四维自动左室定量分析技术评价肥厚型心肌病不同危险分层患者左室心肌力学特征  

Study of left ventricular myocardial mechanics in patients with different risk stratifications of hypertrophic cardiomyopathy by four-dimensional automatic left ventricular quantitation technology

作　　者：戴思露 武丽娜[2] 郭玮涛 王红鹄 师文强[2] 段会参 王玲云[2] 赵琋 张瑞芳[1] Dai Siu;Wu Lina;Guo Weitao;Wang Honghu;Shi Wenqiang;Duan Huican;Wang Lingyun;Zhao Xi;Zhang Ruifang(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Henan Hypertrophic Cardiomyopathy Center,Zhengzhou 450000,China;Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院心血管内科、河南省肥厚型心肌病诊疗中心,郑州450000 [2]郑州大学第一附属医院超声医学科,郑州450000

出　　处：《中华超声影像学杂志》2023年第4期295-302,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81871364);河南省医学科技攻关计划省部共建项目(SBGJ2018014)。

摘　　要：目的探讨四维自动左室定量分析(4D Auto LVQ)技术评价肥厚型心肌病(HCM)不同危险分层患者左室心肌力学特征的应用价值。方法采用病例对照研究。选取2020年2月至2022年2月于郑州大学第一附属医院就诊的HCM患者88例和健康体检者20例。根据猝死风险评分将HCM患者分为3组,其中低危组49例,中危组21例,高危组18例。采集常规超声参数,应用4D Auto LVQ技术获取左室心肌力学参数,包括整体纵向应变(GLS)、整体圆周应变(GCS)、整体面积应变(GAS)、整体径向应变(GRS)、旋转(Twist)和扭力(Torsion),比较4组间各参数的差异。ROC曲线分析常规超声参数以及心肌力学参数对中高危HCM患者的预测价值。结果①低危组、中危组、高危组左室舒张末期内径、左室舒张末期容积、左室收缩末期容积、二尖瓣环收缩期峰值流速小于对照组,但左室最大室壁厚度(LVMWT)、二尖瓣口舒张早期峰值速度/二尖瓣环舒张早期峰值速度(E/e′)大于对照组,中危组、高危组左房前后径(LAD)以及左室流出道压差(LVOTG)大于低危组(均P<0.05)。②与对照组相比,HCM患者各组GLS均降低,且中危组、高危组GLS低于低危组;中危组、高危组GCS、GRS低于低危组,高危组GAS低于低危组、对照组,但高于中危组(均P<0.05);中危组、高危组Twist、Torsion高于对照组,但低于低危组,差异有统计学意义(均P<0.05)。③ROC曲线分析结果显示,包含常规超声参数(LVWMT、LAD、LVOTG)的模型预测中高危HCM患者的ROC曲线下面积(AUC)为0.811,敏感性为0.769,特异性为0.755;左室心肌力学参数联合常规超声参数诊断中高危HCM患者的AUC为0.904,敏感性为0.667,特异性为0.980。结论4D Auto LVQ能够评价不同危险分层HCM患者的左室心肌力学特征;心肌力学参数结合常规超声参数可提高对中高危HCM患者的预测能力。Objective To explore the application value of four-dimensional automatic left ventricular quantitation(4D Auto LVQ)technology,in evaluating the myocardial mechanics in patients with different risk stratifications of hypertrophic cardiomyopathy(HCM).Methods A total of 88 HCM patients and 20 healthy volunteers were selected from February 2020 to February 2022 in the First Affiliated Hospital of Zhengzhou University.According to the HCM Risk-SCD score,HCM patients were divided into 3 groups:low-risk group(n=49),intermediate-risk group(n=21),and high-risk group(n=18).Conventional ultrasound parameters were collected,and 4D Auto LVQ technology was used to obtain the mechanical parameters of left ventricular myocardium,including global longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),global radial strain(GRS),twist and torsion.The differences in these parameters among the four groups were compared.The predictive values of conventional ultrasound parameters and myocardial mechanical parameters in patients with intermediate-and high-risk HCM patients were analyzed by ROC curve.Results①Left ventricular end-diastolic diameter,left ventricular end-diastolic volume,left ventricular end-systolic volume,and peak systolic velocity of mitral annulus in the low-,intermediate-,and high-risk groups were lower than those in the control group while left ventricular maximal wall thickness(LVMWT)and early diastolic peak velocity of mitral value orifice/early diastolic peak velocity of mitral annulus(E/e')were higher,left atrial diameter(LAD)and left ventricular outflow tract gradients(LVOTG)in the intermediate-and high-risk groups were higher than the low-risk group(all P<0.05).②Compared with the control group,the GLS of HCM patients was lower,and the GLS of the intermediate-and high-risk groups was lower than the low-risk group.GCS and GRS in the intermediateand high-risk groups were lower than those in the low-risk group.GAS in the high-risk group was lower than the low-risk and the control grou

关 键 词：心肌病 肥厚性 心室功能 左 四维自动左室定量分析 

分 类 号：R542.2[医药卫生—心血管疾病]