超声三维斑点追踪技术检查肝硬化患者左心室收缩功能初步研究
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摘要
目的探讨三维斑点追踪成像技术(3D-STI)在肝硬化患者左心室收缩功能检查中的应用价值。方法选取68例肝炎肝硬化患者和30例健康体检者,进行超声检查,常规测量左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、射血分数(LVEF),并采用3D-STI测定心肌不同部位的收缩期峰值应变。采用ROC预测模型评估基底段、中间段、心尖段、心尖帽的收缩期峰值应变对患者预后的预测价值。结果肝硬化患者LVEDV和LVESV[(122.7±16.3)ml和(46.2±6.2)ml]均显著高于健康人[(102.6±12.2)ml和(35.3±5.2)ml,P<0.001],两组LVEDD、LVESD、LVEF差异无统计学意义(P>0.05);肝硬化患者基底段、中间段、心尖段、心尖帽的收缩期峰值应变[(18.8±4.3)、(19.2±4.2)、(18.6±3.5)、(19.2±4.1)]均显著低于健康人[(21.3±5.2)、(23.8±3.9)、(22.4±4.1)、(23.9±4.3),P<0.001];随访期间,失访3例,死亡21例。ROC曲线分析显示,基底段、中间段、心尖段、心尖帽的收缩期峰值应变对肝硬化患者死亡预测模型的曲线下面积分别为0.857、0.893、0.869、0.866,应变值分别为18.85、20.05、16.25、18.05,其敏感度分别为78.6%、69.0%、85.7%、74.7%,特异度分别为82.0%、91.0%、66.7%、84.5%。结论肝硬化患者多伴随左心室局部收缩功能减退,3D-STI检测有利于发现肝硬化患者左心室收缩障碍,且对患者预后有一定的预测作用。
Objective To investigate the evaluation of left ventricular systolic function by three-dimensional speckle tracking imaging(3D-STI) in patients with liver cirrhosis. Methods 68 patients with viral hepatitis liver cirrhosis and 30 healthy persons were recruited in this study,and ultrasound was performed. Left ventricular end diastolic diameter(LVEDD),left ventricular end-diastolic diameter(LVESD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),ejection fraction(LVEF) were routinely measured,and the systolic peak strain of different parts of myocardium was assayed by 3D-STI.The LVEDD,LVESD,LVEDV,LVESV,LVEF,the systolic peak strain at the basal segment,middle segment,apical segment,and apex cap between patients with liver cirrhosis and healthy control were compared. The predictive value of systolic peak strain of the parameters on the prognosis of the patients was evaluated by ROC prediction model. Results The levels of LVEDV and LVESV in patients with liver cirrhosis [(122.7±16.3)ml and(46.2±6.2)ml] were significantly higher than [(102.6±12.2)ml and(35.3±5.2)ml,P<0.001] in healthy persons,while there were no significant differences between the levels of LVEDD,LVESD and LVEF in patients with liver cirrhosis and healthy control(P>0.05);the peak systolic peak of basal segment,middle segment,apical segment and apex cap in cirrhotics [(18.8±4.3),(19.2±4.2),(18.6±3.5),(19.2±4.1)] were much lower than [(21.3±5.2),(23.8±3.9),(22.4±4.1),(23.9±4.3),P<0.001] in the healthy person; during the follow-up period,21 died and 3 lost. The ROC curves showed that thearea under ROC by the systolic peak of the basal segment,middle segment,apical segment and apex cap were 0.857,0.893,0.869 and 0.866,the strain was18.85,20.05,16.25,18.05,and the sensitivity were78.6%,69.0%,85.7% and 74.7%,and the specificity were 82.0%,91.0%,66.7% and 84.5%,respectively.Conclusion The patients with liver cirrhosis tends to have left ventricular systolic dysfunction. The 3D-STI is an alternative approach to evaluate the left ventricular systolic dysfunction at early stage non-invasively.
Objective To investigate the evaluation of left ventricular systolic function by three-dimensional speckle tracking imaging(3D-STI) in patients with liver cirrhosis. Methods 68 patients with viral hepatitis liver cirrhosis and 30 healthy persons were recruited in this study,and ultrasound was performed. Left ventricular end diastolic diameter(LVEDD),left ventricular end-diastolic diameter(LVESD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),ejection fraction(LVEF) were routinely measured,and the systolic peak strain of different parts of myocardium was assayed by 3D-STI.The LVEDD,LVESD,LVEDV,LVESV,LVEF,the systolic peak strain at the basal segment,middle segment,apical segment,and apex cap between patients with liver cirrhosis and healthy control were compared. The predictive value of systolic peak strain of the parameters on the prognosis of the patients was evaluated by ROC prediction model. Results The levels of LVEDV and LVESV in patients with liver cirrhosis [(122.7±16.3)ml and(46.2±6.2)ml] were significantly higher than [(102.6±12.2)ml and(35.3±5.2)ml,P<0.001] in healthy persons,while there were no significant differences between the levels of LVEDD,LVESD and LVEF in patients with liver cirrhosis and healthy control(P>0.05);the peak systolic peak of basal segment,middle segment,apical segment and apex cap in cirrhotics [(18.8±4.3),(19.2±4.2),(18.6±3.5),(19.2±4.1)] were much lower than [(21.3±5.2),(23.8±3.9),(22.4±4.1),(23.9±4.3),P<0.001] in the healthy person; during the follow-up period,21 died and 3 lost. The ROC curves showed that thearea under ROC by the systolic peak of the basal segment,middle segment,apical segment and apex cap were 0.857,0.893,0.869 and 0.866,the strain was18.85,20.05,16.25,18.05,and the sensitivity were78.6%,69.0%,85.7% and 74.7%,and the specificity were 82.0%,91.0%,66.7% and 84.5%,respectively.Conclusion The patients with liver cirrhosis tends to have left ventricular systolic dysfunction. The 3D-STI is an alternative approach to evaluate the left ventricular systolic dysfunction at early stage non-invasively.
引文
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[5]陈春,伍思国,杨智娟,等.肝硬化上消化道出血患者预后因素分析.实用肝脏病杂志,2015,18(3):300-301.
[6]Sattarzadeh-Badkoubeh R,Geraiely B,Nassiri-Toosi M,et al.Evaluation of cardiac systolic function in cirrhotic patients undergoing liver transplantation.Acta Med Iran,2015,53(8):476-481.
[7]Mottram PM,Leano R,Marwick TH.Usefulness of B-type natriuretic peptide inhypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function.Am J Cardiol,2003,92(12):1434-1438.
[8]Hung KC,Huang HL,Chu CM,et al.Evaluating preload dependence of a novel Doppler application in assessment of left ventricular diastolic function during hemodialysis.Am J Kidney Dis,2004,43(6):1040-1046.
[9]Miyashita T,Okano Y,Takaki H,et al.Relation between exercise capacity and left ventricular systolic versus diastolic function during exercise in patients after myocardial infarction.Coron Artery Dis,2001,12(3):217-225.
[10]任秀昀,徐惠,舒清明,等.超声弹性成像评估离体肝硬化标本结节性病变性质的初步研究.中华超声影像学杂志,2010,19(1):29-31.
[11]Mindikoglu AL,Dowling TC,Wong-You-Cheong JJ,et al.A pilot study to evaluate renal hemodynamics in cirrhosis by simultaneous glomerular filtration rate,renal plasma flow,renal resistive indices and biomarkers measurements.Am J Nephrol,2014,39(6):543-552.
[12]Gassanov N,Caglayan E,Semmo N,et al.Cirrhotic cardiomyopathy:a cardiologist's perspective.World J Gastroenterol,2014,20(42):15492-15498.
[13]钱嵘,熊爱民,杨唯衷,等.超声三维斑点追踪技术评价肝硬化患者右心室心肌功能.肝脏,2016,21(12):1030-1032.
[14]Zalewski P,Jones D,Lewis I,et al.Reduced thoracic fluid content in early-stage primary biliary cirrhosis that associates with impaired cardiac inotropy.Am J Physiol Gastrointest Liver Physiol,2013,305(6):393-397.
[15]Altekin RE,Caglar B,Karakas MS,et al.Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with non-alcoholic cirrhosis.Hellenic J Cardiol,2014,55(5):402-410.
[16]Goyal S,Dixit VK,Jain AK,et al.Intrarenal resistance index(RI)as a predictor of early renal impairment in patients with liver cirrhosis.Trop Gastroenterol,2013,34(4):235-239.
[17]Bellot P,García-Pagán JC,Francés R,et al.Bacterial DNA translocation is associated with systemic circulatory abnormalities and intrahepatic endothelial dysfunction in patients with cirrhosis.Hepatology,2010,52(6):2044-2052.
[18]Chen Y,Chan AC,Chan SC,et al.A detailed evaluation of cardiac function in cirrhotic patients and its alteration with or without liver transplantation.J Cardiol,2016,67(2):140-146.
[19]Mandorfer M,Bota S,Schwabl P,et al.Nonselectiveβblockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis.Gastroenterology,2014,146(7):1680-1690.
[2]Nazar A,Guevara M,Sitges M,et al.LEFT ventricular function assessed by echocardiography in cirrhosis:relationship to systemic hemodynamics and renal dysfunction.J Hepatol,2013,58(1):51-57.
[3]Ruíz-del-Arbol L,Achécar L,Serradilla R,et al.Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis,portal hypertension,and a normal creatinine.Hepatology,2013,58(5):1732-1741.
[4]Wong F,Raina N,Richardson R.Molecular adsorbent recirculating system is ineffective in the management of type 1 hepatorenal syndrome in patients with cirrhosis with ascites who have failed vasoconstrictor treatment.Gut,2010,59(3):381-386.
[5]陈春,伍思国,杨智娟,等.肝硬化上消化道出血患者预后因素分析.实用肝脏病杂志,2015,18(3):300-301.
[6]Sattarzadeh-Badkoubeh R,Geraiely B,Nassiri-Toosi M,et al.Evaluation of cardiac systolic function in cirrhotic patients undergoing liver transplantation.Acta Med Iran,2015,53(8):476-481.
[7]Mottram PM,Leano R,Marwick TH.Usefulness of B-type natriuretic peptide inhypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function.Am J Cardiol,2003,92(12):1434-1438.
[8]Hung KC,Huang HL,Chu CM,et al.Evaluating preload dependence of a novel Doppler application in assessment of left ventricular diastolic function during hemodialysis.Am J Kidney Dis,2004,43(6):1040-1046.
[9]Miyashita T,Okano Y,Takaki H,et al.Relation between exercise capacity and left ventricular systolic versus diastolic function during exercise in patients after myocardial infarction.Coron Artery Dis,2001,12(3):217-225.
[10]任秀昀,徐惠,舒清明,等.超声弹性成像评估离体肝硬化标本结节性病变性质的初步研究.中华超声影像学杂志,2010,19(1):29-31.
[11]Mindikoglu AL,Dowling TC,Wong-You-Cheong JJ,et al.A pilot study to evaluate renal hemodynamics in cirrhosis by simultaneous glomerular filtration rate,renal plasma flow,renal resistive indices and biomarkers measurements.Am J Nephrol,2014,39(6):543-552.
[12]Gassanov N,Caglayan E,Semmo N,et al.Cirrhotic cardiomyopathy:a cardiologist's perspective.World J Gastroenterol,2014,20(42):15492-15498.
[13]钱嵘,熊爱民,杨唯衷,等.超声三维斑点追踪技术评价肝硬化患者右心室心肌功能.肝脏,2016,21(12):1030-1032.
[14]Zalewski P,Jones D,Lewis I,et al.Reduced thoracic fluid content in early-stage primary biliary cirrhosis that associates with impaired cardiac inotropy.Am J Physiol Gastrointest Liver Physiol,2013,305(6):393-397.
[15]Altekin RE,Caglar B,Karakas MS,et al.Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with non-alcoholic cirrhosis.Hellenic J Cardiol,2014,55(5):402-410.
[16]Goyal S,Dixit VK,Jain AK,et al.Intrarenal resistance index(RI)as a predictor of early renal impairment in patients with liver cirrhosis.Trop Gastroenterol,2013,34(4):235-239.
[17]Bellot P,García-Pagán JC,Francés R,et al.Bacterial DNA translocation is associated with systemic circulatory abnormalities and intrahepatic endothelial dysfunction in patients with cirrhosis.Hepatology,2010,52(6):2044-2052.
[18]Chen Y,Chan AC,Chan SC,et al.A detailed evaluation of cardiac function in cirrhotic patients and its alteration with or without liver transplantation.J Cardiol,2016,67(2):140-146.
[19]Mandorfer M,Bota S,Schwabl P,et al.Nonselectiveβblockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis.Gastroenterology,2014,146(7):1680-1690.