Selvester QRS评分与扩张型心肌病左心室重构及应变关系的探讨  

Relationship of Selvester QRS score with left ventricular remodeling and strain in dilated cardiomyopathy

作　　者：黄志强 夏纪筑 王雪峰 罗勇 Zhi-qiang Huang;Ji-zhu Xia;Xue-feng Wang;Yong Luo(Department of Ultrasound,The Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China;Department of Cardiology,The Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院超声科,四川泸州646000 [2]西南医科大学附属医院心内科,四川泸州646000

出　　处：《中国现代医学杂志》2019年第22期53-57,共5页China Journal of Modern Medicine

摘　　要：目的采用Selvester QRS评分量化评估扩张型心肌病(DCM)的心肌瘢痕,并探讨其与左心室重构及应变的关系。方法选取2018年1月—2019年1月于西南医科大学附属医院心内科住院的扩张型心肌病患者40例作为病例组。根据Selvester QRS评分值将病例组分为阴性组(评分=0)和阳性组(评分≥1)。选取同期该院健康体检者27例作为对照组。分别获得各组左心室收缩期总体纵向应变、圆周应变、面积应变及径向应变峰值等指标,比较亚组之间的差异,并分析QRS评分与各指标的相关性。结果阴性组收缩期总体纵向应变、面积应变、径向应变、左心室射血分数(LVEF)均高于阳性组(P<0.05),而左心室收缩末期容积、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)均低于阳性组(P<0.05)。病例组收缩期总体纵向应变、径向应变、LVEF与QRS评分均呈负相关(r s=-0.582、-0.473和-0.450,均P<0.05),LVEDD、LVESD与QRS评分均呈正相关(r s=0.536和0.514,均P<0.05)。收缩期总体纵向应变敏感性为0.462(95%CI:0.266,0.666),特异性为1.000(95%CI:0.768,1.000);LVEDD敏感性为0.615(95%CI:0.406,0.798),特异性为1.000(95%CI:0.768,1.000);LVESD敏感性为0.595(95%CI:0.369,0.766),特异性为1.000(95%CI:0.768,1.000)。结论Selvester QRS评分对DCM的收缩功能障碍有一定的指示意义,收缩期总体纵向应变、LVEDD及LVESD对Selvester QRS评分系统识别心肌瘢痕有一定的预测价值。Objective To explore the relationship of myocardial“scarring”evaluated by Selvester QRS quantitatively with left ventricular remodeling and strain in dilated cardiomyopathy.Methods Totally 40 patients with DCM and 27 healthy people were recruited to get the echocardiography and ecg imagesconsecutively.According to the QRS score value,case group can be divided into negative group(score=0)and positive group(score=1 or higher),and health people as control group.Left ventricular systolic global longitudinal strain(GLS),global circumferential strain(GCS),global area ostrain(GAS)and global radial strain(GRS)parameters and so on were detected and compared between groups,and their correlation with QRS score were analyzed.Results GLS,GAS,GRS and LVEF of the negative group were all higher than those of the positive group(P<0.05),while LVESV,LVEDD and LVESD were lower than those of the positive group with statistically significant difference(P<0.05).In the case group,GLS,GRS and LVEF were negatively correlated with QRS score(r s=-0.582,-0.473 and-0.450,all P<0.05),while LVEDD and LVESD were positively correlated with QRS score(r s=0.536 and 0.514,all P<0.05).The GLS sensitivity of ROC curve was 46.2%(95%CI:0.266,0.666),the specificity was 100%(95%CI:0.768,1.000);the sensitivity of LVEDd was 61.5%(95%CI:0.406,0.798),the specificity was 100%(95%CI:0.768,1.000);the sensitivity of LVESD was 59.5%(95%CI:0.369,0.766),the specificity was 100%(95%CI:0.768,1.000).Conclusions The Selvester QRS score has certain indicative significance for the systolic dysfunction of DCM,and GLS,LVEDD and LVESD have certain predictive value for the myocardial“scar”recognized by the Selvester QRS score system.

关 键 词：心肌病 扩张型 心电描记术 心内膜心肌纤维化症 

分 类 号：R540.45[医药卫生—心血管疾病]