| 摘要: |
| 目的：探讨超声心动图结合心电图T波振幅对于扩张型心肌病（DCM）左室收缩功能的评估价值。方法：选取2018年4月-2022年12月在我院就诊并诊断为DCM的患者80例作为研究对象，根据纽约心脏病学会（NYHA）心功能分级将其分为 NYHA Ⅱ级组（n=28）、NYHA Ⅲ级组（n=26）和NYHA Ⅳ级组（n=26）。所有患者均完善超声心动图和同步12导联体表心电图检查。采用Spearman秩相关分析超声心动图和心电图T波振幅与DCM心功能分级严重程度的相关性。采用ROC曲线分析超声心动图联合心电图T波振幅评估DCM左室收缩功能的诊断效能。 结果 NYHA Ⅲ级组和NYHA Ⅳ级组左室收缩期末期容积（LVESV）、左室收缩末期内径（LVESD）、左室舒张末期容积（LVEDV）、左室舒张末期内径（LVEDD）均高于NYHA Ⅱ级组，差异有统计学意义（P＜0.05）；NYHA Ⅳ级组LVESV、LVESD、LVEDV、LVEDD均高于NYHA Ⅱ级组和NYHA Ⅲ级组，差异有统计学意义（P＜0.05）。NYHA Ⅲ级组和NYHA Ⅳ级组LVEF低于NYHA Ⅱ级组，差异有统计学意义（P＜0.05）；NYHA Ⅳ级组LVEF低于NYHA Ⅱ级组和NYHA Ⅲ级组，差异有统计学意义（P＜0.05）。NYHA Ⅱ级组、NYHA Ⅲ级组、NYHA Ⅳ级组心电图T波振幅在II、V4、V5、V6导联均逐渐降低，以NYHA Ⅳ级组降低最明显，差异有统计学意义（P＜0.05）。超声心动图参数LVESV、LVESD、LVEDV、LVEDD与DCM患者心功能分级严重程度均呈正相关（r＝0.486、0.514、0.473、0.522，均P＜0.001）；LVEF与DCM患者心功能分级严重程度均呈负相关（r＝0.504，P＜0.001）。心电图T波振幅在II、V4、V5、V6导联与DCM患者心功能分级严重程度均呈负相关（r＝0.438、0.465、0.530、0.512，均P＜0.001）。超声心动图联合心电图T波振幅对DCM左室收缩功能具有较高的诊断价值（AUC＝0.922，95% CI：0.845-0.998，P＜0.001），显著优于单独应用超声心动图对DCM左室收缩功能的诊断价值（AUC＝0.863，95% CI：0.757-0.970，P＜0.001）和单独应用心电图T波振幅对DCM左室收缩功能的诊断价值（AUC＝0.706，95% CI：0.560-0.853，P＝0.024）。结论 超声心动图联合心电图T波振幅可作为评估DCM左室收缩功能的重要指标，为临床治疗提供参考依据。 |
| 关键词: 超声心动图 心电图T波振幅 扩张型心肌病 左室收缩功能 |
| DOI： |
| 投稿时间：2023-03-20修订日期：2023-04-14 |
| 基金项目:福建省卫健委科技计划项目(编号:2021TG025) |
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| Evaluation of left ventricular systolic function in dilated cardiomyopathy by echocardiography combined with electrocardiogram T-wave amplitude |
| LV Jia-ren,JIANG Hui-qiong,XU Deng-xing |
| (Department of Cardiac Function Examination,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian) |
| Abstract: |
| Objective:To investigate the value of echocardiography combined with ECG T wave amplitude in the evaluation of left ventricular systolic function in dilated cardiomyopathy (DCM).Methods:Eighty patients diagnosed with DCM in our hospital from April 2018 to December 2022 were selected as subjects, and were divided into NYHA Class Ⅱ group (n=28), NYHA class Ⅲ group (n=26) and NYHA class Ⅳ group (n=26) according to New York College of Cardiology (NYHA) cardiac function grade.??All patients underwent echocardiography and simultaneous 12-lead combined table electrocardiogram.??Spearman rank correlation was used to analyze the correlation between T-wave amplitude of echocardiography and electrocardiogram and severity of DCM cardiac function classification.??ROC curve was used to analyze the diagnostic efficacy of echocardiography combined with T-wave amplitude of electrocardiogram in evaluating left ventricular systolic function of DCM. Results:LVESV, LVESD, LVEDV and LVEDD in NYHA Ⅲ and Ⅳ groups were higher than those in NYHA Ⅱ group, and the difference was statistically significant (P < 0.05).?LVESV, LVESD, LVEDV and LVEDD in NYHA grade Ⅳ group were higher than those in NYHA grade Ⅱ and NYHA grade Ⅲ groups, and the difference was statistically significant (P<0.05).?LVEF in NYHA Ⅲ and Ⅳ groups was lower than that in NYHA Ⅱ group, and the difference was statistically significant (P < 0.05).??The LVEF of NYHA grade Ⅳ group was lower than that of NYHA grade Ⅱ and NYHA grade Ⅲ groups, and the difference was statistically significant (P<0.05).?The T wave amplitude of ECG in NYHA Grade Ⅱ, NYHA Grade Ⅲ and NYHA grade Ⅳ groups decreased gradually at the II, V4, V5 and V6 leads, and the decrease was most obvious in NYHA grade Ⅳ group, the difference was statistically significant (P<0.05).??Echocardiogram parameters LVESV, LVESD, LVEDV, LVEDD were positively correlated with the severity of cardiac function classification in DCM patients (r=0.486,0.514,0.473, 0.522, all P<0.001).?There was a negative correlation between LVEF and severity of cardiac function classification in DCM patients (r=0.504, P<0.001).Ecg T-wave amplitude was negatively correlated with severity of cardiac function classification in II, V4, V5, V6 leads (r=0.438,0.465,0.530, 0.512,all P<0.001).?Echocardiography combined with ECG T-wave amplitude had a higher diagnostic value for left ventricular systolic function of DCM (AUC=0.922, 95%CI: 0.845-0.998, P<0.001), which was significantly better than that of echocardiography alone (AUC=0.863, 95%CI:??0.7577-0.970, P<0.001) and ECG T-wave amplitude alone in the diagnosis of left ventricular systolic function in DCM (AUC=0.706, 95%CI: 0.560-0.853, P=0.024)?.Conclusion:Echocardiography combined with electrocardiogram T-wave amplitude can be used as an important index to evaluate left ventricular systolic function in DCM, and provide reference for clinical treatment. |
| Key words: Ultrasonic?cardiogram Ecg T-wave amplitude Dilated cardiomyopathy Left?ventricular?systolic?function |
