三维斑点追踪成像在诊断AL淀粉样变性病人心脏受累中的价值

Value of three-dimensional speckle tracking imaging in the diagnosis of cardiac involvement in patients with AL amyloidosis

目的:分析三维斑点追踪成像图像采集及分析对系统性免疫球蛋白轻链型(AL)淀粉样变性病人心脏受累的诊断价值。方法:选择左心室射血分数(LVEF)正常的AL淀粉样变性病人80例,按照心脏受累情况分成心脏未受累组(A组)35例和心脏受累组(B组)45例;对比2组病人临床基础资料、血清学指标、常规超声心动图参数以及三维斑点追踪成像参数的差异,并通过受试者工作特征曲线(ROC)分析三维斑点追踪成像参数对诊断AL淀粉样变性心脏受累的特异度和敏感度。结果:B组氨基末端B型脑钠肽前体(NT-proBNP)水平明显高于对照组,差异有统计学意义(P<0.01);2组常规超声参数比较,差异均无统计学意义(P>0.05);B组左心室整体纵向应变(LVGLS)、左心室整体面积应变(LVGAS)及左心室整体径向应变(LVGRS)均明显比A组更低,差异有统计学意义(P<0.05~P<0.01);ROC曲线分析结果表明,当LVGLS以16.12%为诊断AL心肌淀粉样变性的截断点时,其曲线下面积、灵敏度、特异度及约登指数最高,分别为0.798、94.18%、86.84%及0.619;LVGLS、LVGAS及LVGRS的检查者组内相关系数分别为0.908、0.837及0.839。结论:超声三维斑点追踪成像对AL淀粉样变性病人心脏受累具有一定诊断价值,且简单无创,值得推荐。

Objective:To analyze the diagnostic value of the three-dimensional speckle tracking imaging in cardiac involvement in patients with systemic immunoglobulin light chain(AL)amyloidosis.Methods:Eighty AL amyloidosis patients with normal left ventricular ejection fraction(LVEF)were investigated.According to whether the heart was involved,the patients were divided into the non-heart-affected group(group A,35 cases)and heart-affected group(group B,45 cases).The clinical data,serological parameters,conventional echocardiographic parameters and three-dimensional speckle tracking imaging parameters were compared between two groups,and the receiver operating characteristic curve(ROC)was used to analyze the specificity and sensitivity of three-dimensional speckle tracking imaging parameters in the diagnosis of AL amyloidosis.Results:The level of amino-terminal B-type natriuretic peptide precursor(NT-proBNP)in group B was significantly higher than that in group A(P<0.01).There was no statistical significance in the conventional ultrasound parameters between two groups(P>0.05).The overall left ventricular longitudinal strain(LVGLS),overall left ventricular area strain(LVGAS)and overall left ventricular radial strain(LVGRS)in group B were significantly lower than those in group A(P<0.05 to P<0.01).The results of ROC curve analysis showed that when the 16.12%of LVGLS was used as the cut-off point for diagnosing AL myocardial amyloidosis,the area under curve,sensitivity,specificity and Yuden index were the highest,which were 0.798,94.18%,86.84%and 0.619,respectively.The intra-group correlation coefficients of LVGLS,LVGAS and LVGRS were 0.908,0.837 and 0.839,respectively.Conclusions:The ultrasound three-dimensional speckle tracking imaging has certain diagnostic value in cardiac involvement in patients with AL amyloidosis,is simple,non-invasive and worthy of recommending.