心肌声学造影联合心脏MRI对肥厚性心肌病的诊断价值

Myocardial contrast echocardiography combined with cardiac MRI in the diagnosis of hypertrophic cardiomyopathy

目的探讨心肌声学造影联合心脏MRI对肥厚性心肌病的诊断价值。方法选取95例肥厚性心肌病患者(观察组)和95例健康体检者(对照组),两组均行心肌声学造影和心脏MRI检查,比较两组左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、舒张早期与晚期峰值流速的比值(E/A)、舒张晚期运动速度(Am)、二尖瓣舒张早期血流峰值流速(E)、左室心肌质量指数(LVMMI)、心指数(CI)、左室高峰射血率(LVCO)、左室收缩末期容积指数(LVESVI)、左室每搏输出量指数(LVSVI)的差异。绘制受试者工作特征(ROC)曲线分析心肌声学造影、心脏MRI检查及其联合对肥厚性心肌病的诊断效能,计算曲线下面积(AUC)。结果心肌声学造影检查显示,观察组LVMMI、CI、LVCO、LVESVI均高于对照组(均P<0.05),E/A、Am、E、LVSVI均低于对照组(均P<0.05);心脏MRI检查显示,观察组LVMMI、CI、LVCO、LVESVI均高于对照组,LVSVI、E/A、Am、E均低于对照组(均P<0.05)。两种检查方法测得的Am和LVSVI比较,差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,心肌声学造影和心脏MRI诊断肥厚性心肌病的AUC分别为0.865和0.932,敏感性、特异性、准确率分别为92.90%、80.00%、91.58%和96.47%、90.00%、95.79%,两者联合应用的AUC为0.994,敏感性、特异性、准确率分别为98.82%、100%、98.95%,均高于其单独应用(均P<0.05)。结论心肌声学造影联合心脏MRI诊断肥厚性心肌病具有较好的应用价值,能为临床提供参考依据。

Objective To explore the diagnostic value of myocardial contrast echocardiography combined with cardiac MRI for hypertrophic cardiomyopathy.Methods Ninty-five patients with hypertrophic cardiomyopathy(observation group)and 95 healthy subjects(control group)were selected.Both groups underwent myocardial contrast echocardiography and cardiac MRI,the left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),ratio of early blood flow peak velocity to end-diastolic peak blood flow velocity(E/A),late diastolic motion velocity(Am),early mitral valve diastolic blood flow peak velocity(E),left ventricular myocardial mass(LVMMI),heart index(CI),left ventricular peak ejection rate(LVCO),left ventricular end systolic volume index(LVESVI),left ventricular stroke volume index(LVSVI)were compared between the groups.ROC curve was drawn to analyze the diagnostic efficiency of myocardial contrast echocardiography,cardiac MRI examination and their combination in the diagnosis of hypertrophic cardiomyopathy,and the area under the curve(AUC)was calculated.Results Myocardial contrast echocardiography and cardiac MRI showed that LVMMI,CI,LVCO and LVESVI of the observation group were all higher than those of the control group(all P<0.05),and E/A,Am,E,LVSVI were lower than those of the control group(all P<0.05).There were differences in Am and LVSVI between the two diagnostic methods(both P<0.05).ROC curve analysis showed that the AUCs of cardiac MRI and myocardial contrast echocardiography in the diagnosis of hypertrophic cardiomyopathy were 0.932 and 0.865,respectively,the sensitivity,specificity and accuracy were 96.47%,90.00%,95.79%and 92.90%,80.00%,91.58%,respectively.The AUC of the combination of the two methods was 0.994,the sensitivity specificity and accuracy were 98.82%,100%and 98.95%,respectively,which were higher than those of individual method.Conclusion Cardiac MRI combined with myocardial contrast echocardiography can better reflect the left ventricular volume and systolic function in patients with hypertrophic cardiomyopathy,and has important clinical application value.