心脏超声造影在肥厚型心肌病冠状动脉微循环功能评价中的应用及影响因素  

Contrast echocardiography for evaluation of coronary microcirculation function in patients with hypertrophic cardiomyopathy:application and influencing factors

作　　者：苏亚芬[1] 方小梅 韩薇[1] 杨宁[1] Su Yafen;Fang Xiaomei;Han Wei;Yang Ning(Department of Cardiovascular Medicine,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院心血管内科,150001

出　　处：《中华医学超声杂志（电子版）》2020年第4期341-346,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的应用心脏超声造影评价肥厚型心肌病(HCM)患者冠状动脉微循环功能,并探讨其可能的影响因素。方法选取2013年9月至2019年7月于哈尔滨医科大学附属第一医院就诊的HCM患者82例,所有患者均行二维经胸超声心动图(2D-TTE)及左心声学造影(LVO)检查,评估2种方法对HCM的诊断率。应用心肌声学造影(MCE)评价HCM冠状动脉微循环功能。采用单因素分析及多因素Logistic回归方法分析HCM患者冠状动脉微循环功能异常的独立预测因子。结果82例HCM患者中,2D-TTE诊断率为76.0%(62/82);LVO诊断率为91.5%(75/82),2者差异有统计学意义(P<0.001)。13例心尖肥厚型HCM患者中,2D-TTE诊断率为61.5%(8/13);LVO诊断率为77.0%(10/13),2者差异有统计学意义(P=0.035)。82例HCM患者中,MCE检出冠状动脉微循环功能障碍60例,冠状动脉微循环功能异常发生率为73.1%(60/82)。依据MCE结果将82例患者分为冠状动脉微循环功能正常组(22例)与异常组(60例)。多因素Logistic回归分析结果显示,超敏肌钙蛋白I(hs-cTnI)升高为HCM患者冠状动脉微循环功能异常的独立预测因子(OR=1.13,95%CI:1.01~1.34,P=0.03)。结论LVO可提高HCM患者的诊断率,MCE是评价HCM患者冠状动脉微循环功能障碍的可行和有效方法,hs-cTnI升高对HCM患者冠状动脉微循环功能障碍具有独立预测价值。Objective To explore the application of contrast echocardiography in the evaluation of coronary microcirculation function in patients with hypertrophic cardiomyopathy(HCM),and identify the possible influencing factors.Methods From September 2013 to July 2019,82 patients with HCM were selected at the First Affiliated Hospital of Harbin Medical University.All patients were examined by twodimensional transthoracic echocardiography(2D-TTE)and left ventriculography(LVO)to evaluate their diagnosis rates for HCM.Myocardial contrast echocardiography(MCE)was used to evaluate the coronary microcirculation function of HCM patients.Univariate analysis and multivariate Logistic regression analysis were used to screen independent predictors of coronary microcirculation dysfunction in HCM patients.Results Among 82 patients with HCM,the diagnosis rate by 2D-TTE was 75.6%(62/82),and that by LVO was 91.5%(75/82);the difference between them was statistically significant(P<0.001).In 13 patients with apical HCM,the diagnostic rate by 2D-TTE was 61.5%(8/13),and that by LVO was 77.0%(10/13);the difference between them was statistically significant(P=0.035).Among 82 patients with HCM,60(60/82,73.1%)were diagnosed with coronary microcirculation dysfunction by MCE.According to the results of MCE,82 patients were divided into two groups:normal coronary microcirculation function group(22 cases)and abnormal coronary microcirculation function group(60 cases).Multivariate Logistic regression analysis showed that the increase of high sensitivity troponin I(hs-cTnI)was an independent predictor of coronary microcirculation dysfunction in HCM patients(OR=1.13,95%CI:1.01-1.34,P=0.03).Conclusion LVO can improve the diagnosis rate of HCM patients.MCE is a feasible and effective method to evaluate the coronary microcirculation dysfunction of HCM patients.Hs-cTnI has independent predictive value for the coronary microcirculation dysfunction of HCM patients.

关 键 词：肥厚型心肌病 超声造影 冠状动脉 微循环 肌钙蛋白I 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]