| 左明良,尹立雪,李春梅,邓燕,罗玲,谭今.三维超声评估感染性心内膜炎栓塞事件及住院死亡的危险特征[J].中国医学影像技术,2017,33(6):884~888 |
| 三维超声评估感染性心内膜炎栓塞事件及住院死亡的危险特征 |
| 3D echocardiographic characteristic of embolism and in-hospital mortality in patients with infective endocarditis |
| 投稿时间：2016-09-26 修订日期：2017-04-12 |
| DOI：10.13929/j.1003-3289.201609120 |
| 中文关键词: 心内膜炎 超声心动描记术 栓塞 |
| 英文关键词:Endocarditis Echocardiography Embolisms |
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| 中文摘要: |
| 目的 采用三维经食管超声心动图评估感染性心内膜炎栓塞及住院死亡的超声特征。方法 回顾性收集124例自体瓣膜感染性心内膜炎患者，分析其经胸二维超声、多平面和三维经食管超声特征。将手术前或后1个月内栓塞和死亡作为主要终点事件。将大赘生物、脓肿或瘘、腱索断裂、中重度瓣膜反流和瓣膜穿孔或严重瓣膜破坏各计1分，进行简单积分，对心脏受损累计简单积分、赘生物大小、瓣膜受损严重并失去正常形态结构采用Hosmer和ROC曲线下面积评估栓塞和不良事件。结果 124例患者中，27例（27/124，21.77%）患者发生栓塞。与二维经胸超声心动图比较，多平面和三维经食管超声心动图可识别赘生物的确切位置及其长度，而二维经胸超声心动图漏诊左心房和乳头肌赘生物。栓塞及不良事件患者血红蛋白显著低于非栓塞及不良事件患者（P<0.05）。栓塞及不良事件患者多部位赘生物形成、赘生物活动度和瓣膜严重受损并失去正常形态构成比均高于非栓塞及不良事件患者（P均<0.05）。感染性心内膜炎心脏受损累计简单积分、赘生物大小、瓣膜严重受损并失去正常形态结构曲线下面积分别为0.65（P=0.06）、0.60（P=0.19）、0.70（P=0.03）。结论 多平面及三维经食管超声对感染性心内膜炎，尤其位于不常见位置的赘生物诊断起重要作用。瓣膜严重受损并失去正常形态者与栓塞及不良事件有关。 |
| 英文摘要: |
| Objective To assess the echocardiographic characteristics of embolism and in-hospital mortality in patients with infective endocarditis using three-dimensional transesophageal echocardiography (3D TEE). Methods Retrospective review of 124 patients with native valve infective endocarditis was performed to examine its characteristics by two-dimensional transthoracic echocardiography (2D TTE), multi-plane and 3D TEE. The primary endpoint was embolism and mortality that occurred within one month before or after operation. The combined simple score was calculated by assigning 1 point each for the presence of large vegetation, abscess or fistula, rupture of valvular chord, moderated or severe valvular regurgitation and perforation or serious valvular destruction. Hosmer and area under the curve was calculated to predict embolism and adverse events with the combined simple score, length of vegetation, serious valvular destruction with abnormal morphology. Results In 124 patients, embolic events occured in 27 cases (27/124, 21.77%). Multi-plane and 3D TEE can identify the exact location and length of vegetation compared with 2D TTE, which miss-diagnosed vegetation in left atrium and papillary muscle. The clinical presentation of embolism patients was remarkable for lower hemoglobin level (P<0.05). The ratio of multi-located vegetation, mortality and serious valvular destruction with abnormal morphology were higher in embolism and adverse events patients than those in non-embolism and adverse events patients (all P<0.05). The area under the curve of combined simple score, lengh of vegetation for embolisms and adverse events and serious valve destruction with abnormal morphology for embolism and adverse events were 0.65 (P=0.06), 0.60 (P=0.19)) and 0.70 (P=0.03). Conclusion Multi-plan and 3D TEE plays a key role in the diagnosis of patients with infecitive endocarditis, especially vegetations in occasional location. Serious valve destruction with abnormal morphology is associated with embolism and adverse events. |
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