超声心动图结合声学造影对早期心尖肥厚型心肌病的诊断

Value of echocardiography combined with ultrasound contrast in the diagnosis of pre-apical hypertrophic cardiomyopathy

目的:探讨超声心动图结合声学造影在早期心尖肥厚型心肌病(PAHCM)诊断中的应用。方法:选择磁共振成像确诊为PAHCM的病人32例,正常对照组为32名健康志愿者,对比2组间超声心动图及声学造影特征。结果:与正常对照组比较,PAHCM组左室心尖部与后壁心肌厚度比值、左室心肌重量、左房容积指标均增高(P<0.05),左室心尖部心肌厚度明显增高(P<0.01),E/A比值明显下降(P<0.01);与正常对照组心尖部心肌比较,PAHCM组心尖肥厚心肌组(P-AM组)平台峰值强度(A)、曲线上升斜率(β)及A×β值均明显下降(P<0.01);与PAHCM组左室后壁组(P-LVPW组)比较,P-AM组造影A值下降(P<0.05～P<0.01)、β值及A×β值明显下降(P<0.01);与正常对照组的左室后壁比较,P-LVPW组的A、β及A×β值差异无统计学意义(P>0.05)。以磁共振诊断为金标准,常规超声心动图诊断PAHCM的敏感性和特异性为28.1%、82.1%,超声心动图结合声学造影的敏感性和特异性为100%、100%。结论:超声心动图结合声学造影在PAHCM的诊断中具有较高的临床应用价值。

Objective:To discuss the application value of echocardiography combined with ultrasound contrast in the diagnosis of pre- apical hypertrophy cardiomyopathy(PAHCM). Methods:Thirty-two patients with PAHCM diagnosed by MRI and 32 healthy volunteers were divided into the PAHCM group and normal control group,respectively. The characteristics of echocardiography and ultrasound contrast were compared between two groups. Results:Compared with normal control group,the ratio of the myocardial thickness of left ventricular apical to posterior wall,left ventricular mass and left atrial volume increased (P < 0. 05),the left ventricular apical myocardial thickness increased significantly(P < 0. 01),and the value of E/ A decreased significantly in PAHCM group(P < 0. 01). Compared with the posterior wall myocardium of left ventricle of PAHCM group(P-LVPW group),the level of peak strength of platform (A) decreased(P <0. 05 to P <0. 01),and the curve rise slope(β) and A ×βdecreased significantly in P-AM group(P <0. 01). The differences of the levels of A,βand A ×βbetween P-LVPW group and posterior wall myocardium of left ventricle in normal control group were not statistically significant(P >0. 05). Using the diagnosis of MRI as a golden standard,the sensitivity and specificity of conventional echocardiography in the diagnosis of PAHCM were 28. 1% and 82. 1%, respectively, and both the sensitivity and specificity of echocardiography combined with ultrasound contrast in the diagnosis of PAHCM were 100%. Conclusions: Echocardiography combined with ultrasound contrast has great clinical application value in the diagnosis of PAHCM.