| 摘要: |
| 目的 探讨三维斑点追踪超声心动图（3D-STE）与二维斑点追踪超声心动图（2D-STE）对终末期心力衰竭患者右室（RV）心肌纤维化的诊断价值研究。方法 选取2016年7月至2021年3月来我院就诊并行心脏移植的终末期心力衰竭患者63例。所有患者均行常规超声心动图、3D-STE、2D-STE及右心导管冠状动脉造影检查。心脏移植后取每个患者组织病理学标本检测RV心肌纤维化严重程度。按心肌纤维化严重程度的三分位数分为3组，分别为轻度组、中度组、重度组。采用Pearson相关系数评估心肌纤维化与超声心动图参数的相关性。采用ROC曲线确定各参数的最佳截断值，以检测心肌纤维化严重程度。结果 轻度组心肌纤维化平均值为（6.32±1.74）%，中度组心肌纤维化平均值为（13.08±2.01）%，重度组心肌纤维化平均值为（22.81±4.65）%，组间比较差异有统计学意义（P＜0.05）。轻度组、中度组、重度组三组患者右心室长径、三尖瓣环收缩峰值偏移（TAPSE）、右心室面积改变分数（RVFAC）、三尖瓣侧环收缩峰值速度（s""）、左心室质量、RV每搏容积（RVSV）、RV射血分数（RVEF）、二维RV游离壁的纵向应变（2D-RVFWLS）和三维RV游离壁的纵向应变（3D-RVFWLS）均逐渐减小，差异有统计学意义（P＜0.05）。心肌纤维化与3D-RVFWLS呈强负相关（r＝-0.834，P＝0.000），与2D-RVFWLS呈中度负相关（r＝-0.651，P＝0.000），与RVFAC（r＝-0.465，P＝0.000）、TAPSE（r＝-0.473，P＝0.000）、RVEF（r＝-0.407，P＝0.000）、右心室长径（r＝-0.353，P＝0.000）、s""（r＝-0.252，P＝0.000）、RV舒张末期容积（RVEDV）（r＝-0.248，P＝0.000）、RVSV （r＝-0.364，P＝0.000）、左心室质量（r＝-0.305，P＝0.000）呈弱负相关，与其余超声心动图参数无显著相关性。3D-RVFWLS检测重度RV心肌纤维化的最佳截断值为10.05%，灵敏度为85.33%，特异性为99.27%，AUC值为0.91；2D-RVFWLS检测重度RV心肌纤维化的最佳截断值为10.31%，灵敏度为72.65%，特异性为80.46%，AUC值为0.82；其余超声心动图参数对重度RV心肌纤维化无诊断价值（AUC值为0.21-0.42）。结论 3D-RVFWLS在评估终末期心衰患者的RV心肌纤维化方面优于2D-RVFWLS和常规超声心动图右心室功能指标，3D-RVFWLS可能是预测终末期心衰患者RV心肌纤维化严重程度最可靠的超声心动图参数。 |
| 关键词: 三维斑点追踪超声心动图 二维斑点追踪超声心动图 心力衰竭 心肌纤维化 诊断价值 |
| DOI： |
| 投稿时间：2021-06-18修订日期：2022-03-07 |
| 基金项目:陕西省卫生健康委员会(2018C0377) |
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| Diagnostic value of three-dimensional and two-dimensional speckle-tracking echocardiography in right ventricular myocardial fibrosis in patients with end-stage heart failure |
| Ji Rong |
| () |
| Abstract: |
| Objective：To investigate the diagnostic value of 3D-STE and 2D-STE in the diagnosis of right ventricular fibrosis in patients with end-stage heart failure. Methods：A total of 63 patients with end-stage heart failure who received heart transplantation in our hospital from July 2016 to March 2021 were selected. All patients underwent routine echocardiography, 3D-STE, 3D-STE and right heart catheterization coronary angiography. After heart transplantation, histopathological specimens of each patient were taken to detect the severity of RV myocardial fibrosis. According to the severity of myocardial fibrosis, the patients were divided into three groups: mild group, moderate group and severe group. Pearson correlation coefficient was used to evaluate the correlation between myocardial fibrosis and echocardiographic parameters. The optimal truncation value of each parameter was determined by ROC curve to detect the severity of myocardial fibrosis. Results：The mean value of myocardial fibrosis in mild group was (6.32±1.74) %, that in moderate group was (13.08±2.01) %, and that in severe group was (22.81±4.65) %, and the difference between groups was statistically significant (P < 0.05). RV length diameter, TAPSE, RVFAC, S "", left ventricular mass, RVSV, RVEF, 2D-RVFWLS and 3D-RVFWLS in mild group, moderate group and severe group were decreased gradually, with statistical significance (P < 0.05). Myocardial fibrosis was strongly negatively correlated with 3D-RVFWLS (r = -0.834, P = 0.000), moderately negatively correlated with 2D-RVFWLS(r = -0.651, P = 0.000), RVFAC (r = -0.465, P = 0.000), TAPSE (r = -0.473,P = 0.000), RVEF (r = -0.407, P = 0.000), right ventricular length diameter (r = -0.353, P = 0.000), S ""(r = -0.252, P = 0.000), RVEDV (r = -0.248, P = 0.000), RVSV (r = -0.364,P = 0.000), left ventricular mass (r = -0.305, P = 0.000) were weakly negative correlated, and had no significant correlation with other echocardiographic parameters. The optimal cut-off value of 3D-RVFWLS for the detection of severe RV myocardial fibrosis was 10.05%, the sensitivity was 85.33%, the specificity was 99.27%, and the AUC value was 0.91 (P = 0.000).The best cutoff value of 2D-RVFWLS in the detection of severe RV myocardial fibrosis was 10.31%, the sensitivity was 72.65%, the specificity was 80.46%, and the AUC value was 0.82 (P = 0.000).Other echocardiographic parameters have no diagnostic?value for severe RV myocardial fibrosis (AUC value was 0.21-0.42, P < 0.05). Conclusion：3D-RVFWLS is superior to 2D-RVFWLS and conventional echocardiographic indicators of right ventricular function in the evaluation of RV myocardial fibrosis in patients with end-stage heart failure, and 3D-RVFWLS May be the most reliable echocardiographic parameter to predict the severity of RV myocardial fibrosis in patients with end-stage heart failure. |
| Key words: Three-dimensional speckle-tracking echocardiography Two-dimensional speckle-tracking echocardiography heart failure myocardial fibrosis diagnostic value |
