超声心动图综合参数对慢性心力衰竭诊断及治疗随访的评价
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摘要
【目的】:应用超声心动图综合参数评价慢性心力衰竭患者的整体心脏功能,并对慢性心衰患者治疗效果进行评价。
【方法】:前瞻性研究慢性心力衰竭患者101例,其中随访组72例,非随访组29例,正常对照组30例,应用超声心动图综合参数组成的心衰超声指数进行评分,测定BNP,进行纽约心功能分级。对随访组与非随访组分别于3、6个月进行超声心动图检查,重新进行心衰超声指数评分。1.分析心衰超声指数诊断慢性心力衰竭的敏感性、特异性、阳性预测值、阴性预测值,与血浆BNP、纽约心功能分级之间的相关性。2.分析随访组与非随访组心衰超声指数变化。3.观察合理的教育管理、规范的药物应用对慢性心衰患者治疗效果的影响。
【结果】:1.心衰超声指数可用于慢性心衰患者的整体心功能的评价。当心衰超声指数值≥3时,其诊断慢性有症状性心力衰竭的敏感性、特异性、阳性预测值、阴性预测值分别为95%、96%、98%、81%。心衰超声指数与血浆BNP水平呈正相关(r=0.680),其相关系数相似于NYHA心功能与BNP的相关系数(r=0.730),并高于Tei指数与血浆BNP的相关系数(r=0.590);心衰超声指数、Tei指数与纽约心功能分级呈正相关(r分别为0.663、0.652),两者相关系数相似。超声心动图参数中左房容积、左室收缩末期内径、左室射血分数、二尖瓣E峰峰值流速、二尖瓣E峰减速时间、二尖瓣EA比值与BNP均有相关性。2.随访组治疗6个月后心衰超声指数明显下降,其中首先改善的是左室舒张功能及肺动脉压力参数。3.治疗后6个月随访组与非随访组心衰超声指数、NYHA心功能之间差异有统计学意义。
【结论】:心衰超声指数可用于慢性心衰患者的整体心功能的诊断,指导慢性心衰患者的治疗,评价治疗效果及预后。合适健康教育和规范化用药可提高慢性心力衰竭的治疗效果,改善患者的生活质量。
【Objective】: Using echocardiographic multi-parameters, we evaluate the heart function and the effect of the treatment of patients with chronic heart failure (CHF).
【Methods】: Prospectively we studied 101 patients with CHF, 72 cases in follow-up group, 29 cases in non-follow-up group, and 30 in normal control group. All the subjects were scored by heart failure echochardiographic index (HFEI) which synthesized the parameter of echocardiography, and measured the cardiac functional grading by NHYA, BNP, Tei index. All the 101 patients were scored by HFEI after 3 and 6 months therapy respectively, which were as follows: 1. Analyzing the sensitivity, specificity, positive value and negative value of HFEI to diagnose chronic heart failure. Studying the correlation among HFEI, the level of BNP and the cardiac functional grading by NHYA. 2. Analyzing the changes of HFEI before and after treatment in follow-up group and non-follow-up group. 3. Observing the effect of suitable management and strictly medicine taken on patients with chronic heart failure.
【Results】: 1. It was valuable to diagnose CHF and evaluate the degree of the CHF with HFEI. When HFEI≥3, the sensitivity, specificity, positive value and negative value of HFEI for diagnosing CHF was 95%、96%、98%、81% respectively. The HFEI of the CHF group was significantly higher than control group. HEFI was positively correlated with BNP (r=0.680) and the cardiac functional grading by NHYA (r=0.663). Compared with other parameters of echocardiography, there was remarkable correlation between BNP and LAV, ESV, LVEF, E, DT, E/A. 2. After 3 months, indexes of left ventricular diastolic function and pulmonary artery pressure were changed firstly. After 6 months, HFEI decreased significantly in follow-up group. 3. HFEI and the cardiac functional grading by NHYA in follow-up group were significantly lower than non-follow-up group.
【Conclusions】: It is valuable to diagnose CHF, evaluate the degree of the CHF and judge the overcome of treatment also. Suitable management and strictly medicine taken on patients with chronic heart failure can improve the overcome of treatment and quality of life.
【方法】:前瞻性研究慢性心力衰竭患者101例,其中随访组72例,非随访组29例,正常对照组30例,应用超声心动图综合参数组成的心衰超声指数进行评分,测定BNP,进行纽约心功能分级。对随访组与非随访组分别于3、6个月进行超声心动图检查,重新进行心衰超声指数评分。1.分析心衰超声指数诊断慢性心力衰竭的敏感性、特异性、阳性预测值、阴性预测值,与血浆BNP、纽约心功能分级之间的相关性。2.分析随访组与非随访组心衰超声指数变化。3.观察合理的教育管理、规范的药物应用对慢性心衰患者治疗效果的影响。
【结果】:1.心衰超声指数可用于慢性心衰患者的整体心功能的评价。当心衰超声指数值≥3时,其诊断慢性有症状性心力衰竭的敏感性、特异性、阳性预测值、阴性预测值分别为95%、96%、98%、81%。心衰超声指数与血浆BNP水平呈正相关(r=0.680),其相关系数相似于NYHA心功能与BNP的相关系数(r=0.730),并高于Tei指数与血浆BNP的相关系数(r=0.590);心衰超声指数、Tei指数与纽约心功能分级呈正相关(r分别为0.663、0.652),两者相关系数相似。超声心动图参数中左房容积、左室收缩末期内径、左室射血分数、二尖瓣E峰峰值流速、二尖瓣E峰减速时间、二尖瓣EA比值与BNP均有相关性。2.随访组治疗6个月后心衰超声指数明显下降,其中首先改善的是左室舒张功能及肺动脉压力参数。3.治疗后6个月随访组与非随访组心衰超声指数、NYHA心功能之间差异有统计学意义。
【结论】:心衰超声指数可用于慢性心衰患者的整体心功能的诊断,指导慢性心衰患者的治疗,评价治疗效果及预后。合适健康教育和规范化用药可提高慢性心力衰竭的治疗效果,改善患者的生活质量。
【Objective】: Using echocardiographic multi-parameters, we evaluate the heart function and the effect of the treatment of patients with chronic heart failure (CHF).
【Methods】: Prospectively we studied 101 patients with CHF, 72 cases in follow-up group, 29 cases in non-follow-up group, and 30 in normal control group. All the subjects were scored by heart failure echochardiographic index (HFEI) which synthesized the parameter of echocardiography, and measured the cardiac functional grading by NHYA, BNP, Tei index. All the 101 patients were scored by HFEI after 3 and 6 months therapy respectively, which were as follows: 1. Analyzing the sensitivity, specificity, positive value and negative value of HFEI to diagnose chronic heart failure. Studying the correlation among HFEI, the level of BNP and the cardiac functional grading by NHYA. 2. Analyzing the changes of HFEI before and after treatment in follow-up group and non-follow-up group. 3. Observing the effect of suitable management and strictly medicine taken on patients with chronic heart failure.
【Results】: 1. It was valuable to diagnose CHF and evaluate the degree of the CHF with HFEI. When HFEI≥3, the sensitivity, specificity, positive value and negative value of HFEI for diagnosing CHF was 95%、96%、98%、81% respectively. The HFEI of the CHF group was significantly higher than control group. HEFI was positively correlated with BNP (r=0.680) and the cardiac functional grading by NHYA (r=0.663). Compared with other parameters of echocardiography, there was remarkable correlation between BNP and LAV, ESV, LVEF, E, DT, E/A. 2. After 3 months, indexes of left ventricular diastolic function and pulmonary artery pressure were changed firstly. After 6 months, HFEI decreased significantly in follow-up group. 3. HFEI and the cardiac functional grading by NHYA in follow-up group were significantly lower than non-follow-up group.
【Conclusions】: It is valuable to diagnose CHF, evaluate the degree of the CHF and judge the overcome of treatment also. Suitable management and strictly medicine taken on patients with chronic heart failure can improve the overcome of treatment and quality of life.
引文
1.中华医学会心血管病学分会,《中华心血管病杂志》编辑委员会[J].慢性心力衰竭诊断治疗指南.中华心血管病杂志.2007,35(12),1076-1095.
2. Donald LJ,Robert JA,Todd MB,et al. Heart disease and stroke statistics 2010 update. A Report from the American Heart Association. Circulation, 2010,121,e46-e215
3.中国心血管健康多中心合作研究组.中国心力衰竭流行病学调查及患病率[J].中华心血管病杂志.2003,2(31):3-5.
4. Jessup M, Abraham WT, Casey DE, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation [J]. Am. Coll. Cardiol.2009,53:1343-1382.
5. Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G ,et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)[J]. Eur Heart. 2008, 29(19):2388-442.
6.曹雅旻,胡大一,王宏宇,吴彦.我国基层医院慢性心力衰竭药物治疗现状的流行病学研究[J].中华内科杂志.2006,45(11):907-909.
7.庞海燕,王林,马金萍,等.β-受体阻滞剂在慢性心力衰竭药物治疗中应用现状[J].中国慢性病预防与控制.2007,15(5):442-444.
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1.中华医学会心血管病学分会,《中华心血管病杂志》编辑委员会[J].慢性心力衰竭诊断治疗指南.中华心血管病杂志.2007,35(12),1076-1095.
2. Thomas T. Nancy H. Wayne R, et al. Heart disease and stroke statistics .Circulation .2006.113(6):85-151.
3. Lloyd-Jones D, Adams RJ, Brown TM,et al. Heart disease and stroke statistics 2010 update. A Report from the American Heart Association [J]. Circulation.2010,121(7):e46-e215.
4.中国心血管健康多中心合作研究组.中国心力衰竭流行病学调查及患病率[J].中华心血管病杂志,2003,2(31):3-5.
5.赵水平主编.心血管病诊疗指南解读第3版.北京:人民卫生出版社.2008.
6.陆再英,钟南山主编.内科学第7版.北京:人民卫生出版社.2008
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27. Hasegawa H, Little WC, Ohno M, Brucks S, Morimoto A, Cheng HJ, et al. Diastolic mitral annular velocity during the development of heart failure[J]. J Am Coll Cardiol.2003, 41(9):1590-1597.
28. Rivas-Gotz C, Khoury DS, Manolios M, Rao L, Kopelen HA, Nagueh SF. Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular relaxation: experimental studies and clinical application [J]. J Am Coll Cardiol .2003,42(8):1463-1470.
29. GalièN, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT) [J]. European Heart Journal.2009, 30(20): 2493–2537.
30. Tei C: New non-invasive index for combined systolic and diastolic ventricular function [J]. Cardiol. 1995, 26(2):135-136.
31. Bruch C, Schmcrmund A, Marin D, et al. Tei-index in patients with mild-to-moderate congestive heart failure[J]. Eur Heart .2000, 21(22):1888-1895.
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2. Donald LJ,Robert JA,Todd MB,et al. Heart disease and stroke statistics 2010 update. A Report from the American Heart Association. Circulation, 2010,121,e46-e215
3.中国心血管健康多中心合作研究组.中国心力衰竭流行病学调查及患病率[J].中华心血管病杂志.2003,2(31):3-5.
4. Jessup M, Abraham WT, Casey DE, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation [J]. Am. Coll. Cardiol.2009,53:1343-1382.
5. Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G ,et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)[J]. Eur Heart. 2008, 29(19):2388-442.
6.曹雅旻,胡大一,王宏宇,吴彦.我国基层医院慢性心力衰竭药物治疗现状的流行病学研究[J].中华内科杂志.2006,45(11):907-909.
7.庞海燕,王林,马金萍,等.β-受体阻滞剂在慢性心力衰竭药物治疗中应用现状[J].中国慢性病预防与控制.2007,15(5):442-444.
8. Tei C: New non-invasive index for combined systolic and diastolic ventricular function [J]. Cardiol. 1995, 26(2):135– 136
9.陆再英,钟南山主编.内科学第7版.北京:人民卫生出版社.2008
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