Baccouche Hannibal, Maunz Martin, Beck Torsten, Gaa Elisabeth, Banzhaf Michael, Knayer Ute, Fogarassy Peter, Beyer Martin
Department of Medicine II, Hospital Kirchheim/Teck, Kreiskliniken Esslingen, Germany.
Echocardiography. 2012 Jul;29(6):668-77. doi: 10.1111/j.1540-8175.2012.01680.x. Epub 2012 Apr 4.
Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) are important differential diagnosis of left ventricular hypertrophy. The aim of this study was to investigate if three-dimensional (3D) speckle tracking-derived functional parameters enabled differentiation of CA and HCM by a disease-specific pattern.
Twelve patients with CA and 12 patients with HCM were included. CA and HCM were diagnosed by contrast-enhanced cardiovascular magnetic resonance (CMR). Three-dimensional speckle tracking echocardiography with wall motion analysis was performed for strain (radial [RS(%)], longitudinal [LS (-%)], and circumferential [CS (-%)]), rotation (ROT [degree]), and twist (TWT [degree]). Intergroup comparison included normalized values from 49 healthy volunteers.
Averaged RS, LS, CS, ROT, and TWT were investigated at basal, midventricular, and apical levels. With some exceptions, 3D speckle tracking function parameters were mostly lower in the HCM and minimal in the CA group as compared to controls. Comparing CA and HCM, basal RS was significantly reduced in patients with amyloidosis (7.5 ± 19.7 vs. 22.3 ± 22.7; P < 0.0001), furthermore the "physiological" gradient of basoapically decreasing RS, which was reduced, but still preserved in HCM, showed a clear "inverse pattern" in patients with amyloidosis, comprising a gradual increase from base to apex. Correlation analysis of 3D speckle tracking function and CMR late gadolinium enhancement (LGE) revealed high inverse correlation of RS and LGE in CA (r =-0.82) and only mild correlation in HCM, followed by CS as second best parameter. An increasing/decreasing basoapical RS gradient yielded a sensitivity of 83% versus the CMR-derived diagnosis "CA" and "HCM."
Three-dimensional speckle tracking echocardiography demonstrated significant differences in CA and HCM. The basoapical RS gradient displayed oppositional characteristics in CA and HCM, suggesting a "function-pattern-based" differentiation of amyloidosis and HCM.
心脏淀粉样变性（CA）和肥厚型心肌病（HCM）是左心室肥厚的重要鉴别诊断。本研究的目的是调查三维（3D）斑点追踪衍生的功能参数是否能够通过疾病特异性模式区分CA和HCM。
纳入12例CA患者和12例HCM患者。CA和HCM通过对比增强心血管磁共振（CMR）诊断。采用三维斑点追踪超声心动图结合壁运动分析测量应变（径向[RS(%)]、纵向[LS (-%)]和圆周[CS (-%)]）、旋转（ROT [度]）和扭转（TWT [度]）。组间比较纳入了49名健康志愿者的标准化值。
在心底、心室中部和心尖水平对平均RS、LS、CS、ROT和TWT进行了研究。与对照组相比，除了一些例外情况，HCM组的3D斑点追踪功能参数大多较低，而CA组最低。比较CA和HCM，淀粉样变性患者的心底RS显著降低（7.5±19.7对22.3±22.7；P<0.0001），此外，心底到心尖RS逐渐降低的“生理”梯度在HCM中降低但仍保留，而在淀粉样变性患者中呈现明显的“反向模式”，即从心底到心尖逐渐增加。3D斑点追踪功能与CMR晚期钆增强（LGE）的相关性分析显示，CA中RS与LGE呈高度负相关（r = -0.82），而在HCM中仅呈轻度相关，其次CS是第二好的参数。心底到心尖RS梯度的增加/降低对CMR诊断“CA”和“HCM”的敏感性为83%。
三维斑点追踪超声心动图显示CA和HCM存在显著差异。心底到心尖RS梯度在CA和HCM中表现出相反的特征，提示基于功能模式区分淀粉样变性和HCM。
