摘要
目的应用超声斑点追踪技术评价肥厚型心肌病(HCM)患者左心室整体及局部心肌功能,并探讨超声应变参数与心肌纤维化的相关性。方法回顾性分析2019年12月至2021年5月收治的46例HCM患者(HCM组),同时选取同期健康志愿者66例作为健康对照组。应用超声斑点追踪技术测量HCM组患者及健康对照组整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS),并根据心脏大血管磁共振成像(CMR)所示心肌肥厚及纤维化节段计算病变区域局部LS、CS、RS。比较不同组间及病变区域与非病变区域间参数的差异。结果HCM组患者左心房容积(LAVI)、舒张末期室间隔厚度(IVSD)、左心室后壁厚度(LVPWD)、二尖瓣口舒张早期血流速度峰值E/二尖瓣环舒张期运动峰值e’均大于健康对照组,左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、e’均小于健康对照组,且差异均有统计学意义(P<0.05)。HCM组患者GLS、GCS均小于健康对照组,GRS大于健康对照组,且差异均有统计学意义(P<0.05)。钆对比剂心肌延迟强化(LGE)定量分析显示,HCM组中38例(82.6%)合并LGE,LGE节段共116个(14.0%)。HCM组患者中心肌厚度<15 mm节段、≥15 mm节段、LGE节段LS、CS均小于健康对照组,且差异均有统计学意义(P<0.05)。受试者操作特征(ROC)曲线显示,单一节段LS预测LGE的阈值为-12%,敏感度为79%,特异度为98%,曲线下面积(AUC)为0.863。Pearson相关分析结果显示,GLS及GCS与最大室壁厚度、e’、心肌厚度≥15 mm节段数、LGE及LGE节段数均有相关性(P<0.05),其中GLS与LGE及LGE节段数相关性最高(r=0.598、0.587,P<0.05)。结论心肌肥厚和纤维化均可导致HCM患者心肌功能损害。超声斑点追踪技术可以定量分析心肌功能,可用于HCM患者左心室整体及局部纤维化节段功能评价。
Objective To evaluate the left ventricular global and local myocardial function in patients with hypertrophic cardiomyopathy(HCM)by ultrasonic speckle tracking technique,and to explore the correlation between ultrasonic strain parameters and myocardial fibrosis.Methods Echocardiography and cardiac magnetic resonance imaging(CMR)images of 46patients with HCM were retrospectively analyzed,and 66 patients in the control group were selected.The global longitudinal strain(GLS),global peripheral strain(GCS)and global radial strain(GRS)in HCM group and control group were measured by echocardiography.Local LS,CS and RS in the lesion and fibrosis segments shown by CMR were calculated.The differences of parameters between different groups and between lesion segments and non-lesion segments were compared.Results In HCM group,LAVI,IVSD,LVPWD and E/E’were higher,while LVEDD,LVEDV,LVESV,E’were lower than those in control group(P<0.05).As for strain parameters,the absolute value of GLS and GCS in HCM group was lower,while GRC was higher(P<0.05).In the HCM group,there were 38 patients(82.6%)with a total of 116 segments(14.0%)of delayed myocardial enhancement.In HCM patients,<15 mm segment,≥15 mm segment and LGE segments’LS,CS absolute values were lower than the control group(P<0.05).Correlation analysis showed that GLS and GCS were significantly correlated with maximum wall thickness,E’,number of segments with wall thickness≥15 mm,LGE positive and LGE segment number(P<0.05).GLS had the highest correlation with LGE positivity and the number of LGE segments(r=0.598,0.587,P<0.05).The area under curve(AUC)of LS for LGE prediction was 0.863,the best cutoff value was-12%,the sensitivity was 79%,and the specificity was 98%.Conclusion Both cardiac hypertrophy and fibrosis can lead to impairment of HCM myocardial function.Ultrasonic speckle tracking technology can quantitatively analyze myocardial function and provide functional evaluation for the overall and local fibrosis segmental function of left ventricle in patients wit
作者
李慕子
李慧
孟红
海兴瑞
侯志辉
李维君
骆志玲
王浩
段福建
LI Mu-zi;LI Hui;MENG Hong;HAI Xing-rui;HOU Zhi-hui;LI Wei-jun;LUO Zhi-ling;WANG Hao;DUAN Fu-jian(Department of Echocardiography,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Department of Ultrasonography,Fuwai Yunnan Cardiovascular Hospital,Kunming 650000,China;Department of Radiology,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)
出处
《中国分子心脏病学杂志》
CAS
2022年第1期4403-4408,共6页
Molecular Cardiology of China
基金
云南省心血管病临床医学中心项目(FZX2019-06-01)
中央高校基本科研业务费(3332020018)。
