三维斑点追踪显像超声技术评价左室射血分数保留的心肌淀粉样变的应变指标及预后

Evaluation of strain indexes and prognosis of patients with cardiac amyloidosis with preserved LVEF by three-dimensional speckle tracking imaging

目的利用三维斑点追踪显像超声技术(3D-STI)对左室收缩功能保留的心肌淀粉样变进行评估,并与肥厚型心肌病相鉴别,同时对预后作判断。方法选取2013年6月至2018年1月入住浙江大学医学院附属第一医院经病理确诊的左室射血分数保留(LVEF≥50%)的心肌淀粉样变患者共32例及诊断明确的肥厚型心肌病患者34例,并设经过门诊体检的健康对照组16名,分别利用常规超声心动图及3D-STI对各组指标进行测量,应用Logistic回归方程分析指标差异,采用Kaplan-Meier及Cox作生存回归分析。结果通过3D-STI测得两组整体径向应变(16%±7%比23%±9%)、左室各壁达峰时间差(52ms±17ms比77ms±25ms)、Sokolow-Lyon指数(20mm±6mm比34mm±14mm),两组比较差异有统计学意义,经单因素Logistie回归分析具有较高的敏感度及特异度,其中整体径向应变、左室各壁达峰时间差、sokolow-lyon指数ROC曲线下面积分别为0.725、0.812和0.832。生存分析显示,整体面积应变、房间隔厚度为生存预后的强烈预测因子。结论对于收缩功能保留的心肌淀粉样变的鉴别诊断,不同于常规超声心动图的是,三维斑点追踪显像应变指标可以与肥厚型心肌病相鉴别,体现出明显的诊断优势,结合面积应变及房间隔厚度可对生存预后进行预测,具有重要的临床意义。

Objective To evaluate the patients with Cardiac amyloidosis (CA)and Hypertrophic cardiomyopathy (HCM)by using the strain indexes of three-dimensional speckle tracking imaging(3D-STI) technique,and to evaluate the prognosis.Methods A total of 32 patients with pathologically confirmed cardiac amyloidosis and 34 patients with hypertrophic cardiomyopathy and 16 normal controls were enrolled from the First Affiliated Hospital of Zhejiang University College of Medicine from June,2013 to January, 2018.The color Doppler echocardiography and three-dimensional speckle tracking echocardiography were used to measure strain indexes of each group,and the Logistic regression equation was used to analyze the index differences.The cut-off values were analyzed using the Receiver Operating Characteristic (ROC),and Kaplan-Meier and Cox were used for survival regression analysis.Results The globe radial strain (GRS) (16%±7% vs 23%±9%),left ventricular wall peak time difference (PSD)(52ms±17 ms vs 77ms±25ms),Sokolow-Lyon index (20mm±6mm vs 34mm±14mm)were significantly different between cardiac amyloidosis group and hypertrophic cardiomyopathy group by 3D-STI,which had high sensitivity and specificity by Logistic regression analysis.The area under the ROC curve of GRS was 0.725,PSD was 0.812,Sokolow-Lyon index was 0.832.In addition,the area strain and atrial septal thickness were significant prognostic factors according to survival regression analysis.Conclusions For the differential diagnosis of cardiac amyloidosis with preserved LVEF,unlike echocardiographic parameters,the 3D-STI strain indicators could be used to differentiate cardiac amyloidosis from hypertrophic cardiomyopathy, reflecting obvious diagnostic advantages.When combined with area strain and atrial septal thickness,3D-STI strain indicators could be used to predict the survival prognosis,which are important in clinical practice.