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| 左房时相功能对冠状动脉粥样硬化性心脏病患者左室舒张功能障碍的诊断价值 |
| 付亚梦,刘昕 |
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| (承德医学院研究生学院;保定市第一中心医院超声科) |
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| 摘要: |
| 目的 探讨左心房(LeftSAtrium,LA)时相功能对冠心病(Coronary Heart Disease,CHD)患者左心室舒张功能障碍(Left ventricular diastolic dysfunction,LVDD)的预测价值。资料与方法 将89例左心室射血分数(left ventricular ejectionSfraction,LVEF)≥50%的CHD患者根据指南分为LV舒张功能正常组(38例)、LVDD组(51例),测量心脏结构及功能参数,比较两组间参数差异,并通过二元Logistic回归筛选出LVDD发生的独立影响因素,绘制ROC曲线以评估各独立影响因素对LVDD发生的预测价值。 结果 两组间LVEF、LVEDd、LVEDV、IVSDd、LVPWDd、TR差异均无统计学意义(P均＞0.05),LV舒张功能正常组二尖瓣瓣环间隔e’、二尖瓣瓣环侧壁e’、LAVI、E/e’低于LVDD组,差异有统计学意义(P＜0.05),LV舒张功能正常组LASr、LAScd高于LVDD组,差异有统计学意义(P＜0.001),两组间LASct差异无统计学意义(P＞0.05)；二元Logistic回归分析LASr(OR=0.668,95%CI：0.570~0.783,P＜0.001)、LAScd(OR=0.670,95%CI：0.565~0.796,P＜0.001)为CHD患者LVDD发生的独立影响因素；二尖瓣瓣环间隔e’在ROC曲线下面积0.623(95%CI：0.505~0.740),灵敏度为94.7%,特异度为45.1%,截断值为7.35。二尖瓣瓣环侧壁e’在ROC曲线下面积0.0.662(95%CI：0.547~0.777),灵敏度为78.9%,特异度为62.7%,截断值为10.25。LAVI在ROC曲线下面积0.807(95%CI：0.712~0.902),灵敏度为76.5%,特异度为78.9%,截断值为33.50。E/e’在ROC曲线下面积0.818(95%CI：0.732~0.905),灵敏度为66.7%,特异度为84.2%,截断值为13.45。LASr在ROC曲线下面积0.928(95%CI：0.874~0.982),灵敏度为86.8%,特异度为90.2%,截断值为32.25%。LAScd在ROC曲线下面积0.914(95%CI：0.855~0.973),灵敏度为86.8%,特异度为84.3%,截断值为15.50%。结论 LA功能变化可提示LVEF≥50%的CHD患者发生LVDD,LASr、LAScd是CHD患者发生LVDD的独立影响因素,且LAsr具有较高的预测价值。 |
| 关键词: 冠心病 左心房功能 二维斑点追踪成像 左心室舒张功能 |
| DOI： |
| 投稿时间：2022-04-09修订日期：2022-09-05 |
| 基金项目: |
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| Evaluation of left ventricular diastolic dysfunction and left atrial function in patients with coronary heart disease by speckle tracking imaging #$NBS |
| Fu Yameng,Liu Xin |
| (Graduate School,Chengde Medical College;Department of Ultrasonography,the First Central Hospital of Baoding) |
| Abstract: |
| Objective To investigate the predictive value of left atrial phase function for left ventricular diastolic dysfunction in patients with coronary heart disease. Methods According to the guidelines, 89 CHD patients with left ventricular ejection fraction (LVEF) ≥50% were divided into LV diastolic normal group (38 cases) and LVDD group (51 cases). Cardiac structural parameters were measured and parameter differences were compared between the two groups.The independent influencing factors of LVDD were screened out by binary Logistic regression, and ROC curve was drawn to evaluate the predictive value of each independent influencing factor on LVDD. Results There were no significant differences in LVEF, LVEDd, LVEDV, IVSDd, LVPWDd and TR between the two groups (ALL P>0.05). The mitral annulus interval E ", the lateral wall E ", LAVI and E/ E "of mitral annulus in the normal LV diastolic function group were lower than those in the LVDD group, and the differences were statistically significant (P<0.05).LASr and LAScd in LV group with normal diastolic function were higher than those in LVDD group, the difference was statistically significant (P<0.001), but there was no significant difference in LASct between LV group and LVDD group (P>0.05).Binary Logistic regression analysis showed that LASr (OR=0.668, 95%CI: 0.570-0.783,P<0.001) and LAScd (OR=0.670,95%CI:0.565-0.796,P<0.001) were independent influencing factors of LVDD in CHD patients.The area of mitral annulus interval E "under ROC curve was 0.623 (95%CI:0.505-0.740), the sensitivity was 94.7%, the specificity was 45.1%, and the cut-off value was 7.35.The area of e "under ROC curve was 0.0.662 (95%CI:0.547-0.777), the sensitivity was 78.9%, the specificity was 62.7%, and the cut-off value was 10.25.LAVI had an area of 0.807 (95%CI:0.712-0.902) under ROC curve, a sensitivity of 76.5%, a specificity of 78.9%, and a cut-off value of 33.50.The area of E/ E "under ROC curve was 0.818 (95%CI:0.732-0.905), the sensitivity was 66.7%, the specificity was 84.2%, and the cut-off value was 13.45.The area under ROC curve of LASr was 0.928 (95%CI:0.874~0.982), the sensitivity, specificity and cut-off value were 86.8%, 90.2% and 32.25%, respectively.The area under ROC curve of LAScd was 0.914 (95%CI:0.855-0.973), the sensitivity was 86.8%, the specificity was 84.3%, and the cut-off value was 15.50%.Conclusion Changes in LA function can suggest LVDD in LVEF≥50% of CHD patients. LASr and LAScd are independent influencing factors of LVDD in CHD patients, and LASr has high predictive value. |
| Key words: Coronary Heart Disease Left Atrial Function Speckle Tracking Imaging Left Ventricular Diastolic dysfunction SS |
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