数的对比研究[J].中国超声医学杂志,2010, 26(7):615-618. DOI:10. 3969/j.issn.1002-0101.2010.07.012.
[10]陈万林,吴继雄.实时三维超声心动图的临床应用及研究进展[J].心血管病学进展,2010, 31(3):441-444. DOI:10. 3969/j. issn.1004-3934.2010. 03.033.
[11]陈立宇,段福建,张岩,等.实时三维超声心动图与磁共振成像对比评价室壁瘤患者左心室容积和功能的可行性和准确性[J].中国循环杂志,2012, 27(2):133-136. DOI:10. 3969/j.issn. 1000-3614.2012.02.017.
[12] Almeida N, Papachristidis A, Pearson P, et al. Left atrial volumetric assessment using a novel automated framework for 3D echocardiography:a multi-centre analysis[J]. Eur Heart J Cardiovasc Imaging, 2017, 18(9):1008-1015. DOI:10.1093/ehjci/jew166.