CAJ | 학술논문

目的探讨心音图在慢性心力衰竭诊断中的临床应用价值.方法 2012年3月至2013年9月入住浙江大学医学院附属第二医院心内科的患者共243例,其中慢性心力衰竭组128例,对照组115例.利用心音图技术分别测定两组电-机械激动时间(electromechanical activation time,EMAT)、左心室收缩时间(left ventricular systolic time,LVST)及第三心音(S3)强度,比较两组平均EMAT、LVST及S3强度的差异,分析EMAT及S3在诊断慢性心力衰竭中的敏感性与特异性.结果慢性心力衰竭组平均EMAT较对照组明显延长(121±17)ms对(88±15)ms,(P＜0.001),平均LVST明显缩短(311±39)ms对(340±22) ms,(P＜0.05),S3强度明显增高(4.22±2.30对3.01±0.66,P＜0.05),慢性心力衰竭组S3存在率32.0％,高于对照组11.3％ (P＜0.05).EMAT诊断慢性心力衰竭的敏感性及特异性分别为96.1％、87.0％,对脑钠肽(BNP)处于灰区(100～400 ng/L)的慢性心力衰竭患者,EMAT诊断心力衰竭的敏感性及特异性分别为95.3％、72.4％.结论心音图参数EMAT、LVST、S3强度均有助于快速诊断心力衰竭,尤其EMAT诊断慢性心力衰竭的临床价值较血浆BNP更高.
목적 탐토심음도재만성심력쇠갈진단중적림상응용개치.방법 2012년3월지2013년9월입주절강대학의학원부속제이의원심내과적환자공243례,기중만성심력쇠갈조128례,대조조115례.이용심음도기술분별측정량조전-궤계격동시간(electromechanical activation time,EMAT)、좌심실수축시간(left ventricular systolic time,LVST)급제삼심음(S3)강도,비교량조평균EMAT、LVST급S3강도적차이,분석EMAT급S3재진단만성심력쇠갈중적민감성여특이성.결과 만성심력쇠갈조평균EMAT교대조조명현연장(121±17)ms대(88±15)ms,(P＜0.001),평균LVST명현축단(311±39)ms대(340±22) ms,(P＜0.05),S3강도명현증고(4.22±2.30대3.01±0.66,P＜0.05),만성심력쇠갈조S3존재솔32.0％,고우대조조11.3％ (P＜0.05).EMAT진단만성심력쇠갈적민감성급특이성분별위96.1％、87.0％,대뇌납태(BNP)처우회구(100～400 ng/L)적만성심력쇠갈환자,EMAT진단심력쇠갈적민감성급특이성분별위95.3％、72.4％.결론 심음도삼수EMAT、LVST、S3강도균유조우쾌속진단심력쇠갈,우기EMAT진단만성심력쇠갈적림상개치교혈장BNP경고.
Objective To investigate the diagnostic value of acoustic cardiography in patients with chronic systolic heart failure.Methods Between March 2012 and September 2013,243 patients from our department were enrolled in the study,including 128 patients with chronic heart failure and 115 patients with normal heart function.We measured and compared the acoustic cardiography parameters between the two groups including the electromechanical activation time (EMAT),left ventricular systolic time (LVST) and the S3 strength.And the sensitivity and specificity of these parameters were compared with serum brain natriuretic peptide (BNP) value in patients with chronic systolic heart failure.Results In chronic systolic heart failure group,EMAT was much longer than that in the control group (121 ± 17)ms vs.(88 ± 15)ms,(P＜ 0.001),LVST was obviously shortened (311 ± 39) ms vs.(340± 22) ms,(P＜ 0.05),the S3 strength was significantly increased (4.22±2.30 vs.3.01±0.66,P＜0.05) and the detection rate of the S3 was higher (32.0％ vs.11.3 ％,P＜0.05).Sensitivity and specificity of EMAT for chronic systolic heart failure were 96.1％ and 87.0％.Sensitivity and specificity of EMAT for BNP in patients with BNP value ranging from 100 to 400 ng/L were 95.3％ and 72.4％.Conclusions Acoustic cardiography parameters including EMAT,LVST and the S3 strength were efficient in diagnosis of chronic systolic heart failure.The diagnostic value of EMAT(≥ 90 ms) was much better than that of BNP in patients with BNP value ranging from 100 to 400 ng/L.