二维斑点追踪成像技术评价不同原因引起左心室肥厚的疾病左室纵向应变  

Comparative Analysis of Left Ventricular Longitudinal Strain between Cardiac Amyloidosis and Other Causes of Ventricular Wall Thickening by 2D Strain Imaging Echocardiography

作　　者：张晶[1] 宋光[1] 任卫东[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》2016年第7期603-607,共5页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金项目(No.81571686)

摘　　要：目的探讨斑点追踪成像(STI)评价心脏淀粉样变性(CA)与其他引起左室肥厚的疾病心肌收缩功能的价值及鉴别诊断价值。方法对24例CA、21例HLVH、15例HCM及28例对照组行超声心动图检查,记录心尖四腔、三腔、二腔心切面高帧频图像,应用QLAB 8.1软件测量左室壁18节段收缩期纵向应变峰值(LS),计算各水平LS及整体LS(GLS);最后对各参数绘制ROC曲线。结果 (1)与对照组及HLVH比,CA各节段,各水平及GLS明显减低(P<0.005)。(2)与HCM比,CA各水平及GLS减低(P<0.05),各壁基底段LS减低(P<0.05),侧壁中间段、下壁中间段及心尖段LS减低(P<0.05)。(3)ROC曲线分析:相对心尖LS[平均心尖段LS/(平均基底段LS+平均中间段LS)]鉴别CA和HLVH,CA和HCM准确性高(AUC分别0.81,0.87),以相对心尖LS>0.76及其>0.80为界值鉴别CA和HLVH,CA和HCM具有较高的灵敏度及特异度(CA vs HLVH:85%和71%;CA vs HCM:87%和100%)。结论 STI可以评价CA和其他引起左室肥厚疾病左室纵向心肌收缩功能,相对心尖LS可作为鉴别CA较为准确实用的方法。Objective To describe regional patterns in longitudinal strain（LS）using speckle-tracking echocardiography in CA and to test the hypothesis that regional differences would help differentiate CA from other causes of increased left ventricular（LV）wall thickness.Methods 84subjects（24 with CA,21 with HLVH,15 with HCM and 28 healthy subjects）were examined.2 Dimages were obtained including the LV apical four-chamber view,three-chamber view,two-chamber view.The peak systolic LS of 18 segments were measured using QLAB 8.1software.The global,Basal,mid-LV and apical LS were obtained by averaging the corresponding strain values.The ROC curve was used to analysis strain parameters in differentiating CA from HLVH and HCM.Results （1）Compared with controls and HLVH,the global,basal,mid-LV,apical and 18 segments LS in CA were significantly decreased（P〈0.005）.（2）Compared with HCM,the global,basal,mid-LV and apical LS in CA were decreased（P〈0.05）,all basal segments LS,mid-LV segment LS of lateral wall,mid-LV,apical segments LS of inferior wall were decreased（P〈0.05）.（3）The ROC curves analysis demonstrated that average apical LS/（average basal LS ＋ average mid-LS）had high accuracy for discriminating CA from HLVH and HCM（areas under the curve were 0.81,0.87）.Cutoff values were more than 0.76 and 0.80 with both highest sensitivity and specificity（CA vs HLVH：85% and 71%;CA vs HCM：87%and 100%,respectively）.Conclusions 2D-STI is a feasible technique for the assessment of cardiac longitudinal systolic function in CA and other causes of LV hypertrophy,A relative‘apical sparing＇pattern of LS is an easily recognizable,accurate and reproducible method of differentiating CA from other causes of LV hypertrophy.

关 键 词：斑点追踪技术 心脏淀粉样变性 高血压左室肥厚 肥厚型心肌病 心肌纵向应变 

分 类 号：R540.45[医药卫生—心血管疾病] R541[医药卫生—内科学]