超声心动图在评价轻链型淀粉样变右心功能中的价值

Value of assessing right ventricular function by echocardiography in primary light-chain amyloidosis

目的 初步探讨超声心动图在评价原发性轻链型心脏淀粉样变[(light-chain amyloidosis,AL)-(cardiac amyloidosis,CA)]患者右心功能的价值。方法 选取2018年1月至2021年12月在温州医科大学附属第一医院经病理检查确诊的AL-CA患者25例纳入淀粉样变组;另选取25名健康志愿者纳入对照组。经胸常规超声测量右心结构及功能指标;二维斑点追踪技术分析右心室整体长轴应变(right ventricular global longitudinal strain,RVGLS)和右心室游离壁长轴应变(right ventricular free wall longitudinal strain,RVfw LS);并计算三尖瓣环平面收缩期位移(tricuspid annular plane systolic excursion,TAPSE)/肺动脉收缩压(pulmonary artery systolic pressure,PASP)、RVGLS/PASP、RVfw LS/PASP作为无创的右室-肺动脉偶联指标。结果 (1)与对照组比较,淀粉样变组患者的右心明显增大,右室游离壁明显增厚[(7.16±1.84)mm vs.(3.76±0.66)mm],差异有统计学意义(P<0.001)。(2)与对照组比较,淀粉样变组患者的RVGLS[(17.43±2.45)%vs.(23.22±3.73)%]、RVfw LS [(18.44±2.10)%vs.(22.62±3.64)%]均显著降低,差异有统计学意义(P<0.001);淀粉样变组表现右心系统失偶联,TAPSE/PASP、RVGLS/PASP、RVfw LS/PASP均明显减低,差异有统计学意义(P<0.001)。(3)相关分析结果显示,TAPSE/PASP与N端脑钠肽前体(N-terminal brain natriuretic peptide precursor,NT-pro BNP)、高敏感肌钙蛋白(highly sensitive T cardiac troponin,hs-TNT)呈轻度相关(r=0.45、0.40),有统计学意义(P<0.05)。结论超声心动图能有效评估AL-CA患者右心功能损害情况,可为深入了解该疾病的病理生理学机制提供有价值的信息。

Objective To investigate the value of echocardiography in assessing right ventricular function of primary light-chain amyloidosis(AL)-cardiac amyloidosis(CA)patients.Methods A total of 25 patients biopsy diagnosed as AL-CA,who were admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to December 2021,were enrolled in this study as amyloidosis group.And 25 heathy volunteers were set as control group.The routine right ventricular morphology and functional parameters were acquired by standard echocardiography.Right ventricular global longitudinal strain(RVGLS)and right ventricular free wall longitudinal strain(RVfwLS)were obtained by two-dimensional speckle tracking imagine.Tricuspid annular plane systolic excursion(TAPSE)/pulmonary artery systolic pressure(PASP),RVGLS/PASP,RVfwLS/PASP ratio were calculated as the noninvasively parameters of right ventricular-pulmonary artery coupling.Results①Compared with control group,patients in amyloidosis group showed significantly larger right heart size,and significantly thicker right ventricular free wall[(7.16±1.84)mm vs.(3.76±0.66)mm],the difference was statistically significant(P<0.001).②Compared with control group,RVGLS[(17.43±2.45)%vs.(23.22±3.73)%]and RVfwLS[(18.44±2.10)%vs.(22.62±3.64)%]were significantly impaired in amyloidosis group,the difference was statistically significant(P<0.001).The ratios of TAPSE/PASP,RVGLS/PASP,RVfwLS/PASP were found to be lower in amyloidosis group,the difference was statistically significant(P<0.001).③TAPSE/PASP showed mild correlations with N-terminal brain natriuretic peptide precursor(NT-proBNP),highly sensitive T cardiac troponin(hs-TNT)(r=0.45 and 0.40)there were statistically significant(P<0.05).Conclusion Echocardiography can effectively evaluate the right heart function impairment in AL-CA patients,providing valuable information for a deeper understanding of the pathological and physiological mechanisms of the disease.