三维斑点追踪技术诊断心尖肥厚型心肌病的临床价值  

Clinical value of three-dimensional speckle tracking imaging in the diagnosis of apical hypertrophic cardiomyopathy

作　　者：虞林飞 汪玉龙[1] 张昱[2] YU Linfei;WANG Yulong;ZHANG Yu(Department of Cardiovascular Medicine,Haiyan People’s Hospital,Jiaxing 314300,China;Department of Cardiovascular Medicine,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江省海盐县人民医院心血管内科,浙江嘉兴314300 [2]浙江大学医学院附属第二医院心血管内科,浙江杭州310000

出　　处：《临床超声医学杂志》2025年第3期253-257,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的分析心尖肥厚型心肌病(AHCM)患者三维斑点追踪技术(3D-STI)参数与心电图参数的相关性,探讨3D-STI诊断AHCM的临床价值。方法选取我院收治的AHCM患者30例(观察组)和同期健康体检者24例(健康组),应用二维超声心动图获取舒张末期室间隔厚度(IVSd)、舒张末期左室后壁厚度(LVPWd)、舒张末期左室内径(LVEDD)及左室射血分数(LVEF);3D-STI获取左室整体纵向应变(GLS)、左室整体圆周应变(GCS)、左室整体径向应变(GRS)及左室整体面积应变(GAS);心电图获取12导联QRS波群振幅总和(ΣQRS)、V1导联S波振幅与V5导联R波振幅之和(SV1+RV5)、V3导联S波振幅与aVL导联R波振幅之和(SV3+RaVL)、V2导联R波振幅与V1导联S波振幅之和(RV2+SV1)、V3导联R波振幅与V1导联S波振幅之和(RV3+SV1),比较两组上述参数的差异。采用Pearson相关分析法分析3D-STI参数与心电图参数的相关性;绘制受试者工作特征(ROC)曲线分析3D-STI参数对AHCM的诊断效能。结果二维超声心动图检查显示,观察组IVSd、LVPWd均高于健康组,差异均有统计学意义(均P<0.001);两组LVEDD、LVEF比较差异均无统计学意义。3D-STI检查显示,观察组GRS、GLS均低于健康组,差异均有统计学意义(均P<0.001);两组GCS和GAS比较差异均无统计学意义。心电图检查显示,观察组12导联ΣQRS、SV1+RV5、RV2+SV1、RV3+SV1均高于健康组,差异均有统计学意义(均P<0.001);两组SV3+RaVL比较差异无统计学意义。相关性分析显示,GRS与12导联ΣQRS、SV1+RV5、RV2+SV1、RV3+SV1均呈负相关(均P<0.001);GLS与12导联ΣQRS、SV1+RV5、RV2+SV1、RV3+SV1均呈正相关(均P<0.001)。ROC曲线分析显示,GRS、GLS诊断AHCM的曲线下面积分别为0.889、0.912。结论3D-STI参数与心电图参数相关,其在诊断AHCM中具有较好的临床价值。Objective To analyze the correlation between three-dimensional speckle tracking imaging(3D-STI)parameters and electrocardiogram(ECG)parameters in patients with apical hypertrophic cardiomyopathy(AHCM),and to investigate the clinical value of 3D-STI in the diagnosis of AHCM.Methods A total of 30 AHCM patients(observation group)and 24 healthy subjects(healthy group)were enrolled.Parameters including interventricular septal thickness at end-diastole(IVSd),left ventricular posterior wall thickness at end-diastole(LVPWd),left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF)were obtained by two-dimensional echocardiography.3D-STI was used to measure global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),and global area strain(GAS).ECG parameters including the sum of QRS amplitudes in 12 leads(ΣQRS),SV1+RV5,SV3+RaVL,RV2+SV1,and RV3+SV1.The differences of above parameters between two groups were compared.Pearson correlation analysis was performed to analyze the correlation between 3D-STI parameters and ECG parameters.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of 3D-STI for AHCM.Results Two-dimensional echocardiography showed IVSd and LVPWd in the observation group were significantly higher than those in the healthy group(all P<0.001),while no differences were found in LVEDD and LVEF.3D-STI showed GRS and GLS in the observation group were lower than those in the healthy group(all P<0.001),while GCS and GAS showed no significant differences.ECG showedΣQRS,SV1+RV5,RV2+SV1,and RV3+SV1 in the observation group were significantly higher than those in the healthy group(all P<0.001).Correlation analysis showed GRS was negatively correlated withΣQRS,SV1+RV5,RV2+SV1,and RV3+SV1(all P<0.001),while GLS showed positive correlations with these parameters(all P<0.001).ROC curve analysis showed that the area under the curve of GRS and GLS for diagnosing AHCM were 0.889 and 0.912,respectively.Conclusion 3D-STI has

关 键 词：超声心动描记术 斑点追踪技术 三维 心电图 肥厚型心肌病 

分 类 号：R540.45[医药卫生—心血管疾病]