应用斑点追踪超声心动图技术评估儿童舒张早期左心室室内压力差。
Assessment of Early Diastolic Intraventricular Pressure Difference in Children by Blood Speckle-Tracking Echocardiography.
机构信息
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Division of Ålesund Hospital, Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Division of Ålesund Hospital, Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway.
出版信息
J Am Soc Echocardiogr. 2023 May;36(5):523-532.e3. doi: 10.1016/j.echo.2022.12.025. Epub 2023 Jan 9.
BACKGROUND
The lack of reliable echocardiographic techniques to assess diastolic function in children is a major clinical limitation. Our aim was to develop and validate the intraventricular pressure difference (IVPD) calculation using blood speckle-tracking (BST) and investigate the method's potential role in the assessment of diastolic function in children.
METHODS
Blood speckle-tracking allows two-dimensional angle-independent blood flow velocity estimation. Blood speckle-tracking images of left ventricular (LV) inflow from the apical 4-chamber view in 138 controls, 10 patients with dilated cardiomyopathies (DCMs), and 21 patients with hypertrophic cardiomyopathies (HCMs) <18 years of age were analyzed to study LV IVPD during early diastole. Reproducibility of the IVPD analysis was assessed, IVPD estimates from BST and color M mode were compared, and the validity of the BST-based IVPD calculations was tested in a computer flow model.
RESULTS
Mean IVPD was significantly higher in controls (-2.28 ± 0.62 mm Hg) compared with in DCM (-1.21 ± 0.39 mm Hg, P < .001) and HCM (-1.57 ± 0.47 mm Hg, P < .001) patients. Feasibility was 88.3% in controls, 80% in DCM patients, and 90.4% in HCM patients. The peak relative negative pressure occurred earlier at the apex than at the base and preceded the peak E-wave LV filling velocity, indicating that it represents diastolic suction. Intraclass correlation coefficients for intra- and interobserver variability were 0.908 and 0.702, respectively. There was a nonsignificant mean difference of 0.15 mm Hg between IVPD from BST and color M mode. Estimation from two-dimensional velocities revealed a difference in peak IVPD of 0.12 mm Hg (6.6%) when simulated in a three-dimensional fluid mechanics model.
CONCLUSIONS
Intraventricular pressure difference calculation from BST is highly feasible and provides information on diastolic suction and early filling in children with heart disease. Intraventricular pressure difference was significantly reduced in children with DCM and HCM compared with controls, indicating reduced early diastolic suction in these patient groups.
背景
缺乏可靠的超声心动图技术来评估儿童的舒张功能是一个主要的临床限制。我们的目的是开发和验证使用血流斑点追踪（BST）计算心室内压力差（IVPD），并研究该方法在评估儿童舒张功能中的潜在作用。
方法
血流斑点追踪允许二维角度独立的血流速度估计。从心尖 4 腔切面分析 138 例对照者、10 例扩张型心肌病（DCM）患者和 21 例肥厚型心肌病（HCM）患者的左心室（LV）流入血流的 BST 图像，以研究舒张早期的 LV-IVPD。评估 IVPD 分析的可重复性，比较 BST 和彩色 M 模式的 IVPD 估计值，并在计算机流量模型中测试基于 BST 的 IVPD 计算的有效性。
结果
对照组的平均 IVPD（-2.28±0.62 mm Hg）明显高于 DCM 组（-1.21±0.39 mm Hg，P<.001）和 HCM 组（-1.57±0.47 mm Hg，P<.001）。对照组的可行性为 88.3%，DCM 患者为 80%，HCM 患者为 90.4%。心尖处的峰值相对负压早于心尖底部出现，先于心室早期充盈速度的 E 波峰值，表明它代表舒张期抽吸。观察者内和观察者间的内类相关系数分别为 0.908 和 0.702。BST 和彩色 M 模式的 IVPD 之间的平均差异为 0.15 mm Hg，无统计学意义。在三维流体力学模型中模拟二维速度的估计时，峰值 IVPD 差异为 0.12 mm Hg（6.6%）。
结论
从 BST 计算心室内压力差是高度可行的，并提供了有关心脏病患儿舒张期抽吸和早期充盈的信息。与对照组相比，DCM 和 HCM 患儿的 IVPD 显著降低，表明这些患儿群体的早期舒张期抽吸减少。
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