左心室节段心肌应变对心脏淀粉样变和非梗阻性肥厚型心肌病的鉴别诊断价值  

The differential diagnostic value of left ventricular segmental myocardial strain in cardiac amyloidosis and nonobstructive hypertrophic cardiomyopathy

作　　者：刘阳 孟芳民 周年伟 栾丽娜 潘翠珍 舒先红 LIU Yang;MENG Fangmin;ZHOU Nianwei;LUAN Lina;PAN Cuizhen;SHU Xianhong(Department of Echocardiography,Shanghai Geriatric Medical Center,Shanghai 200030,China;Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市老年医学中心心脏超声诊断科,上海200030 [2]复旦大学附属中山医院心脏超声诊断科,上海200032

出　　处：《中国临床医学》2024年第6期889-897,共9页Chinese Journal of Clinical Medicine

基　　金：上海市卫生健康委员会项目(202140291).

摘　　要：目的探讨心脏淀粉样变(cardiac amyloidosis,CA)患者和非梗阻性肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者整体纵向心肌应变(global longitudinal strain,GLS)和左心室节段心肌应变差异,以及左心室节段性心肌应变对CA的诊断价值。方法选择2016年1月至2022年4月在复旦大学附属中山医院确诊为免疫球蛋白轻链型(AL型)CA的患者20例(CA组)和诊断为非梗阻性HCM的患者20例(HCM组)。所有患者接受二维斑点追踪超声心动图(2D-STE)检查,获取左心室GLS和节段性应变数据。通过受试者工作特征(ROC)曲线及基于主成分分析的二元logistic回归分析评估心肌应变对AL型CA和非梗阻性HCM的鉴别诊断价值。结果CA组患者的左心室3平面(3P)、四腔心切面(4Ch)、二腔心切面(2Ch)、三腔心切面(3Ch)GLS以及节段性(前侧壁中间段、下间隔中间段、前侧壁基底段、下间隔基底段、前壁中间段、下壁中间段、前壁基底段、下壁基底段、下侧壁中间段、前间隔基底段、下侧壁基底段)应变参数绝对值均低于HCM组(P<0.01)。ROC结果显示,GLS(3P、4Ch、2Ch、3Ch)、前侧壁基底段、下间隔基底段、前壁基底段、下壁基底段、前间隔基底段和下侧壁基底段对AL型CA与HCM有良好的鉴别效能。二元logistic回归分析显示,前侧壁基底段能独立区分AL型CA和HCM(P<0.01)。检测结果一致性良好。结论左心室节段心肌应变对AL型CA与HCM具有良好的鉴别效能,以前侧壁基底段应用价值最高。Objective To explore the difference of the left ventricular global longitudinal strain(GLS)and the segment strains between cardiac amyloidosis(CA)and non-obstructive hypertrophic cardiomyopathy(HCM).Methods Twenty patients with immunoglobulin light chain cardiac amyloidosis(AL-CA)as CA group and 20 patients with non-obstructive HCM selected as controls(HCM group)were enrolled from January 2016 to April 2022 in Zhongshan Hospital,Fudan University.All patients underwent two-dimensional speckle tracking echocardiography(2D-STE).The left ventricle GLS and the segmental strains were calculated.The values of these strains to distinguish AL-CA from HCM were analyzed by receiver operating characteristic(ROC)curves and logistic regression analysis.Results In the CA group,the GLS parameters(3P,4Ch,2Ch,3Ch),as well as the left ventricle segmental strains(MID-ANT/LAT,MID-INF/SEPT,BASAL-ANT/LAT,BASAL-INF/SEPT,MID-ANT,MID-INF,BASAL-ANT,BASAL-INF,MID-INF/LAT,BASAL-ANT/SEPT,and BASAL-INF/LAT)were all lower than those in the HCM group(P<0.01).ROC results showed that GLS(4Ch),GLS(2Ch),GLS(3Ch),GLS(3P),BASAL-ANT/LAT,BASAL-INF/SEPT,BASAL-ANT,BASAL-INF,BASAL-ANT/SEPT and BASAL-INF/LAT had good efficacy in distinguishing AL-CA from HCM.Logistic regression analysis showed that BASAL-ANT/LAT was an independent factor in distinguishing AL-CA from HCM(P<0.01).The consistency of test results was good.Conclusions The left ventricular segmental myocardial strains show good efficacy in distinguishing AL-CA from HCM,and BASAL-ANT/LAT has highest application value.

关 键 词：二维斑点追踪超声心动图 心脏淀粉样变 肥厚型心肌病 左心室心肌应变 

分 类 号：R542.2[医药卫生—心血管疾病]