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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 imaging; myocardial 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.

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更新日期/Last Update: 1900-01-01