超声分层应变技术评价多发性骨髓瘤患者左心室心肌收缩功能  

Evaluation of Left Ventricular Myocardial Systolic Function in Patients With Multiple Myeloma by Ultrasonic Layer-Specific Strain Technology

作　　者：刘文坤 梁婧[1] 钟慧颖[1] 李金国[1] LIU Wenkun;LIANG Jing;ZHONG Huiying;LI Jinguo(Department of Cardiology,Union Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院心内科,福建福州350001

出　　处：《中国医学影像学杂志》2022年第4期353-360,共8页Chinese Journal of Medical Imaging

基　　金：福建省医学创新项目(2017-CX-17)。

摘　　要：目的 应用超声分层应变技术评价左心室射血分数(LVEF)正常的多发性骨髓瘤患者左心室心肌纵向机械力学状态改变情况。资料与方法 前瞻性选取2019年2—9月LVEF均正常(LVEF>50%)的多发性骨髓瘤患者49例和同期年龄、性别相匹配的健康正常人40例(对照组),均进行常规超声心动图检查测量;应用分层应变技术获取左心室收缩期心内膜下心肌、中层心肌、心外膜下心肌整体纵向应变(GLS)和基底段、中间段及心尖段心肌各层纵向应变(LS)测值,以及同步性参数峰值应变离散度(PSD),计算左心室基底段跨壁应变梯度(Δbas-LS)、中间段跨壁应变梯度(Δmid-LS)、心尖段跨壁应变梯度(Δap-LS)及整体心肌跨壁应变梯度(ΔGLS)。分析多发性骨髓瘤患者与对照组收缩期分层应变及同步性参数的差异及各参数间的相关性。结果 (1)多发性骨髓瘤组左心房内径、左心室舒张末期内径、左心室质量指数、E/e’均高于对照组(t/Z=-4.521、2.270、4.078、-1.980,P均<0.05)。(2)与对照组比较,多发性骨髓瘤组左心室心内膜下心肌整体纵向应变(GLSendo),中层心肌整体纵向应变(GLSmid),心外膜下心肌整体纵向应变(GLSepi),基底段、中间段及心尖段心内膜下、中层、心外膜下LS值绝对值均减低(t/Z=-4.377、-4.660、-4.932、-3.894、-4.192、-4.341、-4.064、-4.200、-4.341、-2.768、-3.061、-3.140,P均<0.05);两组Δbas-LS、Δmid-LS、Δap-LS、ΔGLS差异均无统计学意义(t/Z=-0.838、-0.785、-1.143、-0.962,P均>0.05);多发性骨髓瘤组不同分型组间左心室纵向应变值两两比较差异均无统计学意义(P均>0.05)。(3)多发性骨髓瘤组峰值应变离散度高于对照组(t=2.931,P=0.004)。(4)LVEF与GLSendo、GLSmid、GLSepi的绝对值均呈正相关(r=0.421、0.414、0.395,P=0.003、0.003、0.005)。结论 超声分层应变技术可以定量测量和分析多发性骨髓瘤患者左心室各节段心肌纵向分层应变及同步性�Purpose To evaluate the changes of longitudinal mechanical parameters of left ventricular myocardium by ultrasonic layerspecific strain technology in patients with multiple myeloma with normal left ventricular ejection fraction(LVEF). Materials and Methods From February to September 2019, 49 cases of multiple myeloma patients with normal LVEF(LVEF>50%) and 40 healthy people(control group) matched in age and sex during physical examination were prospectively selected. Conventional echocardiography was performed in both groups. The longitudinal strain(GLS) of subendocardial, middle and epicardial myocardium during left ventricular systole was obtained by layer-specific strain technology, and the longitudinal strain(LS) of basal, middle and apical segments were measured, and the synchronization parameter peak strain dispersion(PSD) was obtained. The gradient differences of strain in each segment of left ventricle and the whole were calculated, such as Δbas-LS, Δmid-LS, Δap-LS, ΔGLS. The differences of systolic stratification strain and synchronization parameters and the correlation between the parameters were compared and analyzed between multiple myeloma patients and control group.Results 1. Compared with the control group, left atrial diameter, left ventricular end diastolic diameter, left ventricular mass index and E/e’ in multiple myeloma group were higher than those in the control group(t/Z=-4.521, 2.270, 4.078,-1.980, P<0.05), but there was no statistical significance in LVEF, LVSV, IVSD and LVPWD(t=-0.953, 1.960, 1.390, 0.509, P>0.05). 2. Compared with the control group, the left ventricle global longitudinal strain in the endocardial layer(GLSendo), global longitudinal strain in the mid myocardial layer(GLSmid),global longitudinal strain in the epicardial layer(GLSepi), bas-LSendo, bas-LSmid, bas-LSepi, mid-LSendo, mid-LSmid, mid-LSepi, apLSendo, ap-LSmid, ap-LSepi in the multiple myeloma group Absolute value decreased(t/Z=-4.377,-4.660,-4.932,-3.894,-4.192,-4.341,-4.064,-4.200,-4.341,-2.768,-3.061,-3.

关 键 词：多发性骨髓瘤 超声检查 多普勒 彩色 心室功能 左 分层应变 斑点追踪成像 峰值应变离散度 

分 类 号：R445.1[医药卫生—影像医学与核医学] R733.3[医药卫生—诊断学]