Clinical Investigation on Foure-dimensional Left Atrial Automatic Quantitative Technology in Evaluating Left Atrial Volume and Function
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摘要:
目的 探讨四维左心房自动定量（4D Auto LAQ）技术对非选择性连续患者左心房的容积及功能的应用价值。 方法 187例入选患者中成功分析143例患者。应用4D Auto LAQ 技术及Simpson’s双平面技术分别获取左房整体射血分数（LAEF）、左房最大容积指数（LAVImax）、左心房舒张末期容积（LAVmax）、左心房收缩末期容积（LAVmin），同时记录分析时间，比较2种技术所测参数的准确性及可重复性。 结果 4D Auto LAQ 技术及Simpson’s双平面技术所测值相关性高（r值：LAVmax 0.91，LAVmin 0.89，LAVI0.90，LAEF 0.54；P < 0.01）、一致性较好[平均测量差异：LAVmax1 0.1 mL，LAVmin 3.1 mL，LAVI 6.4 mL，LAEF 10.0%；一致性区间：LAVmax（-30.7-50.9） mL，LAVmin（-32.2-38.4） mL，LAVI（-21.2-34.1） mL，LAEF（-19.8-39.8）%]。4D Auto LAQ 技术对不同心动周期各测量值相关性好（r值：LAVmax 0.99，LAVmin 0.98，LAVImax 0.99，LAEF 0.92；P < 0.01），一致性区间为[LAVmax（-8.9-7.9） mL，LAVmin（-7.9-10.8） mL，LAVI（-7.9-10.8） mL/m2，LAEF（-14.8-9.1）%]。4D Auto LAQ 技术各测量值在观察者内部、观察者间的重复性均较好（组内相关系数均 > 0.8，变异系数均 < 10%），且优于Simpson’s双平面法。4D Auto LAQ 技术技术用时较Simpson’s双平面法明显减少，分别为（30.87±5.05） s、（60.20±5.05） s，（P < 0.05）。 结论 4D Auto LAQ 技术评价左心房容积及功能用时更短，重复性好，具有临床推广价值。 -
关键词:
- 四维左心房自动定量分析 /
- Simpson’s法 /
- 左心房功能 /
- 左心房容积
Abstract:Objective To explore the role of four-dimensional left atrial automatic quantitative technology in evaluating the volume and function of the left atrium in non-selective continuous patients, and to preliminarily explore its accuracy and repeatability. Methods Foure-dimensional left atrial full-volume dynamic images of 187 consecutive patients were collected, 44 patients who failed the analysis were excluded, and 143 were successfully analyzed. Using Simpson’s biplane method as the reference standard, the 4D Auto LAQ technology was used to evaluate the left atrial end-diastolic volume （LAVmax）, left atrial end-systolic volume （LAVmin）, left atrial maximum volume index （LAVImax）, and left atrial global ejection fraction. （LAEF） accuracy and repeatability. Results In all patients who were successfully analyzed, the inter-technique comparisons showed good correlations （R-values: LAVmax 0.91, LAVmin 0.89, LAVI 0.90, LAEF 0.54; all P < 0.01）, small biases （ LAVmax 10.1 mL, LAVmin 3.1 mL, LAVI 6.4 mL, LAEF 10.0%; Concordance interval: LAVmax （-30.7-50.9） mL, LAVmin （-32.2-38.4） mL, LAVI （-21.2-34.1） mL, LAEF （-19.8-39.8）%] for all measurements in all patients. 4D Auto LAQ technology showed good correlation between the parameters of different cardiac cycles （r value: LAVmax 0.99, LAVmin 0.98, LAVImax 0.99, LAEF 0.92; all P < 0.01）, and the average measurement difference did not exceed two measurement units （1 mL/volume, 1%/LAEF）, the consistency interval is also narrow [LAVmax （-8.9-7.9） mL, LAVmin （-7.9-10.8） mL, LAVI （-7.9-10.8） mL/m2, LAEF （-14.8-9.1）%. The intra- and inter-observer repeatability of each parameter of 4D Auto LAQ technology was good （within-group correlation coefficients were all > 0.8, 0.81-0.99, and coefficients of variation were all < 10%）, and it was better than Simpson’s biplane method. Compared with Simpson’s biplane method, the time of 4D Auto LAQ quantitative technology was significantly reduced, which were （30.87±5.05）s and （60.20±5.05）s respectively （P < 0.05）. Conclusions Since4D Auto LAQ technology can be widely used in clinical practice as a feasible and objective ultrasound technique. -
图 1 四维左心房自动定量分析（4D Auto LAQ）技术所获得的左心房容积及功能结果及左心房三维模型图
Figure 1. Left atrial volume and function results obtained by 4D Auto LAQ technology，as well as three-dimensional model of the left atrium
图 2 所有患者与Simpson’s双平面法法测值的相关性及Bland-Altman一致性检验
A、B：LAVmax；C、D：LAVmin ；E、F：LAVI；G、H：LAEF。
Figure 2. Correlation and Bland Altman consistency test between all patients and Simpson’s biplane method measurements
表 1 4D Auto LAQ技术与Simpson’s双平面法各参数的相关性和一致性分析（
$\bar x \pm s $ ）Table 1. Comparison，correlation and consistency analysis of parameters between 4D Auto LAQ technology and Simpson’s biplane method （
$\bar x \pm s $ ）变量 n 4D Auto LAQ技术 Simpson’s法 r P 平均测量差异 一致性区间 LAVmax（mL） 全部 150 56.86 ± 31.4 66.99 ± 44.4 0.91 < 0.0001* 10.1 −30.7-50.9 左房正常组 56 30.91 ± 7.0 32.43 ± 7.2 0.58 < 0.0001* 4.3 −11.7-20.4 左房扩大组 94 76.45 ± 33.73 99.11 ± 43.47 0.87 < 0.0001* 22.7 −19.6-64.9 LAVmin（mL） 全部 150 36.49 ± 24.27 39.63 ± 35.86 0.89 < 0.0001* 3.1 −32.2-38.4 左房正常组 56 15.07 ± 4.9 13.26 ± 4.2 0.51 < 0.0001* −1.8 −11.0-7.4 左房扩大组 94 53.51 ± 23.82 64.65 ± 37.17 0.81 < 0.0001* 11.1 −33.2-55.5 LAVImax（mL/m2） 全部 150 37.69 ± 20.57 44.14 ± 29.59 0.90 < 0.0001* 6.4 −21.2-34.1 左房正常组 56 21.86 ± 5.09 20.90 ± 4.18 0.72 < 0.0001* −1.0 −7.9-6.0 左房扩大组 96 46.86 ± 20.50 60.03 ± 26.12 0.88 < 0.0001* 13.2 −12.0-38.4 LAEF（%） 全部 150 37.99 ± 14.7 48.00 ± 16.72 0.54 < 0.0001* 10.0 −19.8-39.8 左房正常组 56 43.56 ± 14.69 62.61 ± 11.05 0.51 < 0.0001* 17.1 −6.7-40.9 左房扩大组 94 30.75 ± 11.67 37.61 ± 13.77 0.52 < 0.0001* 6.9 −18.4-32.2 LAVmax：左房最大容积；LAVmin：左最小容积；LAVImax：左房最大容积指数；LVEF：左房整体射血分数。*P < 0.05。 
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表 2 4D Auto LAQ 技术技术不同心动周期各参数相关性及一致性分析（
$\bar x \pm s $ ）Table 2. Correlation and consistency analysis of various parameters of 4D Auto LAQ technology in different Cardiac cycle （
$\bar x \pm s $ ）变量 心动周期1 心动周期2 r P 平均测量差异 一致性区间 LAVmax（mL） 56.25 ± 30.4 56.77 ± 28.7 0.99 < 0.0001* −0.5 −8.9-7.9 LAVmin（mL） 35.56 ± 23.7 34.09 ± 21.6 0.98 < 0.0001* 1.5 −7.9-10.8 LAVIma（mL/m2） 37.89 ± 20.4 37.15 ± 19.7 0.99 < 0.0001* 0.7 −4.7-5.6 LAEF（%） 39.9 ± 14.8 42.8 ± 14.9 0.92 < 0.0001* −0.29 −14.8-9.1 *P < 0.05。
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表 3 自动定量技术与Simpson’s双平面法重复性检验（
$\bar x \pm s $ ）Table 3. Automatic quantitative technology and Simpson’s biplane method for repeatability testing （
$\bar x \pm s $ ）变量 观察者内 观察者间 变异（%） 组内相关系数 变异（%） 组内相关系数 4D Auto LAQ技术 LAVmax 3.99 ± 5.2 0.99 8.81 ± 6.7 0.93 LAVmin 6.63 ± 5.7 0.96 11.2 ± 5.6 0.93 LAVImax 4.32 ± 5.1 0.98 9.26 ± 7.2 0.94 LAEF 6.50 ± 4.2 0.84 8.5 ± 9.2 0.81 Simpson’s法 EDV 9.1 ± 3.9 0.94 11.5 ± 8.9 0.86 ESV 13.66 ± 7.9 0.85 14.36 ± 9.5 0.83 LAVImax 8.3 ± 5.8 0.90 10.2 ± 5.7 0.86 EF 10.5 ± 7.4 0.71 13.6 ± 7.8 0.58
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