超声心动图自动心肌运动定量技术对尿毒症透析患者早期左心室收缩功能的评估

doi:10.3877/cma.j.issn.1672-6448.2021.01.012

中华医学超声杂志（电子版） ›› 2021, Vol. 18 ›› Issue (01) : 56 -61. doi: 10.3877/cma.j.issn.1672-6448.2021.01.012

所属专题：文献；妇产科超声；

心血管超声影像学

超声心动图自动心肌运动定量技术对尿毒症透析患者早期左心室收缩功能的评估

陈斌¹, 沈丽君¹^,^†(

), 赵博文², 陈冉², 陆佳佳¹, 张升芳¹

^1. 311200　杭州市萧山区第一人民医院超声科
^2. 310016　杭州，浙江大学医学院附属邵逸夫医院超声科　浙江大学邵逸夫临床医学研究所

收稿日期:2019-11-06 出版日期:2021-01-01
通信作者: 沈丽君
基金资助:
杭州市萧山区社会发展重大科技攻关项目(2017302)

Evaluation of early left ventricular systolic function in uremia patients on dialysis by automated cardiac motion quantification

Bin Chen¹, Lijun Shen¹^,^†(), Bowen Zhao², Ran Chen², Jiajia Lu¹, Shengfang Zhang¹

^1. Department of Diagnostic Ultrasound, First People's Hospital of Xiaoshan District, Hangzhou 311200, China
^2. Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China

Received:2019-11-06 Published:2021-01-01
Corresponding author: Lijun Shen

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引用本文：

陈斌, 沈丽君, 赵博文, 陈冉, 陆佳佳, 张升芳. 超声心动图自动心肌运动定量技术对尿毒症透析患者早期左心室收缩功能的评估[J]. 中华医学超声杂志（电子版）, 2021, 18(01): 56-61.

Bin Chen, Lijun Shen, Bowen Zhao, Ran Chen, Jiajia Lu, Shengfang Zhang. Evaluation of early left ventricular systolic function in uremia patients on dialysis by automated cardiac motion quantification[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(01): 56-61.

目的

探讨超声心动图自动心肌运动定量技术（aCMQ）评估不同透析时间段的尿毒症患者左心室收缩功能的价值。

方法

选择2018年5月至2019年2月在浙江省杭州市萧山区第一人民医院血液透析室接受透析治疗的尿毒症患者52例。根据其接受血透时间的不同分为3组，A组为透析时间≤3年的患者，共27例；B组为透析时间＞3年且≤7年的患者，共16例；C组为透析时间＞7年的患者，共9例；正常对照组共60例，既往均无心脏及肾疾病病史，常规心电图及超声心动图检查均未见明显异常。首先运用M型超声心动图，通过Teichholz法获得病例组及对照组左心室射血分数（LVEF），然后启动X-Plane技术采集4个心动周期的四腔心及两腔心，根据心电图指示分别描记左心室舒张末期及左心室收缩末期，运用双平面Simpson法分别计算出病例组及对照组LVEF，最后运用aCMQ分别获取病例组及对照组研究对象的左心室整体长轴应变（LVGLS）、心尖两腔心长轴应变（LVAP2LS）、心尖四腔心长轴应变（LVAP4LS）及心尖三腔心长轴应变（LVAP3LS），分析不同透析年限组尿毒症患者左心室长轴应变变化。多组间比较采用方差分析，组间两两比较采用LSD-t检验。

结果

Teichholz法测得病例组与对照组LVEF分别为：A组（67.21±6.63）%；B组（64.73±6.47）%；C组（64.58±8.38）%；对照组（67.02±3.62）%。Simpson法测得病例组与对照组LVEF分别为：A组（64.71±4.93）%；B组（64.08±6.02）%；C组（63.91±7.49）%；对照组（66.17±3.14）%。病例组与对照组LVEF比较以及病例组间LVEF比较，差异均无统计学意义（P均＞0.05）。运用aCMQ得到病例组与对照组LVGLS分别为：A组（-20.79±2.70）%、B组（-20.03±3.58）%、C组（-18.32±3.71）%、对照组（-24.39±2.05）%；LVAP4LS分别为：A组（-22.09±2.76）%、B组（-20.11±3.94）%、C组（-19.49±3.73）%、对照组（-24.61±2.37）%；LVAP3LS分别为：A组（-19.32±3.85）%、B组（-19.28±4.37）%、C组（-16.61±4.40）%、对照组（-23.53±6.18）%；LVAP2LS分别为：A组（-20.09±2.53）%、B组（-19.57±2.65）%、C组（-18.09±4.01）%、对照组（-23.51±7.52）%。病例组LVGLS、LVAP2LS、LVAP4LS及LVAP3LS的测值均较对照组减低，差异具有统计学意义（A组 vs 对照组：t=-5.949、-3.844、-6.117、-4.863，P均＜0.001；B组 vs 对照组：t=-5.883、-5.619、-5.036、-4.650，P均＜0.001；C组 vs 对照组：t=-6.541、-5.081、-6.130、-4.854，P均＜0.001），其中A组LVGLS、LVAP4LS和LVAP3LS测值比C组减低，差异具有统计学意义（t=-2.493、-2.405、-2.012，P=0.014、=0.018、=0.047），A组与C组LVAP2LS测值比较，差异无统计学意义（P＞0.05），A组与B组间以及B组与C组间在LVGLS、LVAP2LS、LVAP3LS、LVAP4LS测值比较，差异也均无统计学意义（P均＞0.05）。

结论

aCMQ能早期发现尿毒症透析患者左心室收缩功能的异常，为临床早期预防及治疗心功能衰竭提供了新的途径。

关键词: 超声心动描记术, 自动心肌运动定量技术, 尿毒症, 心室功能

Objective

To explore the value of automated cardiac motion quantification (aCMQ) in evaluating left ventricular systolic function in uremia patients with different durations of dialysis.

Methods

Fifty-two cases of uremia were selected at First People's Hospital of Xiaoshan District from May 2018 to February 2019. They were divided into three groups according to the duration of hemodialysis. Group A consisted of 27 patients receiving dialysis for ≤ 3 years, group B consisted of 16 patients receiving dialysis for ＞ 3 years to less than 7 years, and group C consisted of 9 patients receiving dialysis for ＞ 7 years. A normal control group consisting of 60 subjects with no past history of heart and kidney disease was also included. M echocardiography was performed to estimate the left ventricular ejection fraction (LVEF) using the Teichholz method, and the X-Plane technique was used to collect four- and two-chamber view images of the heart for four cardiac cycles. Left ventricular end-diastole and left ventricular end-systole were recorded according to electrocardiogram, and the LVEF of the case group and control group was calculated by double plane Simpson method. The aCMQ was used to obtain left ventricular global longitudinal strain (LVGLS). Longitudinal strain of the left ventricle in apical four-chamber view, two-chamber view, and three-chamber view (LVAP4LS, LVAP2LS, and LVAP3LS) was obtained by aCMQ to analyze the changes of left ventricular long axis strain in uremia patients with different durations of dialysis. Analysis of variance was used for comparison among groups, and LSD-t test was used for pairwise comparison between groups.

Results

The mean LVEF measured by the Teichholz method was (67.21±6.63)% in group A, (64.73±6.47)% in group B, (64.58±8.38)% in group C, and (67.02±3.62)% in control group. The mean LVEF measured by Simpson method was (64.71±4.93)% in group A, (64.08±6.02)% in group B, (63.91±7.49)% in group C, and (66.17±3.14)% in control group. There was no significant difference in LVEF between the case groups or between the case group and control group (P＞0.05 for all). The mean values of LVGLS measured by aCMQ were (-20.79±2.70)%, (-20.03±3.58)%, (-18.32±3.71)%, and (-24.39±2.05)% in groups A, B, C, and control group, respectively. The mean values of LVAP4LS during the systolic period were as follows: group A (-22.09±2.76)%, group B (-20.11±3.94)%, group C (-19.49±3.73)%, and control group (-24.61±2.37)%. The mean values of LVAP3LS during the systolic period were as follows: group A (-19.32±3.85)%, group B (-19.28±4.37)%, group C (-16.61±4.40)%, and control group (-23.53±6.18)%. The mean values of LVAP2LS during the systolic period were as follows: group A (-20.09±2.53)%, group B (-19.57±2.65)%, group C (-18.09±4.01%), and control group (-23.51±7.52)%. LVGLS, LVAP4LS, LVAP2LS, and LVAP3LS were significantly reduced in the case groups compared to the control group (group A vs control group: t=-5.949, -3.844, -6.117, and -4.863, P＜0.001 for all; group B vs control group: t=-5.883, -5.619, -5.036, and -4.650, P＜0.001 for all; group C vs control group: t=-6.541, -5.081, -6.130, and -4.854, P＜0.001 for all). The LVGLS, LVAP4LS, and LVAP3LS values of group A were significantly lower than those of group C (t=-2.493, -2.405, and -2.012; P=0.014, 0.018, and 0.047, respectively). The LVAP2LS value did not differ significantly between group A and group B or group C (P＞0.05), and between group B and group C (P＞0.05).

Conclusion

aCMQ can evaluate the abnormality of left ventricular systolic function in uremia patients with different durations of dialysis, which provides a new way for early prevention and treatment of heart failure.

Key words: Echocardiography, Automated cardiac motion quantification, Uremia, Ventricular function

表1 尿毒症病例组与正常对照组一般资料和常规超声心动图测值比较（

x ˉ

±s）

组别		例数	男/女（例）	体质量指数（kg/m²）	LVIDd（mm）	IVSd（mm）		LVEF-Teichholz法（%）		LVEF-Simpson法（%）	Tei指数
A组		27	15/12	21.87±3.12	49.11±6.42^a	11.82±1.71^a		67.21±6.63		64.71±4.93	0.69±0.40^a
B组		16	11/5	22.02±3.79	49.39±3.83^a	12.17±1.54^a		64.73±6.47		64.08±6.02	0.67±0.29^a
C组		9	6/3	21.48±2.91	49.78±5.41^a	12.63±2.34^a		64.58±8.38		63.91±7.49	0.63±0.27^a
对照组		60	37/23	23.22±2.43	46.52±3.61	9.41±1.21		67.02±3.62		66.17±3.14	0.45±0.09
F值			1.458	1.706	3.493	29.646		0.962		1.436	8.030
P值			0.231	0.171	0.018	＜0.001		0.413		0.236	＜0.001
组别	例数		E峰（cm/s）	A峰（cm/s）	E/A		e峰（cm/s）		a峰（cm/s）	s峰（cm/s）	E/e
A组	27		82.41±26.22	96.54±20.47^a	0.87±0.31^ab		5.89±1.36^ab		9.90±1.62^a	7.55±1.27^a	14.21±4.17^a
B组	16		70.63±17.31	85.42±20.21^a	0.86±0.22^ab		5.90±1.11^ab		9.16±1.20	7.17±0.93^a	13.14±3.32^a
C组	9		63.68±19.02^a	97.88±19.53^a	0.64±0.17^a		4.47±1.62^a		9.34±2.12	7.10±1.87^a	15.47±4.94^a
对照组	60		80.09±16.62	61.21±13.82	1.37±0.44		9.61±1.92		8.84±1.52	8.38±1.21	8.38±1.39
F值			3.037	34.634	20.869		52.323		2.918	6.665	34.840
P值			0.032	＜0.001	＜0.001		＜0.001		0.037	＜0.001	＜0.001

表1 尿毒症病例组与正常对照组一般资料和常规超声心动图测值比较（

x ˉ

±s）

组别		例数	男/女（例）	体质量指数（kg/m²）	LVIDd（mm）	IVSd（mm）		LVEF-Teichholz法（%）		LVEF-Simpson法（%）	Tei指数
A组		27	15/12	21.87±3.12	49.11±6.42^a	11.82±1.71^a		67.21±6.63		64.71±4.93	0.69±0.40^a
B组		16	11/5	22.02±3.79	49.39±3.83^a	12.17±1.54^a		64.73±6.47		64.08±6.02	0.67±0.29^a
C组		9	6/3	21.48±2.91	49.78±5.41^a	12.63±2.34^a		64.58±8.38		63.91±7.49	0.63±0.27^a
对照组		60	37/23	23.22±2.43	46.52±3.61	9.41±1.21		67.02±3.62		66.17±3.14	0.45±0.09
F值			1.458	1.706	3.493	29.646		0.962		1.436	8.030
P值			0.231	0.171	0.018	＜0.001		0.413		0.236	＜0.001
组别	例数		E峰（cm/s）	A峰（cm/s）	E/A		e峰（cm/s）		a峰（cm/s）	s峰（cm/s）	E/e
A组	27		82.41±26.22	96.54±20.47^a	0.87±0.31^ab		5.89±1.36^ab		9.90±1.62^a	7.55±1.27^a	14.21±4.17^a
B组	16		70.63±17.31	85.42±20.21^a	0.86±0.22^ab		5.90±1.11^ab		9.16±1.20	7.17±0.93^a	13.14±3.32^a
C组	9		63.68±19.02^a	97.88±19.53^a	0.64±0.17^a		4.47±1.62^a		9.34±2.12	7.10±1.87^a	15.47±4.94^a
对照组	60		80.09±16.62	61.21±13.82	1.37±0.44		9.61±1.92		8.84±1.52	8.38±1.21	8.38±1.39
F值			3.037	34.634	20.869		52.323		2.918	6.665	34.840
P值			0.032	＜0.001	＜0.001		＜0.001		0.037	＜0.001	＜0.001

表2 尿毒症病例组与正常对照组左心室整体、四腔心、三腔心、二腔心收缩期纵向应变值比较（%，

x ˉ

±s）

组别	例数	LVGLS	LVAP4LS	LVAP3LS	LVAP2LS
A组	27	-20.79±2.70^ab	-22.09±2.76^ab	-19.32±3.85^ab	-20.09±2.53^a
B组	16	-20.03±3.58^a	-20.11±3.94^a	-19.28±4.37^a	-19.57±2.65^a
C组	9	-18.32±3.71^a	-19.49±3.73^a	-16.61±4.40^a	-18.09±4.01^a
对照组	60	-24.39±2.05	-24.61±2.37	-23.53±6.18	-23.51±7.52
F值		24.442	15.878	6.813	3.869
P值		＜0.001	＜0.001	＜0.001	0.011

表2 尿毒症病例组与正常对照组左心室整体、四腔心、三腔心、二腔心收缩期纵向应变值比较（%，

x ˉ

±s）

组别	例数	LVGLS	LVAP4LS	LVAP3LS	LVAP2LS
A组	27	-20.79±2.70^ab	-22.09±2.76^ab	-19.32±3.85^ab	-20.09±2.53^a
B组	16	-20.03±3.58^a	-20.11±3.94^a	-19.28±4.37^a	-19.57±2.65^a
C组	9	-18.32±3.71^a	-19.49±3.73^a	-16.61±4.40^a	-18.09±4.01^a
对照组	60	-24.39±2.05	-24.61±2.37	-23.53±6.18	-23.51±7.52
F值		24.442	15.878	6.813	3.869
P值		＜0.001	＜0.001	＜0.001	0.011

图1 正常组左心室自动心肌运动定量技术分析图。图a为左心室心尖四腔心各节段纵向应变及应变曲线；图b为左心室心尖三腔心各节段纵向应变及应变曲线；图c为左心室心尖二腔心各节段纵向应变及应变曲线

图2 病例组左心室自动心肌运动定量技术分析图。图a为左心室心尖四腔心各节段纵向应变及应变曲线；图c为左心室心尖三腔心各节段纵向应变及应变曲线；图b为左心室心尖二腔心各节段纵向应变及应变曲线

1	Sambi RS, Gaur AK, Hotchandani R, et al. Patterns of left ventricular hypertrophy in chronic kidney disease: an echocardiographic evaluation [J]. Indian Heart J, 2011, 63(3): 259-268.
2	Ma Y, Zhang B, Zhang Y, et al. Ultrasonic image analysis of longitudinal strain in uremic patients with preserved left ventricular ejection fraction [J]. Biomed Eng Online, 2018, 17(1): 112-122.
3	Yu CM, Fung JW, Zhang Q, et al. Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy [J]. Circulation, 2004, 110(1): 66-73.
4	钱胜利, 杨莉, 高菡静, 等. 三种超声斑点追踪技术评价正常人左心室心肌应变 [J] .中国医学影像技术, 2015, 31(6): 854-858.
5	Urbano Moral JA, Arias Godinez JA, Maron S, et al. Left ventricular twist mechanics in hypertrophic cardiomyopathy assessed by three-dimensional speckle tracking echocardiography [J]. Am Cardiol, 2011, 108(12): 1788-1795. URL
6	符梦竹, 杨俊华, 李杏. 三维定量分析与自动心肌运动定量技术评估慢性肾脏病患者左心室收缩功能的价值 [J]. 中华医学杂志, 2019, 99(4): 312-317.
7	宋芫, 赵博文, 王蓓, 等. 超声心动图自动心肌运动定量技术评测左心室收缩功能的相关性研究 [J]. 中华超声影像学杂志, 2017, 26(1): 7-11.
8	陈燕, 赵博文, 潘美, 等. 超声心动图自动心肌运动定量技术评估正常胎儿左心室收缩功能的初步研究 [J]. 中华超声影像学杂志, 2018, 27(11): 977-981.
9	Matsushita K, Blecker S, Pazin-Filho A, et al. The association of hemoglobin a1c with incldent heart failure among people without diabetes: the atherosclerosis risk in communities study [J]. Diabetes, 2010, 59(8): 2020-2026.
10	朱天刚. 超声心动图规范化培训教材 [M]. 北京: 人民卫生出版社, 2012: 26-33.
11	刘丽, 夏稻子, 朱宁, 等. 组织多普勒Tei指数和二维斑点追踪技术评价双腔起搏器患者左心功能 [J/CD]. 中华临床医师杂志(电子版), 2013, 7(4): 1526-1529.
12	Sun X, Zhao B, Chen Y, et al. Preliminary results analysis for left ventricular systolic function in normal fetuses by automated cardiac motion quantitation [J]. J Matern Fetal Neonatal Med, 2019: 1-9. Online ahead of print.
13	Langeland S, D'hooge J, Wouters PF, et al. Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle [J]. Circulation, 2005, 112(14): 2157-2162.
14	Magne J, Mahjoub H, Pierard LA, et al. Prognostic importance of brain natriuretic peptide and left ventricular longitudinal function in asymptomatic degenerative mitral regurgitation [J]. Heart, 2012, 98(7): 584-591. URL
15	Magne J, Mahjoub H, Pibarot P, et al. Prognostic importance of exercise brain natriuretic peptide in asymptomatic degenerative mitral regurgitation [J]. Eur J Heart Fail, 2012, 14(11): 1293-1302. URL
16	Decloedt A, Verheyen T, Sys S, et al. Quantification of left ventricular longitudinal strain, strain rate, velocity, and displacement in healthy horses by 2-dimensional speckle tracking [J]. J Vet Intern Med, 2011, 25(2): 330-338. URL
17	Mall G, Huther W, Schneider J, et al. Diffuse intermyocardiocytic fibrosis in uraemic patients [J]. Nephrol Dial Transplant, 1990, 5(1): 39-44.
18	Cramariuc D, Gerdts E, Davidsen ES, et al. Myocardial deformation in aortic valve stenosis: relation to left ventricular geometry [J]. Heart, 2010, 2(2): 106-112.

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Evaluation of early left ventricular systolic function in uremia patients on dialysis by automated cardiac motion quantification

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Evaluation of early left ventricular systolic function in uremia patients on dialysis by automated cardiac motion quantification