二维斑点追踪超声心动图评价非缺血性心肌病和缺血性心肌病的左心室功能  

Evaluation of left ventricular function in patients with non-ischemic cardiomyopathy and ischemic cardiomyopathy by two-dimensional speckle tracking echocardiography

作　　者：朱慧 左后娟 马飞 李瑞 王红[2] 张焱[2] ZHU Hui;ZUO Houjuan;MA Fei;LI Rui;WANG Hong;ZHANG Yan(Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China;Department of Cardiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,湖北省武汉市430030 [2]华中科技大学同济医学院附属同济医院心血管内科,湖北省武汉市430030

出　　处：《中国动脉硬化杂志》2021年第7期595-599,共5页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金项目(81873535)。

摘　　要：目的应用二维斑点追踪超声心动图(2D-STE)评价非缺血性心肌病(NICM)和缺血性心肌病(ICM)的左心室功能变化。方法选择2014年9月—2017年2月华中科技大学同济医学院附属同济医院心血管内科收治的心脏扩大且合并左心室收缩功能降低的84例患者,根据冠状动脉造影结果分为NICM组43例和ICM组41例。行常规超声心动图及2D-STE分析NICM和ICM患者的左心室功能。结果NICM组左心室射血分数(LVEF)较ICM组明显减低(P<0.05),但两组间左心室舒张期末内径、室间隔厚度及左心室后壁厚度差异均无统计学意义。2D-STE结果显示NICM组和ICM组整体纵向应变值之间无显著性差异,NICM组心尖段局部纵向应变值(RLS)增高(P<0.05),基底段RLS降低(P<0.01)。受试者工作特征曲线结果显示,基底段RLS/(中间段RLS+心尖段RLS)比值区别NICM与ICM的价值最高,其曲线下面积为0.792,截断值为0.47,灵敏度为63.4%,特异度为88.4%。结论NICM和ICM患者具有不同的二维应变超声特点;2D-STE应变分析有助于NICM和ICM的鉴别诊断。Aim To evaluate left ventricular function in patients with non-ischemic cardiomyopathy(NICM)and ischemic cardiomyopathy(ICM)by two-dimensional speckle tracking echocardiography(2D-STE).Methods From September 2014 to February 2017,84 patients with enlarged hearts and reduced left ventricular systolic function admitted to the Department of Cardiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected.According to the results of coronary angiography,the patients were divided into NICM group(n=43)and ICM group(n=41).Routine echocardiography and 2D-STE were performed to analyze left ventricular function in patients with NICM and ICM.Results The left ventricular ejection fraction(LVEF)in NICM group was significantly lower than that in ICM group(P<0.05),but there was no significant difference in left ventricular end-diastolic diameter,interventricular septum thickness and left ventricular posterior wall thickness between the two groups.2D-STE results showed that there was no significant difference in global longitudinal strain value between NICM group and ICM group.In NICM group,regional longitudinal strain value(RLS)in apical segment increased(P<0.05),while RLS in basal segment decreased(P<0.01).The results of receiver operating characteristic curve showed that the basal RLS/(middle RLS+apical RLS)ratio had the highest value in distinguishing NICM from ICM,and the area under the curve was 0.792,the cut-off value was 0.47,the sensitivity was 63.4%,the specificity was 88.4%.Conclusions Patients with NICM and ICM have different characteristics of two-dimensional strain ultrasound.2D-STE strain analysis is helpful in the differential diagnosis of NICM and ICM.

关 键 词：二维斑点追踪超声心动图 非缺血性心肌病 缺血性心肌病 左心室功能 整体纵向应变 局部纵向应变 

分 类 号：R54[医药卫生—心血管疾病]