左心超声造影指标LVESV、LVEF、LVEDV与慢性心力衰竭患者心功能分级的关系及对抗心力衰竭疗效的评估价值

doi:10.3969/j.issn.1006-5725.2026.10.010

摘要/Abstract

摘要：

目的探讨左心超声造影指标左室收缩末期容积（LVESV）、左室射血分数（LVEF）、左室舒张末期容积（LVEDV）与慢性心力衰竭（CHF）患者心功能分级的关系及对抗心力衰竭（心衰）疗效的评估价值。方法选取2021年5月至2025年5月102例CHF患者，所有患者均行常规超声、左心超声造影检查，比较两种检查方式的心尖部图像质量、特殊结构检出情况。102例CHF患者根据纽约心脏协会（NYHA）心功能分级分为Ⅳ级组（n = 27）、Ⅲ级组（n = 40）及Ⅱ级组（n = 35），比较不同心功能分级CHF患者常规超声及左心超声造影检查下LVESV、LVEF、LVEDV，采用Spearman系数分析心功能分级与左心超声造影检查下LVESV、LVEF、LVEDV的关系。CHF患者均接受3个月的抗心衰治疗后复查左心超声造影，根据疗效情况分为无效组（n = 23）及有效组（n = 79），比较不同疗效CHF患者左心超声造影检查下治疗前后差值（Δ）LVESV、ΔLVEF、ΔLVEDV，采用ROC曲线分析左心超声造影对抗心衰疗效的评估价值。结果左心超声造影的心尖部图像质量优于常规超声（P < 0.05）；左心超声造影对心尖血栓、室壁瘤、肌小梁过度的检出率分别为8.82%、9.80%、14.71%高于常规超声的1.96%、3.00%、5.88%（P < 0.05）；左心超声造影检测的LVESV、LVEDV高于常规超声，LVEF低于常规超声（P < 0.05）；不同心功能分级CHF患者经常规超声与左心超声造影检测的LVESV、LVEF、LVEDV比较，差异均有统计学意义（P < 0.05），其中Ⅳ级组LVESV、LVEDV高于Ⅲ级组、Ⅱ级组，LVEF低于Ⅲ级组、Ⅱ级组（P < 0.05）；Ⅲ级组LVESV、LVEDV高于Ⅱ级组，LVEF低于Ⅱ级组（P < 0.05）；Spearman分析显示，CHF患者心功能分级与左心超声造影检查下LVEF呈负相关，与左心超声造影检查下LVESV、LVEDV呈正相关（P < 0.05）；治疗3个月后，有效组ΔLVESV、ΔLVEF、ΔLVEDV高于无效组（P < 0.05）；ROC曲线显示，ΔLVESV、ΔLVEF、ΔLVEDV评估CHF患者抗心衰疗效的曲线下面积（AUC）分别为0.720、0.976、0.696（P < 0.05）。结论左心超声造影可改善CHF患者心尖部图像质量，提高特殊结构检出率，其指标LVESV、LVEF、LVEDV与NYHA心功能分级密切相关，其中ΔLVEF对抗心衰疗效评估最优；本研究通过左心超声造影与常规超声对比及核心指标差值分析，为CHF精准分级及个体化治疗提供依据。

关键词: 心力衰竭, 常规超声, 左心超声造影, 诊断价值, 疗效评估

Abstract:

Objective To explore the relationship between left heart contrast echocardiography indexes， including left ventricular end - systolic volume （LVESV）， left ventricular ejection fraction （LVEF）， and left ventricular end-diastolic volume （LVEDV）， and the grading of cardiac function， as well as their evaluation value for the anti - heart failure effect in patients with chronic heart failure （CHF）. Methods A total of 102 patients with CHF were recruited between May 2021 and May 2025. All patients underwent routine ultrasound examination and left-heart contrast echocardiography. The quality of apical images and the detection of special structures obtained by the two examination methods were compared. Based on the cardiac function grading of the New York Heart Association （NYHA）， the patients were classified into three groups： Grade IV （n = 27）， Grade III （n = 40）， and Grade II （n = 35）. The LVESV， LVEF， and LVEDV measured by routine ultrasound and left - heart contrast echocardiography in these three groups were compared. The relationship between cardiac function grading and LVESV， LVEF， and LVEDV measured by left - heart contrast echocardiography was analyzed using the Spearman coefficient. After 3 months of anti-heart failure treatment， the CHF patients underwent left - heart contrast echocardiography again. According to the treatment efficacy， they were divided into an ineffective group （n = 23） and an effective group （n = 79）. The difference values of LVESV， LVEF， and LVEDV （ΔLVESV， ΔLVEF， ΔLVEDV） before and after treatment measured by left-heart contrast echocardiography in the two groups were compared. The evaluation value of left - heart contrast echocardiography in assessing the anti-heart failure effect was analyzed using receiver operating characteristic （ROC） curves. Results The quality of apical images obtained through left heart contrast echocardiography was superior to that obtained via routine ultrasound （P < 0.05）. The detection rates of apical thrombosis， ventricular aneurysm， and trabecular hyperplasia by left heart contrast echocardiography were 8.82%， 9.80%， and 14.71% respectively， which were higher than those by routine ultrasound （1.96%， 3.00%， 5.88%； P < 0.05）. The LVESV and LVEDV measured by left heart contrast echocardiography were higher than those measured by routine ultrasound， while the LVEF was lower than that measured by routine ultrasound （P < 0.05）. There were significant differences in LVESV， LVEF， and LVEDV measured by routine ultrasound and left heart contrast echocardiography among patients with different cardiac function grading （P < 0.05）. In the grade IV group， grade III group， and grade II group， LVESV and LVEDV gradually decreased， while LVEF gradually increased （P < 0.05）. Spearman analysis indicated that the cardiac function grading of patients with CHF was negatively correlated with LVEF and positively correlated with LVESV and LVEDV measured by left heart contrast echocardiography （P < 0.05）. After 3 months of treatment， the changes in LVESV （ΔLVESV）， LVEF （ΔLVEF）， and LVEDV （ΔLVEDV） in the effective group were higher than those in the ineffective group （P < 0.05）. ROC curve analysis showed that the area under the curve （AUC） values of ΔLVESV， ΔLVEF， and ΔLVEDV for evaluating the anti-heart failure effect were 0.720， 0.976， and 0.696 respectively （P < 0.05）. Conclusions Left heart contrast echocardiography can enhance the quality of apical images and elevate the detection rates of special structures in patients with CHF. The echocardiographic indexes （LVESV， LVEF， LVEDV） are closely associated with cardiac function grading， and ΔLVEF exhibits the best evaluation efficiency for the anti-heart failure effect. This study offers a basis for the accurate grading and individualized treatment of CHF by comparing left ventricular contrast echocardiography with routine ultrasound and analyzing the difference values of core indexes.

Key words: heart failure, routine ultrasound, left heart contrast echocardiography, diagnostic value, evaluation of curative effect

中图分类号:

R541.6

罗利红,邝献宝,谷红丽,李臻. 左心超声造影指标LVESV、LVEF、LVEDV与慢性心力衰竭患者心功能分级的关系及对抗心力衰竭疗效的评估价值[J]. 实用医学杂志, 2026, 42(10): 1762-1769.

Lihong LUO,Xianbao KUANG,Hongli GU,Zhen LI. The relationship between left heart contrast echocardiography indexes （LVESV， LVEF， LVEDV） and grading of cardiac function and their evaluation value for anti-heart failure effect in patients with chronic heart failure[J]. The Journal of Practical Medicine, 2026, 42(10): 1762-1769.

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参考文献 27

[1]	莫乔莹，朱芳一，祝存奎，等. 基于GNRI评分构建慢性心力衰竭患者营养不良风险的列线图模型［J］. 实用医学杂志， 2025， 41（5）：691-698. doi： 10.3969/j.issn.1006-5725.2025.05.011 . doi: 10.3969/j.issn.1006-5725.2025.05.011
[2]	ZHANG L， ONO Y， QIAO Q， et al. Trends in heart failure prevalence in Japan 2014-2019： A report from healthcare administration databases［J］. ESC Heart Fail， 2023， 10（3）：1996-2009. doi： 10.1002/ehf2.14321 . doi: 10.1002/ehf2.14321
[3]	NAGUEH S F， SANBORN D Y， OH J K， et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis： An Update From the American Society of Echocardiography［J］. J Am Soc Echocardiogr， 2025， 38（7）：537-569. doi： 10.1016/j.echo.2025.03.011 . doi: 10.1016/j.echo.2025.03.011
[4]	BECHER H， ALHUMAID W， WINDRAM J， et al. Contrast Echocardiography in Heart Failure： Update 2023［J］. Curr Heart Fail Rep， 2024， 21（2）：63-72. doi： 10.1007/s11897-024-00647-z . doi: 10.1007/s11897-024-00647-z
[5]	ZEB I， UQAILY R， GONUGUNTLA K， et al. Multimodality assessment of high- vs. low-gradient aortic stenosis using echocardiography and cardiac CT［J］. J Cardiovasc Comput Tomogr， 2023， 17（6）：421-428. doi： 10.1016/j.jcct.2023.09.002 . doi: 10.1016/j.jcct.2023.09.002
[6]	CHRISTA M， MÜNTZE J， LENGENFELDER B， et al. Contrast-enhanced ultrasound for non-invasive differential diagnosis of unclear left atrial mass［J］. Int J Cardiovasc Imaging， 2023， 39（11）：2173-2174. doi： 10.1007/s10554-023-02926-7 . doi: 10.1007/s10554-023-02926-7
[7]	ANSARI U， JANSSEN S， BAUMANN S， et al. Sparse 3D contrast-enhanced whole-heart imaging for coronary artery evaluation［J］. Herz， 2023， 48（1）：55-63. doi： 10.1007/s00059-021-05091-6 . doi: 10.1007/s00059-021-05091-6
[8]	中华医学会心血管病学分会，中国医师协会心血管内科医师分会，中国医师协会心力衰竭专业委员会，等. 中国心力衰竭诊断和治疗指南2024［J］. 中华心血管病杂志， 2024， 52（3）：235-275. doi： 10.3760/cma.j.cn112148-20231101-00405 . doi: 10.3760/cma.j.cn112148-20231101-00405
[9]	朱天刚，靳文英，张梅，等. 心脏超声增强剂临床应用规范专家共识［J］. 中华医学超声杂志（电子版）， 2019， 16（10）：731-734. doi： 10.3877/cma.j.issn.1672-6448.2019.10.004 . doi: 10.3877/cma.j.issn.1672-6448.2019.10.004
[10]	SCHOU M， PETRIE M C， BORLAUG B A， et al. Semaglutide and NYHA Functional Class in Obesity-Related Heart Failure With Preserved Ejection Fraction： The STEP-HFpEF Program［J］. J Am Coll Cardiol， 2024， 84（3）：247-257. doi： 10.1016/j.jacc.2024.04.038 . doi: 10.1016/j.jacc.2024.04.038
[11]	LI T， JIANG Y L， KANG J， et al. Prevalence and risk factors of frailty in older patients with chronic heart failure： a systematic review and meta-analysis［J］. Aging Clin Exp Res， 2023， 35（12）：2861-2871. doi： 10.1007/s40520-023-02587-5 . doi: 10.1007/s40520-023-02587-5
[12]	SAVARESE G， BECHER P M， LUND L H， et al. Global burden of heart failure： a comprehensive and updated review of epidemiology［J］. Cardiovasc Res， 2023， 118（17）：3272-3287. doi： 10.1093/cvr/cvac013 . doi: 10.1093/cvr/cvac013
[13]	OBOKATA M， SORIMACHI H， HARADA T， et al. Epidemiology， Pathophysiology， Diagnosis， and Therapy of Heart Failure With Preserved Ejection Fraction in Japan［J］. J Card Fail， 2023， 29（3）：375-388. doi： 10.1016/j.cardfail.2022.09.018 . doi: 10.1016/j.cardfail.2022.09.018
[14]	WU B， YANG Y， ZHAO P. Application of Routine Echocardiography Combined with Contrast-Enhanced Echocardiography in the Diagnosis of Endomyocardial Fibrosis［J］. Discov Med， 2023， 35（179）：1052-1063. doi： 10.24976/Discov.Med.202335179.101 . doi: 10.24976/Discov.Med.202335179.101
[15]	ZHANG M， CHEN X， YANG F， et al. Evaluation of Left Ventricular Mass in Different Cardiac Geometry Using Three-Dimensional Contrast-Enhanced Echocardiography［J］. Int Heart J， 2023， 64（5）：885-893. doi： 10.1536/ihj.22-663 . doi: 10.1536/ihj.22-663
[16]	LEE K C， LIU S， CALLAHAN P， et al. Routine Use of Contrast on Admission Transthoracic Echocardiography for Heart Failure Reduces the Rate of Repeat Echocardiography during Index Admission［J］. J Am Soc Echocardiogr， 2021， 34（12）：1253-1261. doi： 10.1016/j.echo.2021.07.008 . doi: 10.1016/j.echo.2021.07.008
[17]	GUI H Y， LIU S W， ZHU D F. Interaction between the left ventricular ejection fraction and left ventricular strain and its relationship with coronary stenosis［J］. World J Clin Cases， 2023， 11（10）：2246-2253. doi： 10.12998/wjcc.v11.i10.2246 . doi: 10.12998/wjcc.v11.i10.2246
[18]	CHIORESCU R M， LAZAR R D， RUDA A， et al. Current Insights and Future Directions in the Treatment of Heart Failure with Preserved Ejection Fraction［J］. Int J Mol Sci， 2023， 25（1）：440. doi： 10.3390/ijms25010440 . doi: 10.3390/ijms25010440
[19]	SCHMIDT A F， FINAN C， VAN SETTEN J， et al. A Mendelian randomization analysis of cardiac MRI measurements as surrogate outcomes for heart failure and atrial fibrillation［J］. Commun Med （Lond）， 2025， 5（1）：130. doi： 10.1038/s43856-025-00855-1 . doi: 10.1038/s43856-025-00855-1
[20]	ZHANG Y， LI S Y， LU T T， et al. Volume and function changes of left atrium and left ventricle in patients with ejection fraction preserved heart failure measured by a three dimensional dynamic heart model［J］. Int J Cardiovasc Imaging， 2024， 40（3）：509-516. doi： 10.1007/s10554-023-03018-2 . doi: 10.1007/s10554-023-03018-2
[21]	METRA M， TOMASONI D， ADAMO M， et al. Worsening of chronic heart failure： Definition， epidemiology， management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology［J］. Eur J Heart Fail， 2023， 25（6）：776-791. doi： 10.1002/ejhf.2874 . doi: 10.1002/ejhf.2874
[22]	ZHANG X， WANG N， FU P， et al. Dapagliflozin Attenuates Heart Failure With Preserved Ejection Fraction Remodeling and Dysfunction by Elevating β-Hydroxybutyrate-activated Citrate Synthase［J］. J Cardiovasc Pharmacol， 2023， 82（5）：375-388. doi： 10.1097/FJC.0000000000001474 . doi: 10.1097/FJC.0000000000001474
[23]	YANG H R， XU X D， SHAIKH A S， et al. Efficacy and Safety of Sacubitril/Valsartan Compared With ACEI/ARB on Health-Related Quality of Life in Heart Failure Patients： A Meta-Analysis［J］. Ann Pharmacother， 2023， 57（8）：907-917. doi： 10.1177/10600280221140575 . doi: 10.1177/10600280221140575
[24]	CHATUR S， BELDHUIS I E， CLAGGETT B L， et al. Sacubitril/Valsartan in Patients With Heart Failure and Deterioration in eGFR to <30 mL/min/1.73 m² ［J］. JACC Heart Fail， 2024， 12（10）：1692-1703. doi： 10.1016/j.jchf.2024.03.014 . doi: 10.1016/j.jchf.2024.03.014
[25]	HUANG C W， YU A S， ZHOU H， et al. Comparative Effectiveness of Bisoprolol， Carvedilol， and Metoprolol Succinate in Patients with Heart Failure and CKD［J］. Clin J Am Soc Nephrol， 2025， 20（1）：136-138. doi： 10.2215/CJN.0000000000000562 . doi: 10.2215/CJN.0000000000000562
[26]	ELSHAHAT A， ABDELAZIZ A， MANSOUR A， et al. Eplerenone vs Spironolactone and Cardiac Remodeling in Heart Failure With Reduced Ejection Fraction： A Meta-Analysis［J］. Mayo Clin Proc， 2025， 100（3）：572-576. doi： 10.1016/j.mayocp.2024.11.009 . doi: 10.1016/j.mayocp.2024.11.009
[27]	CHATUR S， VADUGANATHAN M， CLAGGETT B L， et al. Dapagliflozin in Patients With Heart Failure and Deterioration in Renal Function［J］. J Am Coll Cardiol， 2023， 82（19）：1854-1863. doi： 10.1016/j.jacc.2023.08.026 . doi: 10.1016/j.jacc.2023.08.026

指标	常规超声	左心超声造影	Z/χ² /t值	P值
心尖部图像质量			6.912	< 0.001
1分	14（13.73）	0（0.00）
2分	24（23.53）	2（1.96）
3分	28（27.45）	14（13.73）
4分	20（19.60）	47（46.07）
5分	16（15.69）	39（38.24）
特殊结构检出
心尖血栓	2（1.96）	9（8.82）	4.708	0.030
室壁瘤	3（2.94）	10（9.80）	3.954	0.047
肌小梁过度	6（5.88）	15（14.71）	4.300	0.038
心尖肥厚	1（0.98）	5（4.90）	2.747	0.097
左心功能指标
LVESV（x ± s）/mL	51.13 ± 12.24	54.56 ± 14.59	5.304	< 0.001
LVEF（x ± s）/%	46.89 ± 6.25	45.75 ± 5.26	2.775	0.007
LVEDV（x ± s）/mL	95.18 ± 13.96	98.98 ± 18.30	4.590	< 0.001

组别	例数	常规超声LVESV/mL	造影LVESV/mL	常规超声LVEF/%	造影LVEF/%	常规超声LVEDV/mL	造影LVEDV/mL
Ⅳ级组	27	64.70 ± 8.29^*#	67.67 ± 10.46^*#	41.66 ± 4.86^*#	41.48 ± 2.98^*#	110.78 ± 9.67^*#	115.26 ± 13.40^*#
Ⅲ级组	40	51.33 ± 8.49^*	55.08 ± 11.98^*	45.98 ± 4.76^*	44.98 ± 3.76^*	94.63 ± 9.63^*	99.05 ± 15.50^*
Ⅱ级组	35	40.43 ± 6.73	43.86 ± 11.40	51.89 ± 4.85	49.91 ± 5.11	83.77 ± 8.60	86.34 ± 14.40
F值		72.420	33.339	35.550	33.315	64.410	29.904
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	ΔLVESV/mL	ΔLVEF/%	ΔLVEDV/mL
有效组	79	9.38 ± 2.86	6.03 ± 1.38	7.73 ± 2.46
无效组	23	7.41 ± 1.98	3.57 ± 0.73	6.18 ± 1.70
t值		3.100	8.219	2.824
P值		0.003	< 0.001	0.006

指标	截断值	AUC	95%CI	P值	敏感度/%	特异度/%
ΔLVESV	8.66 mL	0.720	0.611 ～ 0.828	0.001	57.00	82.61
ΔLVEF	4.51%	0.976	0.927 ～ 1.000	< 0.001	100.00	95.65
ΔLVEDV	6.90 mL	0.696	0.580 ～ 0.811	0.004	69.62	65.22