实时三维超声心动图在小儿扩张型心肌病左心功能评价中的应用

摘要

目的 探讨实时三维超声心动图(RT-3DE)技术在评估小儿扩张型心肌病(DCM)左心功能中的价值.方法 以28例DCM患儿和20例正常儿童为研究对象,应用RT-3DE技术测定反映左室功能的指标如左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、左室容量(LVSV)和左室射血分数(LVEF),并与改良Ross标准及传统二维超声(2DE)测定指标进行比较.结果 RT-3DE评估的EF值与Ross评分值呈负相关(r=-0.97,P<0.001),与2DE相比虽有相关性,但不如前二者显著(r=-0.59,P<0.01);2DE所测LVEDV及LVESV小于RT-3DE,而EF值及SV两者差异无统计学意义;RT-3DE测定的LVEF值与2DE测定的EF有很好的相关性(r=0.68,P<0.001).随访1年后,有6例患儿死亡,死亡组患儿EF值明显低于存活组(P<0.01).结论 RT-3DE所测量的左心室心功能参数能够准确、客观地反映DCM患者的左心功能.%Objective To assess the accuracy and value of real-time three-dimensional echocardiography ( RT-3DE ) in quantifying left ventricular ( LV ) volumes and ejection fraction ( EF ) in children with dilated cardiomyopathy ( DCM ).Methods Twenty-eight patients with DCM and 20 children without heart disease were included.The LV end diastolic volume ( LVEDV ), LV end systolic volume ( LVESV ) and LVEF were measured by RT-3DE.The results were compared with that of 2-DE using modified Simpson method and modified Ross score.Results The results of LVEF obtained by RT-3D showed significantly negative correlation with modified Ross score ( r = -0.966, P ＜ 0.001), and there was also negative correlation between modified Ross score and LVEF obtained by 2DE (r = -0.587, P ＜ 0.01 ), however the correlation was less significant than the former one ( r = 0.869 5, P ＜ 0.05 ); The results of LVEDV and LVESV obtained by 2DE were significantly lower than that of RT-3DE, but there was no differences in LVEF and SV; There was excellent correlation between RT-3DE and 2DE for LVEF ( r = 0.68, P ＜ 0.001 ).After one year follow-up, 6 patients died.The results of LVEF obtained by real-time 3DE in died patients were significantly lower than that in survival and control children.Conclusions RT-3DE can objectively reflect the LVEF changes of patients with DCM.