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目的运用速度向量成像技术(VVI)探究舒张早期左室纵向心肌峰值速度(Ev)测量位点选择及在舒张功能障碍分级中的临床价值。方法 223例患者经过常规超声检查,基于舒张功能评估指南分为舒张功能正常组(124例)和异常组(99例),异常组包括舒张功能障碍Ⅰ级57例、Ⅱ级37例、Ⅲ级5例,分析VVI相应指标:舒张早期左室纵向各节段心肌峰值速度平均值(GMEv)、二尖瓣环6个节段平均值(6MEv)、心尖四腔心切面二尖瓣环侧壁心肌Ev和室间隔心肌Ev以及两者的平均值(2MEv)。结果 (1)侧壁Ev、室间隔Ev、2MEv、6MEv及G-MEv在舒张功能正常组和异常组间差异具有统计学意义(P<0.05),而在异常组中舒张功能Ⅰ级、Ⅱ级、Ⅲ级障碍两两间比较差异不具有统计学意义(P>0.05)。(2)侧壁Ev、室间隔Ev、2MEv、6MEv及G-MEv的ROC曲线下面积分别是0.85、0.87、0.89、0.95、0.95(P均<0.01),截断值分别为4.6、5.8、4.9、4.9、4.0。(3)6MEv、G-MEv的曲线下面积分别与侧壁Ev、室间隔Ev、2MEv间均具有差异性(P<0.01),而2MEv的曲线下面积与侧壁Ev间具有差异性(P<0.01),与室间隔Ev间差异不具有统计学意义(P>0.05)。结论 Ev对诊断舒张功能异常具有一定临床价值,但尚不认为能够评估舒张功能障碍的严重程度。此外,2MEv是一个较好的测量位点,但对于多节段心肌功能异常,G-MEv可能是一个较好的测量位点。
Objective To explore the clinical application of velocity vector imaging (VVI) in the selection of measurement sites of left ventricular longitudinal peak velocity (Ev) and its classification in diastolic dysfunction. Methods Totally 223 patients with diastolic dysfunction were divided into two groups: normal diastolic group (n = 124) and abnormal group (n = 99) according to the guideline of diastolic function. Totally, 223 patients with grade Ⅰ diastolic dysfunction included 57 cases, grade Ⅱ 37 cases, grade Ⅲ 5 cases, the corresponding indexes of VVI were analyzed: the average peak myocardial velocity (GMEv) in each segment of early diastole and the average of 6 segments of mitral annulus (6MEv), the mitral annular wall Ev and ventricular septal myocardium Ev and the mean (2MEv). Results (1) There were significant differences between Ev group, Ev, 2MEv, 6MEv and G-MEv between the normal group and abnormal group in diastolic function (P <0.05) There was no significant difference between the two grades of grade Ⅲ and grade Ⅲ (P> 0.05). (2) The area under the ROC curve of side wall Ev, interventricular septum Ev, 2MEv, 6MEv and G-MEv were 0.85,0.87,0.89,0.95,0.95 (P <0.01), the cutoffs were 4.6,5.8,4.9 , 4.9,4.0. (3) The areas under the curves of 6MEv and G-MEv were significantly different from those of sidewalls Ev and 2MEv (P <0.01), while the area under the curve of 2MEv was significantly different from that of sidewalls Ev <0.01). There was no significant difference with interventricular septum Ev (P> 0.05). Conclusions Ev has some clinical value in diagnosing diastolic dysfunction. However, it is not considered that the severity of diastolic dysfunction can be evaluated. In addition, 2MEv is a good measurement site, but for multi-segment myocardial dysfunction, G-MEv may be a better measurement site.