斑点追踪成像技术评价心脏淀粉样变性患者左室内膜下和外膜下心肌纵向应变研究  

A Study of Left Ventricular Endocardial and Epicardial Myocardial Longitudinal Strain in Patients with Cardiac Amyloidosis Using Speckle Tracking Imaging

作　　者：张晶[1] 宋光[1] 任卫东[1] 郭宝生[1] 肖杨杰[1] 商聪[1] 詹莹[1] 

机构地区：[1]中国医科大学附属盛京医院超声科,沈阳市110004

出　　处：《中国超声医学杂志》2014年第4期342-346,共5页Chinese Journal of Ultrasound in Medicine

基　　金：辽宁省科学技术计划项目(No.2011225015)

摘　　要：目的探讨斑点追踪成像(STI)评价心脏淀粉样变性(CA)左室内膜下和外膜下心肌收缩功能的价值。方法 25例CA患者按左室射血分数(EF)分为CA(EF≥50%)组和CA(EF<50%)组;选取27例健康志愿者为对照组,分别行二维超声心动图检查,记录心尖四腔、三腔、二腔切面高帧频图像,应用QLAB 8.1测量各节段内膜下、外膜下及平面整体心肌收缩期纵向应变峰值(LS),计算左室整体内膜下、外膜下及左室整体心肌LS。结果(1)与对照组比较,CA(EF<50%)及CA(EF≥50%)组各水平(基底、中间、心尖段)整体LS及左室整体LS明显减低(P<0.001)。与CA(EF≥50%)组相比,CA(EF<50%)组心尖段整体LS减低(P<0.05),其余节段LS差异无统计学意义(P>0.05)。(2)与对照组比较,CA(EF<50%)及CA(EF≥50%)组各水平及整体内膜下、外膜下心肌LS明显减低(P<0.001);与CA(EF≥50%)组相比,CA(EP<50%)组心尖段、中间段及整体内膜下心肌LS减低(P<0.05),其余节段LS差异均无统计学意义(P>0.05)。结论 LVEF正常的CA患者已早期出现纵向收缩功能减低,内膜下心肌LS可作为早期评价CA病变程度的无创性检查方法。Objective To evaluate the systolic function of left ventricular endocardial and epicardial myocardium in patients with cardiac amyloidosis by speckle tracking imaging （STI）. Methods 25 patients with CA and 27 healthy volunteers （control group） were enrolled. The patients with CA was divided into two subgroups according to the value of LVEF： CA group （ EF≥50%） and CA group （EF〈50%）. High frame rate two-dimensional images were obtained from the apical four-chamber view, three-chamber view and two-chamber view of the left ventricle in the 3 groups. The peak systolic longitudinal strain （LS） were measured in endocardial myocardium, epicardial myocardium, and transmural myocardium of 16 segments using QLAB 8.1 software. In addition, the average basal LS, the average mid- dle LS, the average apical LS, the globle LS of endocardial myocardium, epicardial myocardium, and transmural myo- cardium were calculated. Results （1）Compared with the controls, the globle, basal, mid-LV and apical LS of trans- mural myocardium in CA group （EF≥50%） and CA group （EF〈 50 % ） were significantly decreased （P〈 0. 001 ）. Compared with the CA group （EF≥50 %）, the apical LS of transmural myocardium CA group （EF〈50%） was de- creased （P〈0.05）, No significant difference were found in the rest of LS parameters（P〉0.05）. （2）Compared with the controls, the globle, basal, mid-LV and apical LS of endocardial, epieardial myocardium in CA group （ EF≥ 50%） and CA group （EF〈50%） were significantly decreased （P〈0. 001）. Compared with the CA group （EF≥ 50 %）, the globle, mid-LV and apical LS of endocardial myocardium in CA group （EF〈 50 % ） were decreased （P〈 0.05）. No significant difference were found in the rest of LS parameters （P〉0.05）. Conclusions Longitudinal LV deformations are impaired in patients with CA with preserved LVEF. LS of endoeardial myocardium traced by 2D-STI would be a useful tool for early evaluating the severity of CA

关 键 词：超声心动描记术 斑点追踪成像 心脏淀粉样变性 收缩功能 心肌应变 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541[医药卫生—诊断学]