Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California.
Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California.
J Am Soc Echocardiogr. 2017 Oct;30(10):974-983. doi: 10.1016/j.echo.2017.06.006. Epub 2017 Aug 9.
The clinical applicability and reliability of three-dimensional (3D) speckle-tracking echocardiography has not been well studied in pediatric patients. The aim of this study was to compare two-dimensional (2D) echocardiography and 3DE real-time full-volume-derived strain and rotation indices in healthy children and patients with dilated cardiomyopathy (DCM).
Children with either normal function or DCM were prospectively recruited in an outpatient setting, and deformation indices, including circumferential, radial, and longitudinal strain and torsion, were measured by 2D and 3D echocardiography. Control subjects were compared with patients using the Mann-Whitney U test, correlations between 2D and 3D measurements were analyzed using Spearman correlation analysis, and reproducibility analyses are reported using intraclass correlation coefficients and coefficient of variations.
The study cohort consisted of 15 patients (47%) with DCM and 17 control subjects (53%). The median age of the cohort was 13.4 years (range, 5.7-19.3 years). By both 2D and 3D analysis, magnitudes of global longitudinal (P = .01), circumferential (P = .007), and radial (P = .004) strain were significantly lower in patients with DCM in comparison with control subjects. Using receiver operating characteristic curves, lower values of absolute circumferential (area under the curve = 0.95, P < .0001) and longitudinal (area under the curve = 0.93, P < .0001) strain were associated with left ventricular dysfunction. No difference was noted in torsion between control subjects and patients. Three-dimensional analysis was superior to 2D analysis in terms of intraobserver, interobserver, and test-retest reliability.
Left ventricular deformation shows significant changes while torsion is preserved in outpatients with DCM compared with control subjects. Three-dimensional global strain can discriminate subtle left ventricular dysfunction and has better reproducibility in comparison with 2D echocardiography. High-resolution 3D imaging is a useful clinical assessment tool for cardiac performance and may overcome some of the limitations of 2D analysis.
三维（3D）斑点追踪超声心动图在儿科患者中的临床适用性和可靠性尚未得到充分研究。本研究旨在比较二维（2D）超声心动图和 3D 实时全容积衍生应变和旋转指数在健康儿童和扩张型心肌病（DCM）患者中的应用。
在门诊环境中前瞻性招募功能正常或 DCM 的儿童，并通过 2D 和 3D 超声心动图测量圆周、径向和纵向应变和扭转等变形指标。使用 Mann-Whitney U 检验比较对照组和患者，使用 Spearman 相关分析分析 2D 和 3D 测量之间的相关性，使用组内相关系数和变异系数报告重复性分析。
研究队列包括 15 名（47%）DCM 患者和 17 名对照组（53%）。队列的中位年龄为 13.4 岁（范围，5.7-19.3 岁）。通过 2D 和 3D 分析，DCM 患者的整体纵向（P = 0.01）、圆周（P = 0.007）和径向（P = 0.004）应变幅度均明显低于对照组。使用受试者工作特征曲线，绝对圆周（曲线下面积 = 0.95，P < 0.0001）和纵向（曲线下面积 = 0.93，P < 0.0001）应变的较低值与左心室功能障碍相关。对照组和患者之间的扭转无差异。在观察者内、观察者间和测试-重测可靠性方面，3D 分析优于 2D 分析。
与对照组相比，DCM 门诊患者的左心室变形明显改变，而扭转保持不变。3D 整体应变可以区分细微的左心室功能障碍，并且与 2D 超声心动图相比具有更好的可重复性。高分辨率 3D 成像对于心脏功能是一种有用的临床评估工具，可以克服 2D 分析的一些局限性。
