ECToolbox软件4种公式计算左心室射血分数的比较分析

Comparison of the four formulas of software ECToolbox for the assessment of left ventricular ejection fraction with the equilibrium radionuclide ventriculography

    摘要
  • 摘要:
    目的 比较爱莫瑞心脏工具箱（ECToolbox）4种公式（R0、R1、R2、R3）计算心电图门控核素心肌灌注SPECT（G-MPS）左心室射血分数（LVEF）与平衡法核素心室造影（ERNV）所得结果的相关性和一致性，并判断4种公式所得结果的诊断阈值。
    方法 选取63例患者，其中，23例有心肌梗死病史，40例为可疑冠心病患者。同一患者在一周内完成99Tcm-MIBI静息态G-MPS和99Tcm-红细胞ERNV，用ECToolbox软件中的R0、R1、R2、R3公式分别计算LVEF，将计算结果与ERNV结果进行对比分析，并以后者所得的LVEF≥50%作为标准，通过受试者操作特征曲线判断R0~R3 4个公式的最佳诊断阈值。
    结果 ERNV得到的LVEF的平均值为55.41%±17.49%，R0~R3 4种公式得到的LVEF分别为63.75%±16.63%、55.87%±15.99%、69.22%±18.83%、56.32%±14.47%。4种公式所得结果与ERNV所得结果具有较强的相关性（r均 > 0.95，P均 < 0.01）；4种公式计算的LVEF平均值均高于ERNV的LVEF平均值，其中，R0和R2公式所得结果与ERNV结果的差异具有统计学意义（t=15.775和21.525，P均 < 0.01）；R1和R3公式所得结果与ERNV结果的差异无统计学意义（t=0.848和1.448，P > 0.05）。以ERNV的LVEF≥50%作为正常诊断值，R0~R3公式所得LVEF的最佳诊断阈值分别为56.5%、51.5%、64.5%和52.5%。
    结论 用于G-MPS的ECToolbox的4种公式与ERNV计算的LVEF具有较强的相关性，但LVEF平均值有差异，同一患者在随诊过程中应采用同一个公式进行计算，用于诊断心功能时，每个公式应选用不同的阈值。

     

    Abstract:
    Objective To compare the correlation and consistency of left ventricular ejection fraction(LVEF) obtained by electrocardiography gated myocardial perfusion SPECT(G-MPS) using the four formulas(R0-R3) in Emory cardiac toolbox(ECToolbox) software and by equilibrium radionuclide ventriculography(ERNV), and determine the optimal diagnostic thresholds of the four formulas.
    Methods Sixty-three patients, including 23 patients with a history of myocardial infarction and 40 patients with suspected coronary heart disease, underwent both 99Tcm-MIBI rest G-MPS and 99Tcm labeled red blood cell ERNV within a week. The LVEF values calculated by R0, R1, R2 and R3 formulas of ECToolbox were compared with those obtained by ERNV. Using LVEF≥50% obtained by ERNV as the gold standard, the optimal diagnostic thresholds of the four formulas (R0-R3) were assessed by receiver operating characteristic(ROC) curve.
    Results The mean LVEF of ERNV was 55.41%±17.49%. The mean LVEF values of the four formulas were 63.75%±16.63%, 55.87%±15.99%, 69.22%±18.83% and 56.32%±14.47%, respectively. On correlation analysis, a strong positive correlation was observed between LVEF values derived by ERNV and those derived by the four formulas(all r > 0.95, all P < 0.01). The differences of LVEF were statistically significant between ERNV and the two formulas R0 and R2(t=15.775 and 21.525, both P < 0.01), while between ERNV and the two formulas R1 and R3(t=0.848 and 1.448, both P > 0.05). Normal cutoff values for LVEF on R0, R1, R2, R3 were 56.5%, 51.5%, 64.5% and 52.5% respectively, using a 50% or more cutoff value on ERNV.
    Conclusions A strong correlation was observed among the four formulas of ECToolbox software programs when compared with ERNV. However, there are subtle differences in the objective values of LVEF generated by individual calculation methods, which must be taken into account for clinical studies.

     

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