使用3D超声心动图评估左心室结构和功能
Summary
在本文中，我们为通过3D超声心动图对左心室进行容量评估和斑点跟踪分析提供了分步采集和分析方案，特别关注最大化该技术可行性的实用方面。
Abstract
左心室 （LV） 的三维 （3D） 定量在诊断准确性和各种心脏疾病的精确风险分层方面提供了显著的附加值。最近，3D超声心动图在常规心脏病学实践中变得可用;然而，高质量的图像采集和后续分析具有陡峭的学习曲线。本文旨在通过提供提示和技巧以及强调潜在的陷阱来引导读者通过详细的3D协议，以促进有关LV的这一重要技术的广泛但技术上合理的使用。首先，我们展示了以最佳空间和时间分辨率获取的高质量3D数据集。然后，我们通过使用应用最广泛的内置软件之一，介绍了对LV进行详细定量的分析步骤。我们将通过测量射血分数和心肌变形（纵向和圆周应变）来量化左心室体积，球形度，质量和收缩功能。我们将讨论并提供临床示例，说明强烈建议从传统的超声心动图方法过渡到基于3D的定量的基本场景。
Introduction
评估左心室 （LV） 形态和功能是心脏病学中一般甚至更具体检查的主要目的1。广泛可用的无创经胸超声心动图（TTE）可以提供大量信息，是方便，快速且具有成本效益的评估的首选方法。
低压质量、容量和随后的射血分数的测量具有重要的诊断价值和预后价值2。给定的度量值越准确，其值就越高。与金标准心脏磁共振（CMR）成像衍生值更好的相关性是对超声心动图技术的持续追逐。通常，临床实践指南推荐双平面辛普森方法测量左心室体积和射血分数3。然而，左心室是一种三维（3D）结构，其形状通常不规则，因此，在某些临床场景中，几个断层扫描平面无疑无法准确描绘左心室形态和功能。超声波硬件和软件技术的最新进展允许实时3D成像的发展，这彻底改变了超声心动图方案。
此外，需要对壁运动异常进行定量方法，导致变形成像的兴起4。应变和应变速率参数可以通过使用标准灰度图像的斑点跟踪来计算。3D 超声心动图还可以克服二维应变评估的几个缺点5。从昂贵的科学工具，3D超声心动图开始成为日常临床实践中使用的一种强大技术，而LV的定量无疑是这一突破的第一线。
本文旨在通过提供提示和技巧以及强调潜在的陷阱来引导读者通过详细的3D协议，以促进有关LV的这一重要技术的广泛但技术上合理的使用。
Protocol
Representative Results
Discussion
左心室形态学和功能测量是心脏病诊断、管理和随访的基石。此外，它们是结果的强大预测因素。通常，现行实践指南建议对左心室进行基于二维超声心动图的评估。然而，3D超声心动图已被证明更准确，因为它没有关于LV形状的几何假设7，8。通过斑点跟踪进行变形成像是评估心肌应变不同方向的可靠方法，可以更灵敏地量化壁运动异常5<…
Disclosures
The authors have nothing to disclose.
Acknowledgements
项目编号NVKP_16-1-2016-0017（”国家心脏计划”）已在匈牙利国家研究，发展和创新基金的支持下实施，该基金由NVKP_16资助计划资助。该研究由匈牙利创新和技术部的专题卓越计划（2020-4.1.1.-TKP2020）资助，在塞梅尔威斯大学的治疗开发和生物成像主题计划的框架内。
Materials
| 3V-D/4V-D/4Vc-D | General Electric | n.a. | ultrasound probe |
| 4D Auto LVQ | General Electric | n.a. | software for analysis |
| E9/E95 | General Electric | n.a. | ultrasound machine |
| EchoPac v203 | General Electric | n.a. | software for analysis |
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