[1]张璐,王叶,程流泉,等.左室长轴收缩期峰值应变在原发性心脏淀粉样变性与肥厚型心肌病诊断中的价值[J].南方医科大学学报,2014,(05):609.
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左室长轴收缩期峰值应变在原发性心脏淀粉样变性与肥厚型心肌病诊断中的价值()
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《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2014年05期
页码:
609
栏目:
出版日期:
2014-05-15

文章信息/Info

Title:
Value of assessing left ventricular longitudinal systolic peak strain in differential
diagnosis of primary cardiac amyloidosis from hypertrophic cardiomyopathy
作者:
张璐王叶程流泉王晶周肖刘淼张威章明张波智光
关键词:
原发性心脏淀粉样变性肥厚型心肌病超声心动图速度向量成像心肌应变心脏核磁
Keywords:
primary cardiac amyloidosis hypertrophic cardiomyopathy echocardiography velocity vector imagingmyocardial strain cardiac magnetic resonance
摘要:
目的分利用速度向量成像(VVI)技术比较原发性心脏淀粉样变性(AL-CA)及肥厚型心肌病(HCM)患者左室各节段以及
室壁的内膜(ENDO)、中层(MYO)、外膜下(EPI)心肌长轴收缩期峰值应变(LSsys)的差异。方法入选20例经过组织活检证实
的AL-CA患者,20例非对称性HCM患者以及年龄匹配的20例健康人作为对照组,收集临床资料并分别进行常规二维心脏超
声检查和VVI技术分析。常规二维超声用于评价左室壁厚度、左房室腔大小以及收缩舒张功能。VVI技术用于分析左室各节
段以及各室壁的ENDO、MYO、EPI心肌LSsys特征。AL-CA和HCM患者还进行了心脏核磁共振(CMR)以评价其心肌延迟强
化(LGE)特征。结果AL-CA 和HCM两组在临床症状、体征上相似,而且两组左室壁厚度、左房内径、E/A比值、室间隔E/e’比值
以及颗粒样回声的比例上均高于正常对照组。AL-CA组左室各节段及室壁ENDO LSsys较HCM和正常对照组均明显减低,且
内外膜LSsys 之差(ENDO-EPI LSsys)在AL-CA 组各个室壁均较正常对照组明显减低,而HCM组各节段LSsys 及各室壁
ENDO-EPI LSsys变异性大,各室壁显示出明显的不均一性。LGE同样显示出与AL-CA和HCM室壁ENDO-EPI LSsys一致的
特征:AL-CA 组以各室壁心内膜下弥漫性延迟强化为特征,而HCM以区域性分布的多发斑片状延迟强化为特征。结论
AL-CA以左室心内膜下各节段LSsys 以及各室壁ENDO-EPI LSsys 均明显减低为特征;而HCM节段和室壁变化变性大。因
此,VVI技术可以为鉴别AL-CA与HCM提供帮助。
Abstract:
Objective To analyze the endocardial, myocardial, and epicardial longitudinal systolic strain (LSsys) in the left
ventricle (LV) segments and walls in patients with cardiac involvement due to primary amyloidosis (AL-CA) and hypertrophic
cardiomyopathy (HCM). Methods Twenty patients with biopsy-proven AL-CA, 20 with asymmetric HCM, and 20
age-matched healthy volunteers were analyzed for their clinical characteristics and underwent conventional echocardiography
for evaluating LV wall thickness, left atrial and ventricle size, systolic and diastolic function and 2-dimensional velocity vector
imaging for evaluating the endocardial, myocardial and epicardial LSsys of the LV segments and walls. AL-CA and HCM
patients also underwent cardiac magnetic resonance to evaluate the late gadolinium enhancement (LGE) features. Results
Compared with the control group, AL-CA and HCM groups, with similar clinical symptoms and physical signs, both showed
increased LV wall thickness, left atrial diameter, E/A ratio, septal E/e’ ratio and the prevalence of granular sparkling. LV
segments and walls endocardial LSsys were significantly lower in AL-CA patients than in HCM patients and the control
subjects. The endocardial-epicardial LSsys difference in all the left ventricle walls were significantly smaller in AL-CA group
than in the control group, but this difference appeared variable in HCM group. The LGE also presented with different features
in AL-CA and HCM: AL-CA group showed subendocardial LGE in almost all the LV walls, but HCM group showed patchy
LGE with a regional, multifocal distribution. Conclusion AL-CA is characterized by a significantly reduced endocardial LSsys
in the LV segments and an uniform decrease of the endocardial-epicardial LSsys difference in all the LV walls, but the changes
in HCM appear variable, and 2-dimensional velocity vector imaging is therefore a useful modality to differentiate AL-CA from
HCM.

相似文献/References:

[1]李敏,程宽,王齐兵,等.中国肥厚型心肌病与肌钙蛋白T基因的相关性研究[J].南方医科大学学报,2011,(09):1589.
[2]赵蓓,李娟,朱伟红,等.实时三维超声评价肥厚型心肌病舒张失同步性及舒张功能[J].南方医科大学学报,2013,(01):8.

更新日期/Last Update: 1900-01-01