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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2018, Vol. 15 ›› Issue (06) : 426 -432. doi: 10.3877/cma.j.issn.1672-6448.2018.06.007

所属专题： 文献；

心血管超声影像学

心脏超声造影评价恶性肿瘤化疗患者左心室射血分数与左心室容积
王佳玉1, 毛宇航1, 田洁1, 黄凌霙1, 王译斌1, 张隽1, 孙睿颖1, 邓又斌1,†()   
  1. 1. 430030　武汉，华中科技大学同济医学院附属同济医院超声影像科
  • 收稿日期:2018-05-21 出版日期:2018-06-01
  • 通信作者: 邓又斌
  • 基金资助:
    国家自然科学基金(81571695)

Measurements of contrast-enhanced echocardiography for left ventricular ejection fraction and left ventricular volume in patients undergoing cancer chemotherapy

Jiayu Wang1, Yuhang Mao1, Jie Tian1, Lingying Huang1, Yibin Wang1, Jun Zhang1, Ruiying Sun1, Youbin Deng1,†()   

  1. 1. Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  • Received:2018-05-21 Published:2018-06-01
  • Corresponding author: Youbin Deng
  • About author:
    Corresponding author: Deng Youbin, Email:
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引用本文：

王佳玉, 毛宇航, 田洁, 黄凌霙, 王译斌, 张隽, 孙睿颖, 邓又斌. 心脏超声造影评价恶性肿瘤化疗患者左心室射血分数与左心室容积[J]. 中华医学超声杂志（电子版）, 2018, 15(06): 426-432.

Jiayu Wang, Yuhang Mao, Jie Tian, Lingying Huang, Yibin Wang, Jun Zhang, Ruiying Sun, Youbin Deng. Measurements of contrast-enhanced echocardiography for left ventricular ejection fraction and left ventricular volume in patients undergoing cancer chemotherapy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(06): 426-432.

目的

比较心脏超声造影与常规超声心动图测量恶性肿瘤化疗患者左心室射血分数（LVEF）与左心室容积的可重复性，探讨心脏超声造影评估恶性肿瘤化疗患者左心功能的价值。

方法

选择2016年7至12月华中科技大学同济医学院附属同济医院119例接受了常规超声心动图检查的恶性肿瘤化疗患者。其中图像清晰者42例，图像欠佳者77例。采集所有患者的胸骨旁左心室长轴、心尖四腔、二腔、左心长轴观以及三维动态图像，对于图像欠佳组患者还需采集心脏超声造影状态下的胸骨旁左心室长轴、心尖四腔、二腔、左心长轴观以及三维动态图像。两位资历相当的检查者分别运用EchoPac工作站测得所有患者不同测量方法的LVEF与左心室容积。

结果

图像清晰组双平面Simpson法与三维全容积法测量的LVEF差异有统计学意义（t=4.224，P<0.01），而左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）差异均无统计学意义；但图像欠佳组双平面Simpson法与三维全容积法测量的LVEF、LVEDV差异均有统计学意义（t=8.650、6.207，P<0.01），而LVESV差异无统计学意义。对于图像清晰组，无论采用双平面Simpson法还是三维全容积法，2位检查者间测量的LVEF、LVEDV、LVESV差异均无统计学意义。而对于图像欠佳组，无论采用双平面Simpson法还是三维全容积法，2位检查者间测量的LVEF、LVEDV差异均有统计学意义（t=4.286、3.645、3.308、4.189，P<0.01），而LVESV差异均无统计学意义；行心脏超声造影后，对于图像欠佳组，无论采用双平面Simpson法还是三维全容积法，2位检查者间测量的LVEF、LVEDV、LVESV差异均无统计学意义。组内相关系数（ICC）显示，图像清晰组、图像欠佳组造影前后双平面Simpson法、三维全容积法测量LVESV的可重复性均较好（ICC=0.901、0.858、0.935、0.920、0.884、0.952）。图像清晰组双平面Simpson法、三维全容积法测量LVEF、LVEDV的可重复性均较好（ICC=0.946、0.895、0.776、0.815）。对于图像欠佳组，双平面Simpson法测量LVEF的可重复性较差（ICC=0.625），但行心脏超声造影后有明显提高（ICC=0.858）；双平面Simpson法、三维全容积法测量LVEDV的可重复性均较差（ICC=0.630、0.712），但行心脏超声造影后均有明显改善（ICC=0.863、0.914）。

结论

心脏超声造影能明显改善图像显示欠佳的化疗患者LVEF与左心室容积测量的可重复性。

关键词: 超声心动描记术, 造影剂, 药物疗法, 癌, 心室功能，左
Objective

To discuss the value of contrast-enhanced echocardiography in assessing left heart function by comparing the reproducibility of contrast-enhanced echocardiography and conventional echocardiography for measurements of left ventricular ejection fraction (LVEF) and left ventricular volume in patients undergoing cancer chemotherapy.

Methods

One hundred and nineteen patients undergoing cancer chemotherapy were divided into satisfactory image group (42 subjects) and unsatisfactory image group (77 subjects) according to the quality of the recorded images. High frame rate two-dimensional and three-dimensional images were recorded from apical long-axis view, four-chamber view and two-chamber view of left ventricle. Contrast-enhanced echocardiography was performed in the unsatisfactory image group. Two equally experienced examiners measured the LVEF and left ventricular volume in all patients by EchoPac software.

Results

The difference of LVEF measured by Simpson′s biplane method and 3D full-volume echocardiography in satisfactory image group was statistically significant (t=4.224, P<0.01), while there were no significant differences in the measurements of left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). However, the differences of LVEF and LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography in unsatisfactory image group were both statistically significant (t=8.650, 6.207, both P<0.01). And there was no significant difference in the measurements of LVESV. In satisfactory image group, LVEF, LVEDV and LVESV measured by Simpson′s biplane method or 3D full-volume echocardiography showed no significant differences between two examiners. While in unsatisfactory image group, LVEF and LVEDV measured by Simpson′s biplane method or 3D full-volume echocardiography showed significant differences between two examiners (t=4.286, 3.645, 3.308, 4.189, all P<0.01), except for LVESV. LVEF, LVEDV and LVESV measured by Simpson′s biplane method or 3D full-volume echocardiography showed no significant differences between two examiners in unsatisfactory image group with contrast-enhanced echocardiography. The results of intraclass correlation coefficient (ICC) showed that the reproducibility of LVESV measured by Simpson′s biplane method and 3D full-volume echocardiography was both well in satisfactory image group and unsatisfactory image group without contrast-enhanced echocardiography (ICC=0.901, 0.858, 0.935, 0.920, 0.884, 0.952). The reproducibility of LVEF and LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography was both well in satisfactory image group (ICC=0.946, 0.895, 0.776, 0.815). The reproducibility of LVEF measured by Simpson′s biplane method showed poor results in unsatisfactory image group (ICC=0.625). However, it was improved by performing contrast-enhanced echocardiography (ICC=0.858). The reproducibility of LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography was poor in unsatisfactory image group (ICC=0.630, 0.712). But it was improved by contrast-enhanced echocardiography in both methods (ICC=0.863, 0.914).

Conclusion

The reproducibility for measurements of LVEF and left ventricular volume with unsatisfactory images was improved in patients undergoing cancer chemotherapy by using contrast-enhanced echocardiography.

Key words: Echocardiography, Contrast media, Drug therapy, Carcinoma, Ventricular function, left
表1 图像欠佳组与图像清晰组患者一般临床资料比较
组别 例数 年龄（岁，±s） 性别（例，男性/女性）
图像欠佳组 107 55±11 30/47
图像清晰组 42 53±12 18/24
检验值 ? t=0.421 χ2=0.171
P值 ? 0.674 0.679
表2 双平面Simpson法与三维全容积法测量结果比较（±s）
方法 图像清晰组 图像欠佳组
例数 LVEF（%） LVEDV（ml） LVESV（ml） 例数 LVEF（%） LVEDV（ml） LVESV（ml）
双平面Simpson法 42 65±6 89±16 30±8 107 65±7 102±26 36±11
三维全容积法 42 61±5 87±15 32±7 107 58±7 86±23 36±13
t值 ? 4.224 0.650 -1.644 ? 8.650 6.207 -0.162
P值 ? <0.01 0.519 0.108 ? <0.001 <0.001 0.872
图1~4 图像欠佳组同一患者不同测量方法测量结果。图1为双平面Simpson法；图2为造影后的双平面Simpson法；图3为三维全容积法；图4为造影后的三维全容积法
表3 图像清晰组不同测量方法检查者间测量结果比较（±s）
检查者 例数 LVEF（%） LVEDV（ml） LVESV（ml）
双平面Simpson法 三维全容积法 双平面Simpson法 三维全容积法 双平面Simpson法 三维全容积法
检查者1 42 65±6 61±5 89±16 87±15 30±8 32±7
检查者2 42 66±7 62±5 90±11 85±10 31±7 32±7
t值 ? 0.903 -1.643 -1.014 -0.292 -1.087 -0.426
P值 ? 0.372 0.108 0.317 0.772 0.283 0.672
表4 图像欠佳组造影前不同测量方法检查者间测量结果比较（±s）
组别 例数 LVEF（%） LVEDV（ml） LVESV（ml）
双平面Simpson法 三维全容积法 双平面Simpson法 三维全容积法 双平面Simpson法 三维全容积法
检查者1 107 64±9 58±7 102±26 86±23 36±11 36±13
检查者2 107 61±8 56±7 94±22 84±19 37±10 36±11
t值 ? 4.286 3.645 3.308 4.189 -1.687 -0.349
P值 ? <0.01 <0.01 <0.01 <0.01 0.096 0.728
表5 图像欠佳组造影后不同测量方法检查者间测量结果比较（±s）
组别 例数 LVEF（%） LVEDV（ml） LVESV（ml）
双平面Simpson法 三维全容积法 双平面Simpson法 三维全容积法 双平面Simpson法 三维全容积法
检查者1 107 62±11 59±7 98±23 86±19 37±13 33±12
检查者2 107 60±13 58±8 97±21 85±21 37±14 34±13
t值 ? 0.919 0.354 0.739 -0.852 0.208 -0.266
P值 ? 0.361 0.724 0.462 0.397 0.836 0.791
表6 不同测量方法测量不同参数的ICC
指标 图像清晰组 图像欠清组造影前 图像欠清组造影后
LVEF ? ? ?
? 双平面Simpson法 0.946 0.625 0.858
? 三维全容积法 0.895 0.789 0.892
LVEDV ? ? ?
? 双平面Simpson法 0.776 0.630 0.863
? 三维全容积法 0.815 0.712 0.914
LVESV ? ? ?
? 双平面Simpson法 0.901 0.858 0.935
? 三维全容积法 0.920 0.884 0.952
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