应用超声心动图应变分析鉴别心脏淀粉样变与高血压左心室肥厚  

Differentiation of Cardiac Amyloidosis and Hypertensive Left Ventricle Hypertrophy Using Echocardiography Strain Imaging

作　　者：王智[1,2] 杨颖[1,2] 孟令超[3] 杜康 范芳芳[1] 龚艳君[1] 马为[1,2] 袁云[3] 丁文惠[1] WANG Zhi;YANG Ying;MENG Lingchao;DU Kang;FAN Fangfang;GONG Yanjun;MA Wei;YUAN Yun;DING Wenhui(Department of Cardiovascular Medicine,Peking University First Hospital,Beijing 100034,China;Department of Echocardiography Core Lab Institute of Cardiovascular Disease,Peking University First Hospital,Beijing 100034,China;不详)

机构地区：[1]北京大学第一医院心血管内科,北京100034 [2]北京大学第一医院心血管疾病研究所超声心动图中心实验室,北京100034 [3]北京大学第一医院神经内科,北京100034

出　　处：《中国医学影像学杂志》2022年第8期783-789,共7页Chinese Journal of Medical Imaging

摘　　要：目的比较心脏淀粉样变与高血压左心室肥厚患者传统超声心动图参数和应变的区别,建立联合两种参数的鉴别模型。资料与方法回顾性选取2014年8月—2021年8月北京大学第一医院经组织活检和99Tcm-焦磷酸盐显像诊断的40例心脏淀粉样变患者(其中轻链型与转甲状腺素蛋白型各20例),选取同期就诊的20例高血压左心室肥厚患者作为对照组。采集受试者的临床资料、传统超声心动图参数,左心室整体长轴应变、左心房储存期、管道期和辅泵期应变及右心室应变,比较以上参数的差异,建立鉴别模型。结果心脏淀粉样变患者的左心室整体长轴应变[(-12.6±4.0)%比(-15.9±3.7)%;t=3.049,P=0.003]、左心房储存期应变[(19.5±10.3)%比(27.1±8.0)%;t=-2.883,P=0.006]和辅泵期应变[(-9.8±6.3)%比(-14.8±5.8)%;t=3.010,P=0.004]较对照组显著减低。前者的左心室应变减低呈现心尖相对保留模式。应用最小绝对收缩和选择算子回归建立鉴别模型,显示应变联合传统超声参数模型诊断敏心脏淀粉样变敏感度为0.9189,特异度为0.9474。结论与高血压左心室肥厚相比,心脏淀粉样变患者左心室长轴应变、左心房应变显著减低,左心室应变呈现心尖相对保留模式。联合传统超声心动图与应变参数可以较好地鉴别两者。Purpose To compare the difference in traditional echocardiographic parameters and strain of cardiac amyloidosis(CA from other hypertrophic mimic diseases, and to establish an identification model. Materials and Methods Forty CA patients diagnosed with tissue biopsy and 99Tcm-PYP in Peking University First Hospital from August 2014 to August 2021 were enrolled in this study,including 20 amyloidosis light chain and 20 amyloidosis transthyretin, and 20 patients with hypertensive left ventricle hypertrophy were selected as the control group. The clinical data, traditional echocardiographic parameters, left ventricular global longitudinal strain(GLS), left atrial reservoir, left atrial conduit and left atrial contractile strain, and right ventricular strain were collected and measured.The differences of the above parameters were compared, and established a differential model. Results The left ventricle GLS [(-12.6±4.0)% vs.(-15.9±3.7)%;t=3.049, P=0.003] and left atrial reservoir strain [(19.5±10.3)% vs.(27.1±8.0)%;t=-2.883, P=0.006]and left atrial contractile strain [(-9.8±6.3)% vs.(-14.8±5.8)%;t=3.010, P=0.004] were significantly reduced in patients with cardiac amyloidosis compared with the control group. The GLS reduction in CA group displayed as an relative apical sparing pattern. The differential model was established by least absolute shrinkage and selection operator regression, and the sensitivity and specificity of strain combined with traditional ultrasound parameter model in the diagnosis of sensitive cardiac amyloidosis were 0.918 9 and 0.947 4,respectively. Conclusion Compared with hypertensive left ventricular hypertrophy, left ventricular long-axis strain and left atrial strain are significantly reduced in patients with cardiac amyloidosis, and left ventricular strain shows a relative apical sparing pattern. The combination of conventional echocardiography and strain parameters can distinguish them well.

关 键 词：淀粉样变 高血压 超声心动图 应变分析 

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]