三维斑点追踪成像评价亚临床甲状腺功能减退患者左心室收缩功能

Three-dimensional speckle tracking echocardiography in evaluation of left ventricular systolic function in patients with subclinical hypothyroidism

目的评价三维斑点追踪成像(3D-STE)技术对亚临床甲状腺功能减退(SCH)患者左心室心肌功能减低的预测价值。方法对32例SCH患者(SCH组)和30名健康志愿者(对照组)行3D-STE检查,获得左心室收缩期整体面积应变(GAS)、整体纵向应变(GLS)和整体环向应变(GCS)。比较对照组和SCH组治疗前后左心室三维应变参数差异,以左心室射血分数<65%为诊断左心室收缩功能减低金标准,采用ROC曲线评价左心室三维应变参数诊断SCH左心室收缩功能减低的效能。结果 SCH组治疗前后GAS、GLS和GCS绝对值均低于对照组(P均<0.05),治疗后GAS、GLS和GCS绝对值均高于治疗前(P均<0.05)。ROC曲线显示GAS、GLS和GCS的AUC分别为0.805、0.723和0.614,分别以-40.5%、-29.3%和-32.6%作为GAS、GLS和GCS诊断左心室功能减低界值,其敏感度分别为85.7%、77.8%和71.1%,特异度分别为72.2%、71.3%和60.1%。结论 3D-STE中GAS诊断SCH患者左心室收缩功能减低效能较高,具有一定的临床预测价值。

Objective To assess the clinical value of three-dimensional speckle tracking echocardiography （3D-STE） in evaluation of left ventricular systolic function in patients with subclinical hypothyroidism （SCH）. Methods A total of 32 patients with SCH （SCH group） and 30 healthy volunteers （control group） underwent 3D-STE to obtain the global area strain （GAS）, global longitudinal strain （GLS） and global circumferential strain （GCS）. The 3D-STE strain parameters were compared between control group and SCH group before and after treatment, and the sensitivity and specificity of strain parameters in diagnosis of potential myocardial systolic dysfunction were assessed ROC curve with left ventricular e- jection fraction 〈65% as gold standard. Results GAS, GLS and GCS deteriorated significantly in SCH group before and after therapy in comparison with those in control group （all P〈0.05）, while were improved after therapy compared with pretreatment （all P〈0.05）. The ROC curve showed that the area under curve was 0. 805, 0. 723 and 0. 614 for GAS, GLS and GCS, and the sensitivity and specificity in diagnosis of potential myocardial systolic dysfunction was 85.7% and 72.2% for GAS with cut-off value of --40.5%, 77.8% and 71.3% for GLS with cut-off value of --29.3%, 71.1% and 60.1% for GCS with cut-off value of --32.6%. Conclusion In 3D-STE, GAS has preferable ability in diagnosis of myocardial sys- tolic dysfunction in patients with SCH.