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摘要: 目的 探索超声心动图、心血管计算机断层扫描(CT)、心脏磁共振(CMR)多模态影像技术对儿童心力衰竭的综合评估方法。方法 回顾性分析2022年1月至今在我院住院诊治的不同病因学导致的儿童心力衰竭病人的超声及影像学资料165例。全部患者均规范进行了二维及三维超声心动图检查，完成脱机定量分析。根据心衰病因学诊断的需要，选择心血管断层扫描(CT)检查及心脏核磁(CMR)检查进一步明确病因并分析心脏功能。对比不同检查手段对心功能评价的一致性。总结3种影像学检查方法的主要功能及优劣势，探索多模态影像评价儿童心力衰竭的方法。结果 165例心力衰竭儿童病例入组，男性60.0%，平均年龄73.2(11.5，132)个月。其中左心衰竭为主115例，右心衰竭为主50例。心衰病因主要包括先天性心脏病105例(63.6%)和心肌病60例(36.4%)。ROSS/NYHA心功能分级Ⅱ级38.2%，Ⅲ级41.2%，Ⅳ级20.6%。共73例完成CT检查，其中20.5%通过CT检查补充了心力衰竭病因学诊断。50例完成CMR检查，12例明确了病因学诊断。3D超声评估心功能指标与CMR结果显著相关，包括LVEDV，r=0.914；LVEF，r=0.871；RVEDV，r=0.892；RVEF，r=0.834；均P < 0.05。结论 无创多模态影像学可以提高超声心动图对儿童心力衰竭的病因学诊断率。超声心动图与CMR对左、右心功能的评价结果显著相关。Abstract: Objective To explore the comprehensive evaluation method of echocardiography, cardiovascular computed tomography(CT) and cardiac magnetic resonance(CMR) in children with heart failure.Methods A retrospective analysis was conducted on 165 cases of pediatric heart failure due to various etiologies, admitted and treated at our hospital from January 2022 to the present. All patients underwent standardized two-dimensional and three-dimensional echocardiography with offline quantitative analysis. Due to the necessity of heart failure etiology for further diagnosis, cardiovascular computed tomography(CT) and cardiac magnetic resonance(CMR) imaging were recommended for finding the underlying causes and evaluating the cardiac function. The results of different imaging modalities in evaluating cardiac function were compared. The main functions, advantages, and disadvantages of the three imaging modalities were summarized, and a method for comprehensive evaluation of pediatric heart failure using multimodal imaging was explored.Results A total of 165 cases of pediatric heart failure were included, with 60.0% being male and an average age of 73.2(11.5, 132) months. Among them, 115 cases were presented predominantly with left heart failure while 50 cases were presented with predominantly right heart failure. The main causes of heart failure included congenital heart disease in 105 cases(63.6%) and cardiomyopathy in 60 cases(36.4%). The distribution of ROSS/NYHA functional classification was as follows: class Ⅱ, 38.2%; class Ⅲ, 41.2%; and class Ⅳ, 20.6%. A total of 73 cases underwent CT examination, with 20.5% of them providing additional diagnostic information regarding the etiology of heart failure. Fifty cases underwent CMR examination, resulting in a definitive diagnosis in 12 cases. Three-dimensional echocardiography-derived indices of cardiac function were significantly correlated with CMR results, including LVEDV, r=0.914; LVEF, r=0.871; RVEDV, r=0.892; RVEF, r=0.834; all P < 0.05.Conclusion Non-invasive multimodal imaging can increase the diagnostic rate of echocardiography for the etiology of pediatric heart failure. There is a significant correlation between echocardiography and CMR in the assessment of left and right ventricular function.
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Key words:
- pediatric heart failure /
- echocardiography /
- magnetic resonance imaging /
- computed tomography /
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表 1 入组患儿基线资料
Table 1. General data
X±S, M(P25, P75), 例(%) 参数 总病例(165例) 左心衰竭组(115例) 右心衰竭组(50例) P 年龄/月 73.2(11.5，132.0) 65.6(9.0，120.0) 90.6(39.3，144.0) 0.01 男性/% 56.9 60.0 50.0 Ross/NYHA分级 Ⅱ 63(38.2) 32(27.8) 31(62.0) Ⅲ 68(41.2) 48(41.7) 20(40.0) Ⅳ 34(20.6) 29(25.2) 5(10.0) 身高/cm 117.5(89.5，146.0) 65.6(73，145) 133.8(117.0，151.3) 0.00 体重/kg 25.9(11.4，37.9) 22.61(8.4，35.7) 33.4(19.9，50.2) 0.00 BSA/m2 0.9±0.4 16.2±0.4 1.1±0.3 0.00 SBP/mmHg 96.3±1.0 0.8±10.1 99.6±9.0 0.00 DBP/mmHg 57.1±9.3 94.9±8.9 58.5±10.0 0.20 心率/(次/min) 109.0±21.2 56.5±22.6 100.9±14.9 0.00 病因学诊断 先天性心脏病 105(63.6) 63(54.8) 42(84.0) 心肌病 60(36.4) 52(45.2) 8(16.0) 二维超声心动图 LAD/mm 28.8±12.5 30.5±13.7 24.6±7.5 0.01 LVEDD/mm 42.8±15.0 44.9±16.1 38.1±10.5 0.01 LVESD/mm 31.2(20.0，38.3) 33.6(21.0，41.5) 25.6(19.5，28.5) 0.00 LVEF/% 54.4(31.3，70.8) 51.7(30.0，69.0) 60.6(54.0，73.0) 0.04 TRv/(m/s) 3.9(2.3，3.7) 4.1(2.4，3.4) 3.4(2.3，4.7) 0.56 TDIse′ 7.8(5.5，10.0) 9.1(7.0，10.3) 7.6(6.1，9.3) 0.15 TDIle′ 10.9(6.7，14.0) 10.5(6.6，13.5) 11.7(9.5，14.3) 0.06 E/e′ 11.4(8.1，13.4) 12.4(8.9，15.4) 8.8(7.0，14.5) 0.00 TAPSE/mm 15.7(10.0，20.0) 17.8(16.0，20.0) 11.0(10.0，12.0) 0.02 CT检查 73(44.2) 37(32.2) 36(72.0) CMR检查 50(30.3) 38(33.0) 12(24.0) LVEDV-MRI/mL 148.2(58.9，239.6) 162.9(59.0，263.5) 109.5(56.7，139.5) 0.00 LVEF-MRI/% 39.5(24.5，56.5) 36.1(23.8，49.5) 48.8(40.3，60.5) 0.01 RVEDV-MRI/mL 114.6(60.2，139.0) 86.7(45.0，112.2) 149.4(94.0，182.6) 0.02 RVEF-MRI/% 37.1(27.0，46.7) 32.5(26.5，36.6) 43.4(26.3，52.3) 0.00 
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表 2 三维超声心动图与CMR对心功能评估的相关性
Table 2. Three-dimensional echocardiography and CMR assessment of cardiac function
M(P25, P75) 参数 三维超声 CMR r P LVEDV/mL 111.8(46.5，152.2) 148.4(58.9，230.7) 0.914 0.00 LVEF/% 38.1(24.6，50.2) 40.0(25.2，57.5) 0.871 0.00 RVEDV/mL 86.1(38.1，124.5) 112.1(62.6，138.0) 0.892 0.00 RVEF/% 34.5(24.7，41.5) 34.1(26.7，40.9) 0.834 0.00
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