三维斑点追踪成像评价慢性肾功能不全患者左心室收缩功能
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摘要
目的应用三维斑点追踪成像(3D-STI)评价不同阶段慢性肾功能不全患者左心室心肌收缩功能变化。资料与方法选取2015年6月-2016年6月于青岛大学附属医院西海岸医疗中心就诊的26例轻度慢性肾功能不全患者(CKD2~3期组)、20例中-重度慢性肾功能不全患者(CKD4~5期组)及20例健康志愿者(对照组)。行常规二维超声心动图测量并比较常规超声心动图指标,包括室间隔舒张末期厚度(IVSTd)和左心室舒张末期厚度(LVPWTd),同时行3D-STI分析并比较舒张末期左心室容积(LVEDV)、收缩末期左心室容积(LVESV)、左心室三维射血分数(3D-LVEF)、左心室整体纵向应变(GLS)、径向应变(GRS)、圆周应变(GCS)等指标;通过ROC曲线分析比较GLS、GCS、GRS诊断慢性肾功能不全患者左心室收缩功能异常的检验效能。结果与对照组相比,CKD2~3期组血肌酐、三酰甘油增高(t=22.152、2.655),肾小球滤过率(GFR)、血红蛋白含量降低(t=-36.527、-19.610),IVSTd增大(t=6.035),3D-LVEF、GLS、GRS、GCS减小(t=-2.958、-5.336、-9.552、-4.384);与对照组相比,CKD4~5期组收缩压、血肌酐、总胆固醇、三酰甘油增高(t=15.060、29.461、8.210、6.512),GFR、血红蛋白含量降低(t=-67.557、-28.071),IVSTd增大(t=10.959),3D-LVEF、GLS、GRS、GCS减小(t=-7.315、-7.460、-17.99、-6.052);与CKD2~3期组相比,CKD4~5期组收缩压、血肌酐、总胆固醇升高(t=14.551、28.902、8.555),GFR、血红蛋白降低(t=-18.455、-16.832),IVSTd增大(t=7.331),3D-LVEF、GRS、GCS、GLS减小(t=-4.977、-3.847、-4.929、-2.553);以上组间比较差异均有统计学意义(P<0.05)。ROC曲线显示,分别采用GLS、GCS、GRS判定慢性肾功能不全患者左心室收缩功能异常时,当GLS以17.80%为截断值时,其灵敏度最高(88.89%),约登指数为0.673;当GCS以14.70%为截断值时,其特异度最高(89.47%),约登指数为0.561。结论慢性肾功能不全患者左心室收缩功能减低,且随着病情进展,心功能逐渐减低3D-STI能准确评价不同阶段慢性肾功能不全患者左心室心肌收缩功能变化。
Purpose To evaluate changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency using three-dimensional speckle tracking imaging(3D-STI). Materials and Methods Twenty-six patients with mild chronic renal insufficiency(CKD2-3 group), 20 patients with moderate-severe chronic renal insufficiency(CKD4-5 group), who accepted treatment in the West Coast Medical Center, Qingdao University Affiliated Hospital from June 2015 to June 2016, and 20 healthy volunteers(control group) were enrolled. Routine two-dimensional echocardiography was carried out, and the indicators were compared, including inter-ventricular septum end-diastolic thickness(IVSTd) and left ventricular posterior wall end-diastolic thickness(LVPWTd). In addition, 3D-STI analysis was conducted, and the indicators were compared, including left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), three-dimensional left ventricular ejection fraction(3D-LVEF), left ventricular global longitudinal strain(GLS), global radial strain(GRS) and global circumferential strain(GCS). The efficacy of GLS, GCS and GRS in the diagnosis of left ventricular systolic dysfunction in patients with chronic renal insufficiency was compared by ROC curve analysis. Results Compared with the control group, serum creatinine and triglyceride increased(t=22.152 and 2.655), glomerular filtration rate(GFR) and hemoglobin content decreased(t=-36.527 and-19.610), IVSTd increased(t=6.035), and 3D-LVEF, GLS, GRS and GCS decreased(t=-2.958,-5.336,-9.552 and-4.384) in CKD2-3 group. Compared with the control group, systolic blood pressure, serum creatinine, total cholesterol and triglyceride increased(t=15.060, 29.461, 8.210 and 6.512), GFR and hemoglobin content decreased(t=-67.557 and-28.071), IVSTd increased(t=10.959), and 3D-LVEF, GLS, GRS and GCS decreased(t=-7.315,-7.460,-17.99 and-6.052) in CKD4-5 group. Compared with CKD2-3 group, systolic blood pressure, serum creatinine and total cholesterol increased(t=14.551, 28.902 and 8.555), GFR and hemoglobin content decreased(t=-18.455 and-16.832), IVSTd increased(t=7.331), and 3D-LVEF, GRS, GCS and GLS decreased(t=-4.977,-3.847,-4.929 and-2.553) in CKD4-5 group. All the above differences were statistically significant(P<0.05). ROC curve showed that determining left ventricular systolic dysfunction in patients with chronic renal insufficiency using GLS, GCS and GRS, when the cutoff value of GLS was 17.80%, the sensitivity was the highest(88.89%), and the Youden index was 0.673; however, when the cutoff value of GCS was 14.70%, the specificity was the highest(89.47%), and the Youden index was 0.561. Conclusion In patients with chronic renal insufficiency, left ventricular systolic function reduces, and with the progress of the disease, the cardiac function also gradually reduces. 3D-STI can accurately assess changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency.
Purpose To evaluate changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency using three-dimensional speckle tracking imaging(3D-STI). Materials and Methods Twenty-six patients with mild chronic renal insufficiency(CKD2-3 group), 20 patients with moderate-severe chronic renal insufficiency(CKD4-5 group), who accepted treatment in the West Coast Medical Center, Qingdao University Affiliated Hospital from June 2015 to June 2016, and 20 healthy volunteers(control group) were enrolled. Routine two-dimensional echocardiography was carried out, and the indicators were compared, including inter-ventricular septum end-diastolic thickness(IVSTd) and left ventricular posterior wall end-diastolic thickness(LVPWTd). In addition, 3D-STI analysis was conducted, and the indicators were compared, including left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), three-dimensional left ventricular ejection fraction(3D-LVEF), left ventricular global longitudinal strain(GLS), global radial strain(GRS) and global circumferential strain(GCS). The efficacy of GLS, GCS and GRS in the diagnosis of left ventricular systolic dysfunction in patients with chronic renal insufficiency was compared by ROC curve analysis. Results Compared with the control group, serum creatinine and triglyceride increased(t=22.152 and 2.655), glomerular filtration rate(GFR) and hemoglobin content decreased(t=-36.527 and-19.610), IVSTd increased(t=6.035), and 3D-LVEF, GLS, GRS and GCS decreased(t=-2.958,-5.336,-9.552 and-4.384) in CKD2-3 group. Compared with the control group, systolic blood pressure, serum creatinine, total cholesterol and triglyceride increased(t=15.060, 29.461, 8.210 and 6.512), GFR and hemoglobin content decreased(t=-67.557 and-28.071), IVSTd increased(t=10.959), and 3D-LVEF, GLS, GRS and GCS decreased(t=-7.315,-7.460,-17.99 and-6.052) in CKD4-5 group. Compared with CKD2-3 group, systolic blood pressure, serum creatinine and total cholesterol increased(t=14.551, 28.902 and 8.555), GFR and hemoglobin content decreased(t=-18.455 and-16.832), IVSTd increased(t=7.331), and 3D-LVEF, GRS, GCS and GLS decreased(t=-4.977,-3.847,-4.929 and-2.553) in CKD4-5 group. All the above differences were statistically significant(P<0.05). ROC curve showed that determining left ventricular systolic dysfunction in patients with chronic renal insufficiency using GLS, GCS and GRS, when the cutoff value of GLS was 17.80%, the sensitivity was the highest(88.89%), and the Youden index was 0.673; however, when the cutoff value of GCS was 14.70%, the specificity was the highest(89.47%), and the Youden index was 0.561. Conclusion In patients with chronic renal insufficiency, left ventricular systolic function reduces, and with the progress of the disease, the cardiac function also gradually reduces. 3D-STI can accurately assess changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency.
引文
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[10]Foley RN,Collins AJ.A novel model of cardiovascular risk based on kidney function.Am J Nephrol,2011,34(6):505-511.
[11]Van Biesen W,De Bacquer D,Verbeke F,et al.The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years.Eur Heart J,2007,28(4):478-483.
[12]黄琳,陈爱华.超声评价慢性肾功能不全患者左心结构及功能变化.吉林医学,2013,34(5):924-925.
[13]张丽,林萍,于妍洁.二维应变技术对不同分期慢性肾脏病患者右室功能的评价.中国临床医学影像杂志,2012,23(3):201-203.
[14]于蓝,王银荣,田永梅,等.三维斑点追踪成像技术评价急性前壁心肌梗死患者左心室收缩功能.中国医学影像学杂志,2014,22(10):739-744.
[15]高磊,刘昕,郭淑芹,等.实时三维斑点追踪成像评价2型糖尿病血糖控制不良患者左心室整体收缩功能.中国医学影像学杂志,2015,23(6):439-443,448.
[2]王喜梅,吴永健,杨跃进.慢性肾功能不全与急性冠状动脉综合征的研究进展.心血管病学进展,2012,33(1):21-23.
[3]Takeguchi T,Nishiura M,Abe Y,et al.Practical considerations for a method of rapid cardiac function analysis based on threedimensional speckle tracking in a three-dimensional diagnostic ultrasound system.J Med Ultrason(2001),2010,37(2):41-49.
[4]Urbano-Moral JA,Patel AR,Maron MS,et al.Three-dimensional speckle-tracking echocardiography:methodological aspects and clinical potential.Echocardiography,2012,29(8):997-1010.
[5]段利科,李玲,谢明星,等.三维斑点追踪技术评价正常人左心室心肌应变的初步研究.中华医学超声杂志(电子版),2010,7(5):803-810.
[6]Maffessanti F,Nesser HJ,Weinert L,et al.Quantitative evaluation of regional left ventricular function using threedimensional speckle tracking echocardiography in patients with and without heart disease.Am J Cardiol,2009,104(12):1755-1762.
[7]Hayat D,Kloeckner M,Nahum J,et al.Comparison of realtime three-dimensional speckle tracking to magnetic resonance imaging in patients with coronary heart disease.Am J Cardiol,2012,109(2):180-186.
[8]李春艳,朱文晖,刘稳刚.三维斑点追踪成像评价原发性高血压患者左心室整体收缩功能.中国医学影像学杂志,2013,21(3):197-200.
[9]高帅,孙志丹,徐静,等.三维斑点追踪成像评价轻型系统性红斑狼疮患者左心室收缩功能.中国医学影像学杂志,2016,24(1):16-18,23.
[10]Foley RN,Collins AJ.A novel model of cardiovascular risk based on kidney function.Am J Nephrol,2011,34(6):505-511.
[11]Van Biesen W,De Bacquer D,Verbeke F,et al.The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years.Eur Heart J,2007,28(4):478-483.
[12]黄琳,陈爱华.超声评价慢性肾功能不全患者左心结构及功能变化.吉林医学,2013,34(5):924-925.
[13]张丽,林萍,于妍洁.二维应变技术对不同分期慢性肾脏病患者右室功能的评价.中国临床医学影像杂志,2012,23(3):201-203.
[14]于蓝,王银荣,田永梅,等.三维斑点追踪成像技术评价急性前壁心肌梗死患者左心室收缩功能.中国医学影像学杂志,2014,22(10):739-744.
[15]高磊,刘昕,郭淑芹,等.实时三维斑点追踪成像评价2型糖尿病血糖控制不良患者左心室整体收缩功能.中国医学影像学杂志,2015,23(6):439-443,448.