64-MDCT评价左心室舒张功能的的可行性

目的：参照心脏超声左心室舒张功能指标，探讨64-MDCT测量可疑冠心病患者左心室舒张功能的可行性。资料与方法：60例可疑冠心病患者，同期进行了二维超声心动图及冠状动脉CTA。所有入选者的MDCT原始数据在0～95％R-R间期、间隔5％重建后传至AW4．4工作站，利用相关软件结合人工方法测量左心室舒张功能。MDCT测量以二维超声为参照，计算二尖瓣口舒张早期、晚期峰值血流速度（E、A）、二尖瓣舒张早期最大组织运动速度（Ea）、左心室充盈压力（E／Ea）。所有cT心功能测量值与同期超声测量值进行对比分析。所有入选者中随机选择20名在初次CT心功能测量两周后由同一操作者对其进行再次测量，同时指定另一名医师对该亚组再次进行测量并与初次测量值进行比较。结果：cT和超声测定左心室舒张功能的相关性好，分别为E（r=0．82，P=0．000）、E／A（r=0．91，P=0．000）、Ea（r=0．82，P=0．000）、E／Ea（r=0．83，P=0．000）。Bland—Altman图显示两种方法对各参数的评价变异性低。随机选择的研究亚组cT评价E／A、Ea的观察者内、观察者间重复性好，Bland—Altman图显示E／A和Ea的变异均在95％一致性界限内。其相应的观察者内、观察者间相关系数分别为E／A（r=0．91，P=0．000：r=0．89，P=0．000）、Ea（r=0．87，P=0．000；r=0．84，P=0．000）。结论：64-MDCT回顾性心电门控冠状动脉成像的同时，可进行左心室舒张功能的定量评价。

Feasibility of 64-MDCT in Evaluating Left Ventricular Diastolic Function

Objective： to evaluate the feasibility of 64-MDCT measurement of left ventricle diastolic function in refer to echocardiography. Materials and methods： 60 patients with suspected coronary diseases, underwent echocardiography and 64-MDCT during the same period. All participants＇ raw data of MDCT were reconstructed with an interval of 5% in 0-95% R-R interval, and images were transferred to AW4.4 workstation. The left ventricular function parameters such as early （E） and late （A） trans-mitral peak velocity, peak mitral septal tissue velocity （Ea）, the estimation of LV filling pressure （E/Ea） were quantified with peculiar software. The CT-derived cardiac function parameters were analyzed and compared to that obtained from echocardiography. The randomly selected 20 cases as a subset were measured again by the same operator and another operator two weeks after their initial CT measurements. Results： Pearson correlation showed a good correlation for E （r = 0.82, P = 0.000）, E/A （r=0.91, P=0.000）, Ea （r=0.82, P=0.000）, E/Ea （r=0.83, P=0.000）. Bland-Altman plots for variability shows minimal bias between E, E/A, Ea, E/Ea. The Bland-Altman plots for intra- and inter-observer variability shows minimal bias between E/A and Ea measurements by CT. The corresponding coefficient were 0.91 and 0.89 for E/A （r = 0.91, P = 0.000; r = 0.89, P = 0.000）, 0.87 and 0.84 for Ea （r = 0.87, P = 0.000; r =0.84, P = 0.000）. Conclusion： Retrospective ECG gated 64-MDCT coronary imaging, can be employed for quantitative evaluation of left ventricular diastolic function.