超声心动图诊断心肌致密化不全

Echocardiographic diagnosis of noncompaction of ventricular myocardium

目的探讨心肌致密化不全(NVM)的超声图像特征,评价超声心动图对该病的诊断价值。方法回顾分析临床疑诊的21例NVM患者的超声心动图结果,以尸检结果作为金标准,确定超声心动图诊断该病的真实性和可靠性。结果本组21例NVM患者超声诊断16例。超声心动图主要表现为:①左室或右室中、下1/3至心尖的心腔内可见多数粗大的肌小梁结构,小梁间隙深陷形成窦状;②受累腔室扩大,室壁变薄,运动减弱,收缩增厚率减低;③彩色多普勒显示肌小梁血窦内血流缓慢,且与心腔相通。超声诊断NVM的真实性指标灵敏度、特异度、准确度、假阳性率、假阴性率、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数比分别是93.75%、80.00%、90.48%、20.00%、6.25%、93.75%、80.00%、4.69、0.078、0.74。可靠性指标卡帕值为0.74。结论多数NVM患者显示典型的二维及多普勒超声心动图特征,后者可作为超声心动图检测该病的诊断标准。

Objective To explore the echocardiographic characteristics of noncompaction of ventricular myocardium （NVM）, and to assess its value in the diagnosis of NVM. Methods The diagnostic results of 21 NVM-suspected patients by echocardiography were retrospectively analyzed and compared with the results of autopsy to verify the reliability of echocardiography. Results Among 21 patients suspected with NVM, 16 cases had been confirmatively diagnosed by echocardiography. The characteristics of echocardiography included many thick muscle trabeculae and deep blood sinusoid in the chambers from one-third left or right sub-ventricle to apex cordis, the involved ventricular chambers expanded, the wall became thinner, the movement became weaker, the contraction thickening rate became lower, the velocity lower in blood sinusoid of muscle trabecula and the blood sinusoid connected with ventricular chamber. The sensitivity, specificity, accuracy, false positive rate, false negative rate, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Yourdon＇s index and Kappa value were 93.75% , 80.00%, 90.48% , 20.00% , 6.25% , 93.75% , 80.00%, 4.69, 0. 078, 0.74 and 0.74, respectively. Conclusion The two-dimensional and Doppler echocardiographic images, typical of most NVM patients, can be regarded as standard index of ultrasonic echocardiogram in the diagnosis of NVM, which may facilitate the diagnosis, treatment and follow-up of NVM patients.