二维斑点追踪成像技术评价蛛网膜下腔出血患者心脑功能损伤程度

Evaluation of Neuro-Cardiac Injury in Patients with Aneurysmal Subarachnoid Hemorrhage by Two-Dimensional Speckle Tracking Imaging

目的探讨二维斑点追踪成像(2D-STI)评价动脉瘤性蛛网膜下腔出血(a-SAH)患者心脑功能损伤程度的临床价值。方法常规超声心动图检查评价入组患者射血分数(EF),并且从3个心尖切面18个左室节段评价左室长轴应变。计算整体长轴应变(GLS)及每个节段应变达峰时间之变异程度(Dispersion)。结果纳入40例a-SAH患者。按心肌肌钙蛋白(cTnI)水平将其分为高cTnI组(cTnI≥0.3ng·mL^-1,n=12)及低cTnI组(cTnI<0.3ng·mL^-1,n=28)。2组急性期晚期GLS与Dispersion值较急性期早期有明显改善(P<0.05),低cTnI组的改善程度较高cTnI组更为显著(P<0.05)。结论GLS以及反映左室局部运动不协调的指标Dispersion与表现为cTnI升高的a-SAH心脑损伤密切相关。对比EF等常规超声指标评价a-SAH患者心脑功能损伤程度,GLS与Dispersion更加敏感,可以为临床诊断及治疗提供更多的支持。

Objective To investigate the clinical value of two-dimensional speckle tracking imaging(2D-STI) in evaluating the severity of neuro-cardiac injury in patients with aneurysmal subarachnoid hemorrhage(a-SAH). Methods The ejection fraction(EF) was assessed by echocardiography in patients with a-SAH.Furthermore,left ventricular longitudinal strain(18 segments from 3 apical views) was evaluated.Global longitudinal strain(GLS) and standard deviation(dispersion) of time-to-peak strain were calculated. Results Of the 40 a-SAH patients,12(30%) had highly positive cTnI cardiac troponin Ⅰ(cTnI)(≥0.3 ng·mL^-1),and 28(70%) had mildly positive cTnI cTnI(<0.3 ng·mL^-1).GLS and dispersion in late acute stage of a-SAH were significantly improved compared with those in early acute stage in both groups,and the improvement in mildly positive cTnI group was more obvious than that in highly positive cTnI group( P <0.05). Conclusion GLS and left ventricular regional discoordination measured by prolonged dispersion are significantly associated with neuro-cardiac injury after a-SAH as reflected by highly positive cTnI.GLS and dispersion are more sensitive than EF and other routine ultrasound indicators for evaluating the severity of neuro-cardiogenic injury,and can provide more support for clinical diagnosis and treatment in patients with a-SAH.