收缩及舒张末期左心声学造影检查在左心室心肌致密化不全辅助诊断中的应用

Application of Left Ventricular Opacification Systolic-End and Diastolic-End Stage in Assisted Diagnosis of Patients with Left Ventricular Noncompaction

目的:探讨收缩及舒张末期左心声学造影(LVO)检查在左心室心肌致密化不全(LVNC)辅助诊断中应用价值。方法:回顾性纳入2019年1月—2022年5月于我院诊治可疑LVNC患者共168例,均行常规二维超声心动图、LVO及心脏磁共振检查;比较单纯二维超声心动图、二维超声心动图联合LVO及心肌磁共振检查下收缩/舒张末期节段显示结果,描绘ROC曲线评价收缩及舒张末期LVO非致密与致密心肌厚度比值(NC/C)用于LVNC辅助诊断临床效能。结果:168例可疑LNVC患者最终确诊55例;以心脏磁共振检查作为“金标准”,结果显示二维超声心动图联合LVO检查下收缩末期节段显示率显著高于单纯二维超声心动图检查(P<0.05);二维超声心动图联合LVO检查下舒张末期节段显示率、分层心肌节段数及NC节段数均显著高于单纯二维超声心动图检查(P<0.05)。二维超声心动图联合LVO检查下舒张末期NC/C值诊断LVNC敏感性和准确性显著高于收缩末期NC/C值(P<0.05);二维超声心动图联合LVO检查下舒张末期NC/C值诊断LVNC准确性显著高于单纯二维超声心动图(P<0.05)。ROC曲线分析结果显示,二维超声心动图联合LVO检查下舒张末期NC/C值用于LVNC诊断AUC显著高于其他指标(P<0.05)。结论:二维超声心动图联合LVO可准确检出LVNC节段,其中舒张末期NC/C值相较于收缩末期具有更佳诊断效能。

Objective:To investigate the application value of left ventricular opacification(LVO)systolic-end and end-diastolic stage in assisted diagnosis of patients with left ventricular noncompaction(LVNC).Methods:168 patients with suspected LVNC were retrospectively chosen in the period from January 2019 to May 2022.The section displays results in systolic-end and diastolic-end stage were compared between 2D ultrasound alone,2D ultrasound combined with LVO and myocardial magnetic resonance.ROC curves were described to evaluate the clinical efficacy of contrast-to-dense ratio(NC/C)of contrast-to-dense myocardium thickness in systolic-end and diastolic-end echocardiography in assisted diagnosis of LVNC.Results:55 cases were confirmed in 168 patients with suspected LNVC.By cardiac magnetic resonance examination as the“gold standard”,the results showed that the rate of end-systolic segments displayed by 2D ultrasound combined with LVO was significantly higher than 2D ultrasound alone(P<0.05).The display rate of diastolic-end segments,the number of stratified cardiac segments and the number of NC segments in 2D ultrasound combined with LVO were significantly higher than 2D ultrasound alone(P<0.05).The sensitivity and accuracy of NC/C value in diastolic-end stage were significantly higher than NC/C value in systolic-end stage under 2D ultrasound combined with left ventricular contrast-enhanced ultrasound(P<0.05).The diagnosis accuracy of LVNC by 2D ultrasound combined with left ventricular contrast-enhanced ultrasound was significantly higher than 2D ultrasound alone(P<0.05).ROC curve analysis results showed that the AUC of NC/C value in end-diastolic stage by 2D ultrasound combined with left ventricular contrast-enhanced ultrasound in LVNC diagnosis was significantly higher than other indexes(P<0.05).Conclusion:2D ultrasound combined with LVO can accurately detect LVNC segments,and the NC/C value in diastolic-end stage has better diagnostic efficacy than systolic-end stage.