二维斑点追踪成像心脏淀粉样变与其他引起左心室肥厚的疾病左心室旋转和扭转运动的研究

Evaluation of left ventricular rotation and torsion by two-dimensional strain imaging echocardiography in the patients with cardiac amyloidosis and ventricular wall thickening caused by other diseases

目的应用斑点追踪成像（STI）技术测量心脏淀粉样变（CA）与其他引起左心室肥厚的疾病左心室短轴方向旋转和扭转角度,探讨STI评价CA患者左心室旋转和扭转运动的临床价值。方法 24例CA患者（CA组）,其中男性15例,女性9例;年龄42-70岁,平均57.25岁。21例高血压左心室肥厚（HLVH）患者（HLVH组）,其中男性13例,女性8例;年龄39-73岁,平均年龄54.24岁。15例肥厚型心肌病（HCM）患者（HCM组）,其中男性9例,女性6例;年龄41-69岁,平均年龄55.07岁。健康志愿者28例（对照组）,其中男性17例,女性11例;年龄42-72岁,平均年龄54.75岁。对24例CA、21例HLVH、15例HCM及28例健康志愿者,分别行二维超声心动图检查,分别采集左心室短轴图像,测量各平面的内膜下心肌旋转（endo-rot）、外膜下心肌旋转（epi-rot）、平面旋转（bulk-rot）及跨壁扭转（mural-tor）峰值。计算左心室整体扭转（lv-tor）峰值。结果 1与对照组比,CA组各个水平旋转及扭转峰值、lv-tor峰值均减低（P〈0.05）;HLVH组心尖水平endo-rot、epi-rot、bulk-rot峰值减低（P〈0.05）;HCM组二尖瓣水平endo-rot、mural-tor峰值减低（P〈0.05）,心尖水平endo-rot、epi-rot、bulk-rot峰值明显减低（P〈0.005）。2CA组二尖瓣水平各旋转及扭转峰值低于HLVH组及HCM组（P〈0.05）,lv-tor峰值低于HLVH组（P〈0.05）。3HCM组与HLVH组比较,各旋转及扭转峰值差异无统计学意义（P〉0.05）。结论 CA、HCM、HLVH患者心功能受损,左心室旋转及扭转运动发生变化,CA表现在全部水平及整体减低,HCM组及HLVH组主要集中在心尖水平减低,与HCM及HLVH组相比,CA旋转及扭转运动主要集中在基底水平,示二维STI能够从短轴各平面心肌旋转和扭转运动的角度更准确及敏感反映CA患者心肌功能变化。

Objective To comparatively analyze left ventricular（LV） rotation and torsion characteristics of cardiac amyloidosis（CA） and ventricular wall thickening caused by other diseases, and assess the clinical value of LV rotation and torsion by STI.Methods A total of 84 cases were enrolled, included 24 patients with CA（CA group, which included 15 males and 9 females,42-70 years old with mean age of 57.25 years old）, 21 with hypertensive left ventricular hypertrophy（HLVH）（HLVH group,which included 13 males and 8 females, 39-73 years old with mean age of 54.24 years old）, 15 with hypertrophic cardiomyopathy（HCM）（HCM group, which included 9 males and 6 females, 41-69 years old with mean age of 55.07 years old）, and 28 healthy volunteers（control group, which included 17 males and 11 females, 42-72 years old with mean age of 54.75 year old）.All of them were performed two-dimensional echocardiography, and high frame rate two-dimensional images of LV at basal and apical short-axis views were acquired. The peak subendocardial rotation（endo-rot）, peak subepicardial rotation（epi-rot）,peak bulk rotation（bulk-rot）, and peak mural torsion（mural-tor） were measured. Then, peak left ventricular torsion（lv-tor） were calculated. Results ① Compared with control group, LV rotation and torsion characteristics, and epi-rot were decreased in CA group（P〈0.05）; peak endo-rot, peak epi-rot, and peak bulk-rot at apex level were decreased in HLVH group（P〈0.05）;peak endo-rot and peak mural-tor at the base level were decreased in HCM group（P〈0.05）, peak endo-rot, peak epi-rot, and peak bulk-rot at apex level were significantly decreased（P〈 0.005）; ②Compared with HLVH group and HCM group, the rotation and torsion characteristics at the base level were decreased in CA group（P〈0.05）, and compared with HLVH group, peak lv-tor were decreased in CA group（P〈0.05）; ③No significant difference existed between CA group and HCM group（P〉0.05）.Conclusion It is demonstrated that cardiac function was impaired with abnormalities of left ventricular rotation and torsion in CA, HLVH and HCM patients. Furthermore, rotation and torsion characteristics, peak lv-tor are decreased in CA group. As for HCM group and HLVH group, rotation and torsion characteristics at apex level are decreased. Compared with HLVH group and HCM group, the rotation and torsion characteristics at the base level are decreased in CA group, which showed STI could exactly and sensitively evaluate myocardial functional changes from the alteration of LV rotation and torsion in patients with CA.