Palka Przemyslsoław, Lange Aleksandra, Donnelly J Elisabeth, Scalia Gregory, Burstow Darryl J, Nihoyannopoulos Petros
Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.
J Am Soc Echocardiogr. 2002 Nov;15(11):1353-60. doi: 10.1067/mje.2002.125285.
The purpose of the study was to assess whether quantification of myocardial involvement by Doppler tissue echocardiography (DTE) enhances the accuracy of echocardiographic characterization of cardiac amyloidosis (CA). A group of 36 patients with CA (mean age 58 +/- 13 years; 22 male) and 40 age-matched control patients were studied. Patients with CA were divided into CA-1 subgroup with nonrestrictive (n = 22) and CA-2 with restrictive left ventricular (LV) filling pattern (n = 14). Peak lateral and medial mitral annulus velocities by pulsed wave DTE were measured in systole, early diastole, and late diastole. Using color M-mode DTE of the LV posterior wall, mean myocardial velocities (MMV) and myocardial velocity gradient (MVG) were measured during ventricular ejection, early and late isovolumic relaxation (IVR), rapid ventricular filling, and atrial contraction. In both CA-1 and CA-2 groups, mitral annulus velocities, MMV, and all MVG were lower than those measured in control patients, with the exception of peak late diastolic annulus velocities at lateral side and MMV in atrial contraction. MVGs in both early IVR and rapid ventricular filling were lower in the CA-1 as compared with the CA-2 group. Late IVR-MVG was negative in control patients and positive in patients with CA indicating a faster movement of the subendocardium rather than the subepicardium during late IVR in patients with CA (0.88 +/- 0.50 s(-1) vs -0.40 +/- 1.59 s(-1); P <.001). The following parameters: peak early diastolic annulus velocities at lateral side < or = -12 cm/s, peak early diastolic annulus velocities at medial side < or = -10 cm/s, early IVR-MMV < or = -2.5 cm/s, early IVR-MVG < or = -0.7 s(-1), and late IVR-MVG > or = 0.5 s(-1) differentiated patients with CA from control patients with an overall accuracy of 0.82, 0.83, 0.81, 0.87, and 0.81, respectively. In patients with CA, reduction in early IVR-MMV was independent of patients' age and LV mass. DTE indices proved helpful in differentiating patients with CA from control patients including those patients with CA who had borderline conventional echocardiographic features and nonrestrictive LV filling pattern.
本研究的目的是评估通过多普勒组织超声心动图（DTE）对心肌受累情况进行定量分析是否能提高心脏淀粉样变性（CA）超声心动图特征描述的准确性。对一组36例CA患者（平均年龄58±13岁；22例男性）和40例年龄匹配的对照患者进行了研究。CA患者被分为左心室充盈模式为非限制性的CA - 1亚组（n = 22）和限制性的CA - 2亚组（n = 14）。采用脉冲波DTE测量二尖瓣环侧壁和内侧壁在收缩期、舒张早期和舒张晚期的峰值速度。使用左心室后壁的彩色M型DTE，测量心室射血期、等容舒张早期和晚期、快速心室充盈期及心房收缩期的平均心肌速度（MMV）和心肌速度梯度（MVG）。在CA - 1组和CA - 2组中，二尖瓣环速度、MMV和所有MVG均低于对照患者，外侧舒张晚期二尖瓣环峰值速度及心房收缩期MMV除外。与CA - 2组相比，CA - 1组等容舒张早期和快速心室充盈期的MVG较低。对照患者等容舒张晚期MVG为负，CA患者为正，表明CA患者等容舒张晚期心内膜下运动快于心外膜下运动（0.88±0.50 s⁻¹ vs -0.40±1.59 s⁻¹；P <.001）。以下参数：外侧舒张早期二尖瓣环峰值速度≤ -12 cm/s、内侧舒张早期二尖瓣环峰值速度≤ -10 cm/s、等容舒张早期MMV≤ -2.5 cm/s、等容舒张早期MVG≤ -0.7 s⁻¹、等容舒张晚期MVG≥0.5 s⁻¹，将CA患者与对照患者区分开来，总体准确率分别为0.82、0.83、0.81、0.87和0.81。在CA患者中，等容舒张早期MMV的降低与患者年龄和左心室质量无关。DTE指标有助于将CA患者与对照患者区分开来，包括那些传统超声心动图特征临界且左心室充盈模式为非限制性的CA患者。
