超声斑点追踪成像预测和评价肥厚型心肌病患者心肌纤维化的临床价值

摘要

Objective To study the correlation between global longitudinal strain (GLS) and myocardial fibrosis in patients with hypertrophic cardiomyopathy(HCM) by using speckle tracking echocardiography (STI), to explore the clinical value of STE in patients with HCM. Methods Eighty-one patients with HCM were selected, and 46 subjects were included in the normal control groups. GLS was obtained by STI, the presence of myocardial fibrosis was detected by MRI, and the patients were divided into fibrosis( 52 patients ) and non-fibrosis( 29 patients ) subgroups. Left atrial end-systolic diameter(LADs), left ventricular end-diastolic diameter (LVEDd),interventricular septal thickness (IVST) and mitral valvular early diastolic inflow velocity (E peak) were measured by routine echocardiography. Mitral annular early diastolic velocity (Em) was abtained by using tissue Doppler imaging (TDI), and E/Em was calculated. Results GLS in patients with HCM was significantly lower than controls, while LADs , IVST, E/Em in patients with HCM were significantly higher than controls (P<0.005). GLS in fibrosis subgroups was significantly lower than that in non-fibrosis subgroups, while IVST, E/Em in fibrosis subgroups were significantly higher than those in non-fibrosis subgroups (P<0.001). GLS was significantly correlated with LGE segments. The area under the ROC curve was 0.69. Conclusion GLS can be accurately measured by using STI, These results suggest that GLS provides useful information on myocardial fibrosis in patients with HCM.%目的应用超声斑点追踪成像（STI）技术分析肥厚型心肌病（HCM）患者左室整体纵向应变（GLS）与心肌纤维化程度之间的关系，探讨STI预测HCM患者心肌纤维化的临床价值。方法选择HCM组患者81例，体检健康者46例为对照组。根据心脏MR检测有无延迟强化将HCM患者分为纤维化组52例和无纤维化组29例；应用STI测量左室GLS；常规超声测量左房收缩末期前后径（LADs）、左室舒张末期前后径（LVEDd）、室间隔厚度（IVST）、二尖瓣口舒张早期峰值（E）；组织多普勒测量二尖瓣环舒张早期运动速度峰值（Em），并计算E/Em。结果与对照组比较，HCM患者左室GLS降低，IVST、E/Em和LADs增高（P＜0.005）。与无纤维化组比较，纤维化组GLS降低，IVST和E/Em增高，差异均有统计学意义（P<0.001）。左室GLS与心肌纤维化节段数呈正相关，ROC曲线显示左室GLS检测心肌纤维化的曲线下面积为0.69。结论 STI技术能够准确测量HCM患者左室GLS，并可通过左室GLS来预测HCM患者是否发生心肌纤维化。