二维斑点追踪显像评价左室旋转和扭转运动在早期心尖肥厚型心肌病诊断中的价值

Evaluation the Value of Left Ventricular Rotation and Torsion in Pre-apical Hypertrophic Cardiomyopathy Diagnosis Using Two-dimensional Speckle Tracking Imaging

目的探讨二维斑点追踪显像评价左室旋转和扭转运动在早期心尖肥厚型心肌病(PAHCM)患者诊断过程中的准确性。方法选择26例PAHCM患者、26例高血压左心室肥厚(HLVH)患者和26例健康志愿者,分别行二维超声心动图检查,记录二尖瓣和心尖水平左室短轴及心尖四腔、二腔心切面的二维超声图像。使用QLAB 9.1软件测量各短轴平面内膜下心肌旋转(endo-rot)、外膜下心肌旋转(epi-rot)、跨壁扭转(mural-tor)及平面旋转(bulk-rot),计算出整体扭转角度(G-tor)。筛选出诊断效力的指标,并绘制受试者工作特征(ROC)曲线来评价诊断的效果。结果在二尖瓣水平,PAHCM组与正常对照组相比,endo-rot、epi-rot、mural-tor及bulk-rot指标的差异无统计学意义(P>0.05);PAHCM组与HLVH组相比,这些指标的差异有统计学意义(P<0.05)。HLVH组与正常对照组相比,endo-rot、epi-rot、mural-tor及bulk-rot指标的差异有统计学意义(P<0.05)。在心尖水平,3组间epi-rot的差异无统计学意义(P>0.05)。PAHCM组与正常对照组相比,endo-rot、mural-tor及bulk-rot指标的差异有统计学意义(P<0.05);PAHCM组与HLVH组相比,这些指标的差异有统计学意义(P<0.05)。与正常对照组相比,HLVH组在endo-rot、mural-tor及bulk-rot指标上的差异有统计学意义(P<0.05)。各组间G-tor的差异均有统计学意义(P<0.05)。ROC曲线分析显示,G-tor鉴别诊断PAHCM的准确性高(ROC曲线下的面积为0.89),敏感度为73.08%,特异度为92.31%。结论二维斑点追踪显像技术可以准确定量测量PAHCM患者左室心肌旋转和扭转的变化。使用G-tor可精确地识别和鉴别高血压心肌肥厚和PAHCM。

Objective To discuss the diagnostic value of two-dimensional speckle tracking imaging in the evaluation of left ventricular rotation and torsion in pre-apical hypertrophic cardiomyopathy （PAHCM） patients. Methods A total of 26 patients with PAHCM, 26 patients with hyperten- sive left ventricular hypertrophy （HLVH） and 26 healthy volunteers were recruited for the study. Two-dimensional echocardiogmphs were performed carefully. Two-dimensional images were obtained from the left ventricular apical four-chamber section, two-chamber section and two short-axis sec- tions, including mitral valve and apical levels. The peak subendocardial rotation （endo-rot）, epicardial rotation （epi-mt）, transmural torsion （mural- tot） and bulk rotation （bulk-mr） of each short-axis section were measured and analyzed using QLAB 9.1 software. Results In the mitral level, there was no statistically significant difference in endo-rot, epi-rot, mural-tot and bulk-rot between the PAHCM group and normal control group （P 〉 0.05 ）. There was statistically significant difference in endo-rot, epi-rot, mural-tor and bulk-rot between the PAHCM group and HLVH group （all P 〈 0.05 ）. There was statistically significant difference in endo-rot, epi-rot, mural-tor and bulk-mr between the HLVH group and normal conm）l group （all P 〈 0.05 ）. In the apical level, there was no statistically significant difference in epi-rot among three groups （P 〉 0.05 ）. There was statisti- cally significant difference in endo-mt, mural-tot and bulk-mr between each two groups （P 〈 0.05）. There was statistically significant difference in G- tot between each two groups （P 〈 0.05 ）. The receiver operating characteristic curve analysis showed that the accuracy of differential diagnosis of G- tor PAHCM was high （the area under the receiver operating characteristic curve is 0.89） , the sensitivity was 73.08% , and the specificity was92.31%. Condusion Two- dimensional speckle tracking imaging could accurately and quantitatively measure the left ventricular rotation and torsion in PAHCM patients. The G-tor could accurately screen and identify between PAHCM and HLVH.