三维斑点追踪技术评价系统性硬化病患者左心室收缩功能

Evaluation of Left Ventricular Global Systolic Function in Patients with Systemic Sclerosis by Three-Dimensional Speckle Tracking Imaging

目的应用三维超声斑点追踪成像技术(3D-STI)评价系统性硬化病(SSc)患者左心室整体收缩功能,并探讨各整体应变指标诊断SSc心脏损害的应用价值。方法选取临床确诊SSc患者34例,其中弥漫性皮肤型(dcSSc)18例,局限性皮肤型(lcSSc)16例,正常健康对照组22例。采集标准心尖四腔心三维全容积图像,运用3D-STI软件脱机分析得出左心室整体面积收缩期峰值应变(GAS)、整体圆周收缩期峰值应变(GCS)、整体纵向收缩期峰值应变(GLS)、整体径向收缩期峰值应变(GRS)及左心室射血分数(LVEF)等指标。结果 SSc组左心室GAS、GCS、GLS及GRS较对照组减低,差异有统计学意义(P<0.05);dcSSc组左心室GAS、GCS、GLS及GRS较lcSSc组减低,其中GAS和GLS差异有统计学意义(P<0.05)。ROC曲线显示,GAS诊断SSc左心室损害的AUC最大,为0.877,当GAS截断值为-29.34%时,其灵敏度为88.2%,特异度为77.3%。结论 SSc患者左心室纵向、环向及径向收缩功能均已存在不同程度的受损,3D-STI可早期评价SSc患者的左心室整体收缩功能,在各项应变指标中,以GAS诊断SSc心脏损害的准确度最高。

Objective To evaluate the global systolic function of left ventricle by three-dimensional speckle tracking imaging（3D-STI）in patients with systemic sclerosis（SSc）and determine the diagnostic value of all global strain parameters in detecting cardiac function damage of SSc.Methods A total of 34 cases with SSc were enrolled and put into the experiment group.18 cases were with diffuse cutaneous SSc（dcSSc）and 16 cases were with limited cutaneous SSc（lcSSc）.Meanwhile,22 healthy subjects were enrolled and put into the control group.After collecting full-volume image of apical four-chamber,the software of 3D-STI Offline Analysis was applied to acquire the data including left ventricular global area peak systolic strain（GAS）,global circumferential peak systolic strain（GCS）,global longitudinal peak systolic strain（GLS）,global radial peak systolic strain（GRS）and left ventricular ejection fraction（LVEF）.The global strain values to diagnose cardiac function damage were analyzed by the receiver operating characteristic（ROC）curve.Results The experiment group was significantly lower in GAS,GCS,GLS and GRS of left ventricle than the control group（P〈0.05）.The dsSSc group was lower in GAS,GCS,GLS,and GRS of left ventricle than the lcSSC group,but there were significant differences in GAS and GLS between the two groups（P〈0.05）.According to the ROC curve,the area under the curve（AUC）of GAS to diagnose cardiac function damage was the largest with 0.877.The sensitivity and specificity were 88.2% and77.3% respectively when the catoff value of GAS was-29.34%.Conclusion The longitudinal,circumferential and radial systolic functions have been damaged to varying degree in patients with SSc.The 3D-STI analysis can be used to detect subtle global systolic dysfunction of left ventricle at an early stage.It is the most accurate to diagnose the cardiac function damage by detecting GAS than the other global strain parameters.