二尖瓣空间变化联合左心房应变对肥厚型心肌病合并左心室流出道梗阻的预测价值  

Predictive value of mitral valve spatial changes combined with left atrial strain for left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy

作　　者：夏靖涵 林凤娇 王胰[2] 丁戈琦 张清凤[2] 张红梅[2] 谢盛华[2] 李明星 尹立雪[2] 李文华 Xia Jinghan;Lin Fengjiao;Wang Yi;Ding Geqi;Zhang Qingfeng;Zhang Hongmei;Xie Shenghud;Li Mingxing;Yin Lixue;Li Wenhua(Department of Ultrasound,Clinical Medicine Academy,Southwest Medical University,Luzhou 646000,China;Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province&Department of Cardiovascular Ultrasound&Noninvasive Cardiology,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Ultrasound,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学临床医学院超声医学科,泸州646000 [2]四川省医学科学院·四川省人民医院(电子科技大学附属医院)心血管超声及心功能科,超声心脏电生理学与生物力学四川省重点实验室,四川省心血管病临床医学研究中心(国家心血管疾病临床医学研究中心四川分中心),成都610072

出　　处：《中华医学超声杂志（电子版）》2024年第6期585-592,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的:联合二尖瓣空间参数和左心房应变参数,探讨静息超声心动图相关参数对肥厚型心肌病(HCM)合并左心室流出道梗阻(LVOTO)的预测价值。方法:回顾性纳入2021年1月至2023年12月在四川省人民医院门诊或住院期间行超声心动图确诊为HCM的患者95例。获取临床资料、常规超声心动图参数、二尖瓣空间参数和左心房应变参数。依据静息时和激发后左心室流出道压力阶差(LVOTG)将研究对象分为非梗阻性HCM 49例和梗阻性HCM 46例两组,比较各参数的组间差异。对单因素分析组间差异有统计学意义的二尖瓣及左心房参数进行ROC曲线分析,计算曲线下面积,获得最佳截断值及其敏感度和特异度。将ROC曲线分析有统计学意义的参数纳入多因素Logistic回归分析,获得HCM合并LVOTO的独立预测因素及其预测效能。结果:与非梗阻性HCM组相比,静息状态下梗阻性HCM组的舒张期二尖瓣前叶(AML)长度、收缩早期和收缩末期二尖瓣叶剩余长度(RML)、左心房僵硬度指数(LASI)均增大,收缩早期和收缩末期二尖瓣对合点与室间隔的距离(CS)及二尖瓣瓣尖与室间隔的距离(TIS)、左心房储备期应变(LASr)、左心房通道期应变(LAScd)绝对值均减小。HCM患者收缩早期TIS<21.84 mm、LASI>?0.56是发生LVOTO的独立预测因素,OR值分别为25.248、13.524(P均<0.05)。收缩早期TIS、LASI及二者联合参数预测HCM合并LVOTO的曲线下面积分别为0.821、0.715、0.827(P均<0.001),其敏感度分别为95.6%、60.5%、97.8%,特异度分别为63.8%、78.7%、59.2%。收缩早期TIS≥21.84 mm联合LASI≤0.56可排除HCM合并LVOTO或隐匿LVOTO的可能性,其阴性预测值分别为91.3%、95.5%。结论:静息超声心动图评估的收缩早期TIS、LASI可作为HCM合并LVOTO的独立预测因素。二者的联合应用可实现对HCM合并LVOTO的早期预测,提示进一步实施负荷超声心动图的必要性,使HCM患者的诊疗流程更加合理化。ObjectiveTo evaluate the value of mitral valve spatial parameters combined with left atrial strain parameters assessed by resting echocardiography in predicting left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy (HCM).MethodsNinety-five patients diagnosed with HCM by echocardiography during outpatient or inpatient visits at the Sichuan Provincial People's Hospital from January 2021 to December 2023 were retrospectively included. Clinical data, conventional echocardiographic parameters, mitral valve spatial parameters, and left atrial strain parameters were obtained. According to left ventricular outflow tract gradient (LVOTG) at rest and after provocation, the subjects were divided into either a non-obstructive HCM group (n=49) or an obstructive HCM group (n=46), and the differences of the above parameters were compared between the two groups. Receiver operating characteristics (ROC) curve analysis was performed on mitral valve parameters and left atrial parameters with statistically significant differences between the two groups in the univariate analysis, and the area under the ROC curve (AUC) was calculated to obtain the optimal cutoff value and sensitivity and specificity. Parameters with statistically significant differences in the ROC curve analysis were subjected to multivariate Logistic regression analysis to identify the independent predictors and evaluate their predictive efficacy for HCM with LVOTO.ResultsCompared with the non-obstructive HCM group, diastolic anterior mitral leaflet (AML), early-systolic and late-systolic residual mitral leaflet (RML), and left atrial stiffness index (LASI) at rest increased in the obstructive HCM group, while early-systolic and late-systolic coaptation point-interventricular septum (CS), early-systolic and late-systolic mitral leaflet tip-interventricular septum (TIS), left atrial strain during reservoir phase (LASr), and the absolute value of left atrial strain during conduit phase(LAScd) decreased. Early-systolic TIS < 21

关 键 词：肥厚型心肌病 左心室流出道梗阻 二尖瓣 左心房应变 超声心动图 

分 类 号：R542.2[医药卫生—心血管疾病]