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目的探究实时三维超声心动图(RT-3DE)对评估不同程度冠脉狭窄的冠心病患者左心房容积及机械功能的作用,为临床合理运用RT-3DE提供有效的理论参数。方法选择2012年2月至2013年4月于绍兴市中心医院就诊的冠心病患者56例为研究对象,冠状动脉造影后,依据其狭窄程度将患者分为3组,其中A组(狭窄程度<50%)12例,B组(狭窄程度50%~75%)23例,C组(狭窄程度>75%)21例。对受检者血浆N末端B型脑利钠肽(NT-pro BNP)浓度进行检测,同时对左心房各时相容积及机械功能做二维超声心动图(2DE)及RT-3DE监测,并对相关参数进行分析。绘制预测冠状动脉狭窄程度≥75%的工作特征(ROC)曲线,并计算曲线下面积。结果 B、C两组与A组患者相比,血浆中NT-pro BNP浓度显著升高,差异均有统计学意义(P<0.01)。C组中,由RT-3DE所得LAVmin与其校正指数LAVminindex及LAVpre-P均明显低于2DE所获对应参数,差异均有统计学意义(P<0.05)。对于RT-3DE所得参数,与A组相比,C组中LAVmin及LAVminindex、LAVpre-P及LAVpre-Pindex均明显升高,差异均有统计学意义(P<0.05,P<0.01);与B组相比,C组中LAVmin及LAVminindex明显升高,LAEF、LAEFpassive明显减低,差异均有统计学意义(P<0.05)。RT-3DE所得参数LAVmaxindex、LAVminindex、LAVpre-Pindex预测冠状动脉狭窄程度≥75%的ROC曲线下面积依次为0.534(P=0.364)、0.823(P=0.003)和0.701(P=0.009)。结论 RT-3DE可以准确测量不同程度冠脉狭窄的冠心病患者左房各时相容积及机械功能,可作为评估左心室舒张功能的敏感指标。
Objective To explore the effect of real-time three-dimensional echocardiography (RT-3DE) on assessing left atrium volume and mechanical function in patients with coronary artery stenosis with different degrees of coronary stenosis and to provide valid theoretical parameters for RT-3DE. Methods From February 2012 to April 2013, 56 patients with coronary heart disease in Shaoxing Central Hospital were enrolled in this study. After coronary angiography, the patients were divided into 3 groups according to their stenosis. Group A (degree of stenosis < 50 cases), 12 cases in group B (stenosis of 50% -75%), 23 cases of group C (stenosis> 75%) in 21 cases. The concentration of N-terminal NT-pro BNP in the plasma of the subjects was measured. 2DE and RT-3DE were performed on the volumes and mechanical functions of the left atrium at each time point. Analysis of the relevant parameters. Draw a working characteristic (ROC) curve that predicts coronary stenosis ≥75% and calculate the area under the curve. Results Compared with patients in group A, the concentration of NT-pro BNP in plasma of group B and C were significantly increased (P <0.01). In group C, the LAVmin, LAVminindex and LAVpre-P obtained by RT-3DE were significantly lower than the corresponding parameters obtained by 2DE (P <0.05). Compared with group A, LAVmin, LAVminindex, LAVpre-P and LAVpre-Pindex in group C were significantly increased in RT-3DE group (P <0.05, P <0.01) Compared with the control group, LAVmin and LAVminindex in group C were significantly increased, LAEF and LAEFpassive were significantly decreased, the differences were statistically significant (P <0.05). The areas under the ROC curve of LAVmaxindex, LAVminindex and LAVpre-Pindex predicted by RT-3DE were 0.534 (P = 0.364), 0.823 (P = 0.003) and 0.701 (P = 0.009) in turn, respectively. Conclusion RT-3DE can accurately measure left ventricular volume and mechanical function in patients with coronary artery disease of different degrees of coronary artery stenosis and can be used as a sensitive index to evaluate left ventricular diastolic function.