Zheng Yi, Yang Xiaohong, Zhou Qiping, Huang Yaoyao, Zhang Fan, Wang Liangyu
Department of Ultrasound, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou Guangdong 515031, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 Apr 28;42(4):400-405. doi: 10.11817/j.issn.1672-7347.2017.04.006.
To evaluate the effect of left ventricular hypertrophy and deformation on cardiac function in patients with uremic cardiomyopathy (UCM) by using the technology of two dimensional speckle tracking imaging (2D-STI). Methods: A total of 67 UCM patients were randomly divided into the normal cardiac function group (subgroup A, 32 cases) and the abnormal cardiac function group (subgroup B, 35 cases) according to the New York Heart Association points (NYHA-P). A total of 30 healthy subjetcs served as the control group. Parameters including left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular spherical index (LVSI), left ventricular myocardial mean radial strain (MRS), mean radial strain rate (MRSR), mean longitudinal strain (MLS), local systolic twist angle (STA), and mitral annulus maximum displacement (TMAD) were detected. Results: MLS, MRS, MRSR, LVSI, STA and TMAD in the Group A and Group B were lower than that in the control group (P<0.05), and LVMI in the Group A and Group B was increased than those in the control group (P<0.05); LVEF, MLS, MRS, MRSR, LVSI and STA in the Group B was decreased than that in the Group A (P<0.05). MLS in the Group A and B were positively correlated with LVEF and LVSI, but negatively correlated with LVMI. Using the point of 14.10% for MLS to evaluate UCM patients with NYHA-P>4 points, the sensitivity, the specificity and Yuedden index were 90.5%, 71% and 0.585, respectively. STA in UCM patients were lower than that in the control (P<0.05). Conclusion: 2D-STI possesses a unique advantage in detecting left ventricular strain and strain rate on left ventricular regional function in UCM with left ventricular hypertrophy and ventricular deformation. There is no direct correlation between the left ventricular hypertrophy and ventricular deformation, but the ventricular hypertrophy and deformation are correlated with regional cardiac function and clinical cardiac function. Left ventricular regional dysfunction may occur before cardiac hypertrophy and deformation.
应用二维斑点追踪成像(2D-STI)技术评估尿毒症性心肌病(UCM)患者左心室肥厚及变形对心功能的影响。方法:67例UCM患者按纽约心脏病协会心功能分级(NYHA-P)随机分为心功能正常组(A组,32例)和心功能异常组(B组,35例)。选取30例健康受试者作为对照组。检测左心室射血分数(LVEF)、左心室质量指数(LVMI)、左心室球形指数(LVSI)、左心室心肌平均径向应变(MRS)、平均径向应变率(MRSR)、平均纵向应变(MLS)、局部收缩期扭转角(STA)及二尖瓣环最大位移(TMAD)等参数。结果:A组和B组的MLS、MRS、MRSR、LVSI、STA及TMAD均低于对照组(P<0.05),A组和B组的LVMI高于对照组(P<0.05);B组的LVEF、MLS、MRS、MRSR、LVSI及STA低于A组(P<0.05)。A组和B组的MLS与LVEF及LVSI呈正相关,与LVMI呈负相关。以MLS 14.10%为界值评估NYHA-P>4分的UCM患者,敏感性、特异性及约登指数分别为90.5%、71%及0.585。UCM患者的STA低于对照组(P<0.05)。结论:2D-STI在检测左心室肥厚及心室变形的UCM患者左心室局部功能的应变及应变率方面具有独特优势。左心室肥厚与心室变形之间无直接关联,但心室肥厚及变形与局部心功能及临床心功能相关。左心室局部功能障碍可能在心脏肥厚及变形之前出现。