二维斑点追踪成像评价心脏淀粉样变性与肥厚型心肌病左心室内膜下及外膜下心肌应变比较  

Speckle Tracking Imaging in Assessing Left Ventricular Endocardial and Epicardial Myocardial Strain of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

作　　者：张晶[1] 詹莹[1] 任卫东[1] 郑松[2] 刘爽[3] 潘福治[1] 

机构地区：[1]中国医科大学附属盛京医院超声科,辽宁沈阳110004 [2]中国医科大学附属第一医院皮肤科,辽宁沈阳110001 [3]中国医科大学附属第一医院心功能科,辽宁沈阳110001

出　　处：《中国医学影像学杂志》2014年第1期36-40,44,共6页Chinese Journal of Medical Imaging

基　　金：辽宁省科学技术计划项目(2011225015)

摘　　要：目的探讨斑点追踪成像评价心脏淀粉样变性(CA)与肥厚型心肌病(HCM)患者左心室内膜下和外膜下心肌收缩功能的价值。资料与方法 25例CA患者、20例HCM患者及27例健康志愿者分别行超声心动图检查,应用Qlab 8.1软件测量左心室各节段内膜下、外膜下及平面整体心肌收缩期纵向应变峰值(LS),计算左心室整体内膜下、外膜下及平面整体心肌LS;HCM组心肌节段分为HCM非肥厚节段组和HCM肥厚节段组,比较CA组与HCM肥厚节段组心肌各应变指标的差异,并比较相应指标的诊断效能。结果①与对照组比较,CA组及HCM组各水平及左心室整体内膜下、外膜下、平面整体心肌LS减低(P<0.001);与HCM组比较,CA组基底段及整体内膜下、外膜下、平面整体心肌LS、中间段外膜下心肌LS减低(P<0.05)。②与HCM肥厚节段组比较,HCM非肥厚节段组心肌应变值稍高(P<0.01);CA组病变心肌应变值差异均无统计学意义(P>0.05),左心室平均内膜下心肌LS/整体心肌LS比例明显增高(P<0.001)。③以左心室平均内膜下心肌LS/整体心肌LS>1.050作为判断CA和HCM病变心肌的临界值,其敏感度为96%,特异度为72%。结论 CA和HCM患者左心室纵向内膜下、外膜下及平面整体心肌收缩期功能均受损,CA以内膜下心肌为著,HCM以肥厚节段为著,CA左心室平均内膜下心肌LS/整体心肌LS高于HCM,可以为临床提供一定的参考价值。Purpose To discuss the value of speckle tracking imaging （STI） in assessing left ventricular epicardial and endocardial strain of cardiac amyloidosis （CA） and hypertrophic cardiomyopathy （HCM）. Materials and Methods Seventy-two people （25 patients with CA, 20 patients with HCM and 27 healthy volunteers） underwent echocardiography. The peak systolic longitudinal strain （LS） was measured in 16 segments of endocardial myocardium, epicardial myocardium and transmural myocardium and calculated with software Qlab 8.1. Furthermore, all HCM segments were divided into two subgroups： HCM non-hypertrophic segments and HCM hypertrophic segments. Each strain indicator in HCM hypertrophic segments group and CA group was compared and diagnostic efficacy was further compared. Results ① Compared with control group, the LS of endocardial, epicardial and transmural myocardium at three long-axis levels （basal, middle and apical） in both CA and HCM groups decreased significantly （P〈0.001）; compared with that in HCM group, the basal and global LS of endocardial, epicardial and transmural myocardium, the middle of thresholdepicardial myocardium decreased in CA group （P〈0.05）.② Compared with that of hypertrophic segments in HCM hypertrophic segments group, myocardial strain was slightly higher in HCM non-hypertrophic segments group （P〈0.01）; in CA group, the mean-endo LS/transmural LS were significantly increased （P〈0.001）; and no significant difference was found in the other LS parameters （P〉0.05）. ③ The mean-endo LS/transmural LS had high accuracy in differentiating segments in CA group from hypertrophic segments in HCM hypertrophic segments group. A cut-off value of mean-endo LS/transmural LS more than 1.050 had both high sensitivity and specificity of96% and 72%, respectively. Conclusion Longitudinal LV deformations are impaired in patients with CA and HCM; in particular, CA is more likely to have impairment in endocardial myocardium and HCM is more likely to have impairm

关 键 词：淀粉样变性 心肌病 肥厚性 超声心动描记术 斑点追踪成像 心室功能 左 心肌应变 诊断 鉴别 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]