斑点追踪成像技术评价心脏淀粉样变性患者左心室整体及局部纵向收缩功能

Assessment of general and local left ventricular systolic function by speckle tracking imaging in patients with cardiac amyloidosis

目的应用二维斑点追踪成像技术(2D-STI)检测心脏淀粉样变性(CA)患者左心室长轴收缩功能的变化,探讨其临床应用价值。方法选择确诊的CA患者20例为CA组,其中男性13例,女性7例,平均年龄54.80岁。选取年龄和性别匹配的健康志愿者30例为正常对照组,其中男性18例,女性12例,平均年龄54.85岁。分别采集心尖四腔心切面、心尖两腔心切面和心尖左心室长轴切面的二维动态图像,应用2D-STI获取左心室18个心肌节段收缩期纵向峰值应变,计算左心室基底段、中间段、心尖段的平均纵向峰值应变及左心室整体纵向峰值应变。结果所有受检者左心室心尖段到基底段纵向峰值应变逐渐减低。CA组左心室各节段收缩期纵向应变峰值均显著低于正常对照组,差异均有显著统计学意义(P<0.001)。CA组左心室基底段、中间段、心尖段平均纵向峰值应变及左心室整体纵向峰值应变均显著低于正常对照组,差异均有显著统计学意义(P<0.001)。结论 CA患者左心室整体及局部纵向收缩功能均减低,2D-STI能够从长轴纵向应变的角度更敏感、准确评估CA患者收缩功能的变化,适合临床广泛开展。

Objective To evaluate the left ventricular long-axis systolic function in patients with cardiac amyloidosis （CA） by two-dimensional speckle tracking imaging （2D-STI）, and investigate its clinical significance. Methods A total of 20 patients with CA were set as CA group, which included 13 males and 7 females with mean age of 54.80 years old. The 30 healthy volunteers were set as control group, which included 18 males and 12 females with mean age of 54.85 years old. The apical 4-chamber view, apical two-chamber view and apical long-axis view of left ventricle were obtained by two-dimensional dynamic images. The systolic longitudinal strain（LS） peaks of 18 myocardial segments in left ventricular were obtained by 2D-STI. The left ventricular basal segments, middle sections and apical segments of mean peak LS and left ventricular general LS were calculated. Results The LS of healthy subjects and CA patients decreased from apical to basal in left ventricular. The LS of all left ventricular segments in CA group were significantly lower than those in control group, and the differences were statistically significant （P〈0.001）. The left ventricular basal segment, middle section and apical segment of mean peak LS and left ventricular general LS in CA group were significantly lower than those in control group and the differences were statistically significant （P〈0.001）. Conclusion It is demonstrated that the general and local of left ventricular systolic function in CA patients are all decreased. The 2D-DTI is the feasible technique for sensitive and accurate assessment of cardiac longitudinal systolic function in CA patient, which could be widely used in cardiac examination.