常规超声联合左心声学造影测量不同时相非致密心肌与致密心肌厚度比值在心肌致密化不全中的诊断价值

Diagnostic value of thickness ratio between noncompacted and compacted myocardium of different phases with conventional and left heart contrast echocardiography in noncompaction cardiomyopathy

目的对比分析超声心动图舒张末期和收缩末期非致密心肌与致密心肌厚度比值(NC/C)在诊断左室心肌致密化不全(LVNC)中的价值。方法2019年6月至2020年6月于华中科技大学同济医学院附属协和医院就诊、超声疑诊LVNC患者35例,分别应用常规超声(2DE)和左心声学造影(LVO),于收缩末期和舒张末期测量NC/C,以收缩末期NC/C值>2.0、舒张末期NC/C值>2.3为阳性节段(NC节段),记录NC/C值、分层心肌节段数、NC节段数和诊断结果,并与心脏磁共振成像(cMRI)结果对照。结果在2DE基础上联合LVO,与2DE相比,收缩末期观察节段显示数增多(P<0.001),但分层节段数、NC节段数无明显提高(P>0.006),诊断准确性差异无统计学意义(P>0.05);舒张末期观察3种节段数明显增多(均P<0.001),诊断准确性明显提高(P<0.05)。2DE+LVO于舒张末期观察分层节段、NC节段显示数与cMRI差异无统计学意义(均P>0.006),诊断的敏感性(88.9%)和准确性(85.7%)最高,且ROC曲线下面积最大(0.95)。结论在2DE基础上,联合应用LVO能够显著提高对NC节段的显示,且应用舒张末期NC/C值诊断LVNC的准确性高于收缩末期。

Objective To analyze the diagnostic value of thickness ratio between noncompacted and compacted myocardium(NC/C ratio)measured by echocardiography at end-systole and end-diastole comparatively in left ventricular noncompaction(LVNC).Methods Thirty-five patients with suspected LVNC were collected and underwent conventional(2DE)and left ventricular opacification(LVO)in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from June 2019 to June 2020.The distribution and detection rate of two-layered segments,non-compaction(NC)segments and their NC/C ratios were comparatively analyzed at end-diastole and end-systole using 2DE,LVO and combined techniques respectively.With the diagnostic criteria of end-diastolic NC/C ratio>2.3 or end-systolic NC/C ratio>2.0,echocardiographic results were also recorded and compared with cMRI results.Results Compared with 2DE,the number of detected segments was increased(P<0.001),but the numbers of two-layered segments and NC segments were not significantly improved in end-systole using 2DE combined with LVO(P>0.006).The diagnostic accuracy was not statistically significant(P>0.05).However,when observing in end-diastole,the detected numbers of 3 kinds of segments were significantly increased using 2DE+LVO in comparison with 2DE(all P<0.001),and the diagnostic accuracy was also significantly improved(P<0.05).There were no significant differences in the detected rates of two-layered and NC semgents between 2DE+LVO and cMRI(P>0.006).2DE+LVO in end-diastole resulted in the highest diagnostic sensitivity(88.9%)and accuracy(85.7%),and also the largest area under ROC curve(0.95).Conclusions The combination of 2DE and LVO can detect more NC segments,and diagnostic accuracy of end-diastolic NC/C ratio is higher than that in end-systolic in patients with LVNC.