应变成像评价扩张型心肌病临床心功能分级

The Preliminary evaluation of left ventricular strain in clinical cardiac function classification in patients with dilated cardiomyopathy

目的应用超声斑点追踪技术(STI)检测扩张型心肌病(DCM)心肌应变及扭转,并与临床心功能分级进行比较分析,探讨心肌应变及扭转定量评估DCM临床心功能分级的价值。方法随机对51例DCM患者分为临床心功能低积分组(A组27例)及高积分常组(B组24例),并选择正常对照组30例(C组),比较受检者临床心功能积分(NYHA-AP)左室射血分数(LVEF)、左室心肌整体径向应变(GRS)、纵向应变(GLS)、左室心肌收缩期心肌扭转角度(TA)。结果 DCM组与对照组比较:LVEF减低(P<0.05),GLS、GRS、TA减低(P<0.05);DCM组中A组GLS、GRS、TA与LVEF相关性不大,与NYHA-AP相关性好,(P>0.05),B组GLS及GRS、TA与LVEF及NYHA-AP相关性较好(P<0.05);若以GLS-13.05%为截断点判定患者心功能符合临床NYHA分级Ⅰ-Ⅱ级灵敏度为87.33%、特异度为74%,Yuedden指数最高0.579。结论2D-STI技术检测心肌应变及扭转评价DCM左心室局部功能具有独特的优越性,左室局部心肌应变及扭转与临床心功能分级相关,临床心功能分级尚好或程度患者局部心肌应变及扭转角度已经下降,应变及扭转变化与临床心功能分级同步发展,应变及扭转明显异常预示心功能向异常化进展。

Objective To detect the left ventricular myocardial strain and torsion by using 2D speckle tracking technology （2D - STI） , compare the myocardial strain and torsion with New York Heart classification accumulated points （ NYHA - AP） , so as to explore the value of myocardial strain and torsion in quantitative assessment of NYHA - AP in patients with dilated cardiomyopathy （DCM）. Methods 51 patients with DCM were divided into group A with lower NYHA -AP （27 patients） and group B with higher NYHA -AP （24 cases） , 30 subjects as normal control group of （group C）. The left ventricular ejection fraction （LVEF） , left ventrieular myocardial overall longitudinal strain （GLS）, overall radial strain （GRS） and left ventlicular myocardial systolic torsion angle （TA） were compared in all the subjects. Results （1）The LVEF,GLS, GRS, TA were lower in DCM group than that in the control group （P 〈0.05） , and The LVEF,GLS, GRS, TA were lower in group B than that in group A （P 〈0.05） ; （2） There was less correlation between GLS, GRS, TA and LVEF in group A （P 〉 0.05） ; then there was positively correlated between GLS, GRS, TA and LVEF,NYHA - AP in group B ,GLS, GRS;The cut - off point of GLS - 13.05% for determing NYHA class Ⅰ - Ⅱ grade with sensitivity 87,33% , specificity was 74%. Conclusion 2D - STI has unique advantages in evaluating the regional myocardial function and the clinical cardiac function classification, myocardial strain and rotation are correlated with clinical cardiac function, regional myocardial function variation is simutaneous development with the clinical cardiac function, the myocardial strain and rotation decrease even if NYHA is still good or lesser degree, the decreased myocardial strain and rotation indicate heart dysfunction development.