二维斑点追踪成像评价儿童左心室心肌致密化不全左心室收缩功能  

Two-dimensional Speckle Tracking in Evaluation of Left Ventricular Systolic Function in Children with Left Ventricular Noncompaction

作　　者：胡原[1] 刘倩君 周梦洁[1] 陈文娟[1] HU Yuan;LIU Qianjun;ZHOU Mengjie;CHEN Wenjuan＊(Department of Ultrasound,Hunan Chidren＇s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院超声科,湖南长沙410007

出　　处：《中国医学影像学杂志》2018年第5期347-352,共6页Chinese Journal of Medical Imaging

基　　金：湖南省卫生计生委科研计划课题(20180459)

摘　　要：目的儿童心肌致密化不全易以心力衰竭起病,预后较差。本研究应用二维斑点追踪成像评价左心室心肌致密化不全(LVNC)儿童的左心室收缩功能。资料与方法选取30例LVNC患儿进行常规超声心动图检查,并采集二维斑点追踪成像所需相关切面图,得到左心室整体长轴应变(GLS)和17节段长轴应变值牛眼图。按照双平面Simpson法所得的射血分数(EF)将30例患儿分为两组,EF≥50%的16例患儿为LVNC-1组,EF<50%的14例患儿为LVNC-2组,另设28例健康儿童为对照组。比较3组左心室各节段长轴应变的差异。分析LVNC组GLS与EF的相关性。根据17节段牛眼图得出左心室壁受累节段数,绘制左心室壁受累节段数诊断EF<50%的受试者工作特性曲线。结果 (1)与对照组比较,LVNC组各壁心尖段、下侧壁的基底段和中间段、下壁基底段和中间段长轴应变值减低,差异有统计学意义(P<0.05)。(2)与对照组比较,LVNC-1组各壁心尖段、下侧壁的基底段和中间段、下壁基底段和中间段长轴应变值减低,差异有统计学意义(P<0.05)。(3)LVNC-2组左心室所有节段室壁长轴应变值较对照组明显减低,差异有统计学意义(P<0.05)。LVNC-2组左心室所有节段室壁长轴应变值较LVNC-1组明显减低,差异有统计学意义(P<0.05)。(4)LVNC组GLS与EF呈正相关(r=0.756,P<0.05)。(5)LVNC组患儿左心室壁受累节段数与EF呈负相关(r=-0.554,P<0.05)。左心室壁受累节段数诊断EF<50%的受试者工作特性曲线下面积为0.961,最佳截断值为10。结论二维斑点追踪成像能准确地定量评价LVNC患儿左心室整体和节段心肌功能,为儿童LVNC的诊治提供有价值的信息。Purpose Children with noncompaction of ventricular myocardium are prone to heart failure and have poor prognosis. In this study, two-dimensional speckle tracking technique is used to evaluate left ventricular systolic function in children with left ventricularnoncompaction （LVNC）. Materials and Methods Thirty children with LVNC were selected for routine echocardiography and relevantsectional images required for two-dimensional speckle tracking technique were collected. Left ventricular global longitudinal strain （GLS） and bull＇s eye image of 17-segment longitudinal strain values were obtained. Thirty patients were divided into two groups based on ejectionfraction （EF） obtained via duel plane Simpson method. 16 patients with EF≥50% were classified as LVNC-1 group, 14 patients withEF〈50% LVNC-2 group, and another 28 healthy children control group. The difference of longitudinal strain in each segment of leftventricle was compared among the three groups and the correlation between GLS and EF in LVNC group was analyzed. The number of left ventricular wall involvement segments was obtained according to 17-segment bull’s eye image, and ROC curve of EF〈50% via the number of left ventricular wall involvement segments was drawn. Results ①Compared with the control group, the longitudinal strainvalues of apical segment of each wall, basal and middle segment of inferior lateral wall, basal and middle segment of inferior wall in LVNC group were decreased （P〈0.05）. ②Compared with the control group, the longitudinal strain values of apical segment of each wall, basal and middle segment of inferior lateral wall, basal and middle segment of inferior wall in LVNC-1 group were decreased （P〈0.05）. ③Ventricular wall longitudinal strain values of all segments in left ventricle in LVNC-2 group were significantly reduced compared with those in control group （P〈0.05）. Ventricular wall longitudinal strain values of all segments in left ventricle in LVNC-2 group weresignificantly reduced compar

关 键 词：心肌疾病 心脏缺损 先天性 超声心动描记术 斑点追踪成像 心室功能 左 左心室 儿童 

分 类 号：R541[医药卫生—心血管疾病] R445.1[医药卫生—内科学]