二维斑点追踪成像评价的心尖相对纵向应变指标对心尖肥厚型心肌病的诊断价值  

Diagnostic Value of the Apical Relative Longitudinal Strain Indices Evaluated by Two-dimensional Speckle Tracking Imaging for Patients With Apical Hypertrophic Cardiomyopathy

作　　者：吴永鑫 林胜男 崔婕琳 黄惠美 阮琴韵[1,2] WU Yongxin;LIN Shengnan;CUI Jielin;HUANG Huimei;RUAN Qinyun(Department of Ultrasound,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Ultrasound,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou 350212,China)

机构地区：[1]福建医科大学附属第一医院超声医学科,福州350005 [2]福建医科大学附属第一医院滨海院区、国家区域医疗中心超声医学科,福州350212

出　　处：《中国循环杂志》2024年第11期1086-1091,共6页Chinese Circulation Journal

基　　金：福建省科技计划引导性项目(2017Y0031);福建省科技创新联合资金项目(2023Y9094)。

摘　　要：目的:应用二维斑点追踪成像技术(2D-STI)寻找能反映心尖肥厚型心肌病(AHCM)患者心肌功能学特征的纵向应变指标。方法:回顾性纳入2015年1月至2019年5月在福建医科大学附属第一医院确诊的典型AHCM患者30例(AHCM组),另纳入35例原发性高血压左心室肥厚(HTLVH)患者(HTLVH组)和45名健康志愿者(正常对照组)进行比较。应用二维超声心动图测量三组患者的心腔大小及室壁厚度,应用2D-STI分析左心室收缩期纵向应变,获得左心室整体纵向应变(GLS)及心尖段、中间段、基底段纵向应变(LS_(A)、LS_(M)、LS_(B))。以心尖与整体及其余节段纵向应变的比值作为心尖相对纵向应变指标,包括心尖与基底段纵向应变比(ABLR,LS_(A)/LS_(B))、心尖与整体纵向应变比(AGLR,LS_(A)/GLS)、心尖与基底-中间段纵向应变比[ABMLR,LS_(A)/(LS_(B)+LS_(M))]。结果:AHCM组与HTLVH组的GLS差异无统计学意义(P>0.05),但均显著低于正常对照组(P均<0.05);AHCM组与HTLVH组的LS_(A)、LS_(M)、LS_(B)均明显低于正常对照组,但AHCM组以LSA降低为著且低于HTLVH组,而HTLVH组则以LSB降低为著且低于AHCM组(P均<0.05)。与正常对照组相比,AHCM组的ABLR、AGLR、ABMLR均明显降低,而HTLVH组的ABLR、AGLR、ABMLR均显著增加(P均<0.05)。ROC曲线显示,在诊断AHCM时,ABLR、AGLR、ABMLR及LS_(A)的AUC为0.873~0.916,ABLR<1.28诊断AHCM的灵敏度(90.0%)和特异度(88.7%)最好。结论:心尖相对纵向应变指标较单一心尖纵向应变值更能反映AHCM患者的心肌功能学特性,尤其ABLR可能有助于鉴别AHCM与其他原因所致的左心室肥厚,可作为AHCM心肌功能损伤的评价参数。Objectives:To identify the two-dimensional speckle tracking imaging(2D-STI)-derived longitudinal strain indices that reflect the myocardial functional characteristics of patients with apical hypertrophic cardiomyopathy(AHCM).Methods:This retrospective study included 30 patients with typical AHCM diagnosed at the First Affiliated Hospital of Fujian Medical University from January 2015 to May 2019(AHCM group),35 patients with essential hypertensive left ventricular hypertrophy(HTLVH group),and 45 healthy volunteers(normal control group)were also included.Twodimensional echocardiography was used to measure the cardiac chamber size and wall thickness,and 2D-STI was used to analyze the longitudinal strain during the left ventricular systolic phase,the global longitudinal strain(GLS)and the longitudinal strain of the apical,mid,and basal segments(LS_(A),LS_(M),LS_(B))were assessed.The ratios of the apical to the overall and other segmental longitudinal strains were used as the apical relative longitudinal strain indices,including the apical to basal longitudinal strain ratio(ABLR,LS_(A)/LS_(B)),the apical to global longitudinal strain ratio(AGLR,LS_(A)/GLS),and the apical to basal-mid segment longitudinal strain ratio(ABMLR,LS_(A)/[LS_(B)+LS_(M)]).Results:GLS was significantly lower in the AHCM group and HTLVH group than in the normal control group(both P<0.05),and was similar between the AHCM group and HTLVH group(P>0.05).The LSA,LSM,and LSB were also significantly lower in the AHCM group and HTLVH group than in the normal control group,LSA decrease was more significant in the AHCM group as compared to the HTLVH group,while the HTLVH group was mainly characterized by a decrease in LSB,which was significantly lower as compared to the AHCM group(all P<0.05).Compared with the normal control group,the ABLR,AGLR,and ABMLR were significantly reduced in the AHCM group,while significantly increased in the HTLVH group(all P<0.05).The ROC curve showed that the AUC of ABLR,AGLR,ABMLR,and LS_(A) was 0.873 to 0.916,using<1.28 as t

关 键 词：心尖肥厚型心肌病 二维斑点追踪成像 心尖收缩功能 心尖相对纵向应变 

分 类 号：R54[医药卫生—心血管疾病]