二维斑点追踪超声心动图评估COPD患者右心衰竭严重程度的效能OA

Objective To evaluate the diagnostic efficacy of two-dimensional speckle tracking echocardiography(2D-STI)in assessing the severity of right heart failure in patients with chronic obstructive pulmonary disease(COPD).Methods A retrospective study was conducted on 100 COPD patients who were hospitalized in Jinhua People's Hospital from August 2023 to August 2024.According to the percentage of forced expiratory volume in the first second to predicted value(FEV1％pred)detected by pulmonary function test on admission,the patients were divided into the mild group(FEV1％pred≥80％,n=48)and the moderate-to-severe group(30％≤FEV1％pred＜80％,n=52).Color Doppler echocardiography was used to detect the right ventricular end-diastolic diameter(RVEDd),right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic diameter(RVESd)and right ventricular end-systolic volume(RVESV)of the patients.Right ventricular ejection fraction(RVEF)was measured by 2D-STI and cardiac magnetic resonance(CMR)respectively,and right ventricular global longitudinal strain(RVGLS)and right ventricular free wall strain(RVFWS)were obtained by 2D-STI at the same time.The detection repeatability of RVGLS and RVFWS was further analyzed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of RVGLS,RVFWS and RVEF for the severity of the right heart failure in COPD patients.Results The levels of RVEDd,RVEDV,RVESd and RVESV in the moderate-to-severe group were significantly higher than those in the mild group(all P＜0.01).The intra-observer and inter-observer intraclass correlation coefficients(ICC)of RVGLS detected by 2D-STI were 0.863[95％confidence interval(CI):0.812-0.900)and 0.847(95％CI:0.807-0.912),respectively;the intra-observer and inter-observer ICC of RVFWS were 0.896(95％CI:0.840-0.923)and 0.810(95％CI:0.800-0.850),respectively.The ICC of RVEF measured by the two methods was both higher than 0.80 in intra-observer and inter-observer tests,indicating good repeatability of 2D-STI.The areas under the ROC curve(AUC)of RVGLS,RVFWS and RVEF for evaluating the severity of right heart failure in COPD patients were 0.891,0.811 and 0.805,respectively,with the optimal cut-off values of 15.53％,16.20％and 43.67％accordingly.Conclusion 2D-STI can accurately and quantitatively assess the severity of right heart failure in patients with COPD.The levels of RVGLS and RVFWS in these patients show a significant decrease as the severity of right heart failure increases.The results of this technique in detecting RVEF have good consistency with CMR,and the detection repeatability is excellent.It can provide a reliable quantitative tool for clinical assessment of the severity of right heart failure in COPD patients,and is worthy of promotion and application.