摘要
目的应用三维斑点追踪显像（3D-STE）技术评价家族性肥厚型心肌病（HCM）基因突变携带者左心室收缩功能的改变。方法连续选择家族性HCM携带突变基因但无左心室肥厚者41例为基因阳性表型阴性（G^＋／P^-）组，同期选择性别、年龄相匹配的无基因突变的家族成员以及健康志愿者40例为对照组。采用3D-STE测量所有受试者左心室三维整体纵向应变（3D-GLS）、三维整体圆周应变（3D-GCS）和三维整体径向应变（3D-GRS），比较两组上述参数值差异。结果与对照组比较，G^＋／P^-组左房容积指数显著增大（P〈0．001），组织多普勒（TDI）二尖瓣环舒张早期峰值速度（Ea）显著降低（P=0．05），E／Ea显著升高（P=0．045）。G^＋／P^-组3D-GLS（P=0．001）以及3D-GRS（P=0．009）较对照组显著减低，两组3D-GCS差异无统计学意义（P〉0．05）。ROC分析显示：3D-GLS（截点值=-19．5％）诊断HCM基因携带者的敏感性为70．7％，特异性为95．0％，曲线下面积为0．835（95％CI：0．747-0．924，P〈0．001），3D-GRS（截点值=43．8％）诊断HCM基因携带者的敏感性为55．0％，特异性为65．9％，曲线下面积为0．632（95％CI：0．512-0．753，P〈0．001）。结论家族性HCM基因突变携带者左心室收缩功能发生早期改变，3D-STE可为基因携带者早期诊断提供定量信息。
Objective To explore the value of three dimensional speckle tracking echocardiography （3D-STE） in evaluating the left ventricular systolic function in familiar hypertrophic cardiomyopathy （HCM） mutation carriers. Methods Eighty-one subjects were divided as： HCM mutation carriers but without left ventricular hypertrophy （G^＋/P^- ） （ n = 411 and normal controls （ n = 40）. Normal control group including healthy volunteers and heahhy family members in whom sarcomere gene mutations were excluded by genetic analysis. They also prospectively underwent 3D-STE to complete strain analysis of the left ventricle. The variables of 3D global systolic longitudinal strain（3D-GLS）, 3D global systolic radial strain （3D-GRS） and 3D global circumferential strain（3D-GCS） in two groups were compared. Results Compared with normal controls, the G^＋/P^- group showed significantly higher left atrial volume index （P〈 0.001）. Averaged Ea value by TDI was reduced （ P = 0.05/, while averaged E/Ea was higher （ P = 0.045/. GLS of G^＋/P^- group showed a notable reduction （ P = 0.001）, as well as GRS （ P = 0.009）; however 3D-GCS were not significantly different from controls （ P 〉0.05）. 3D-GLS determined after ROC analysis identified mutation carriers with 70.7% sensitivity and 96% specificity, 3D-GRS with 55.0% sensitivity and 65.9% specificity. Conclusions The systolic function of left ventricular has changed in familiar hypertrophic cardiomyopathy mutation carriers, 3D-STE could provide quantitative information for gene mutation carriers in early identification.
出处
《中华超声影像学杂志》
CSCD
北大核心
2016年第10期834-839,共6页
Chinese Journal of Ultrasonography
基金
科技部国家国际合作专项（2014DFA31980）
国家自然科学基金青年项目（81501472）
关键词
三维斑点追踪显像
心肌病
肥厚性
基因突变
携带者
心室功能
左
Three dimensional speckle tracking imaging
Cardiomyopathy, hypertrophic
Genemutation
Carriers
Ventricular function, left
