Song Yi, Zhang Rui-Fang, Liu Yu
Department of Medical Ultrasonics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.
Exp Ther Med. 2017 Aug;14(2):981-994. doi: 10.3892/etm.2017.4602. Epub 2017 Jun 14.
This study aimed to investigate the reliability of ultrasound two-dimensional speckle tracking imaging (2D-STI) for the evaluation of myocardial ischemia in familial hypercholesterolemia (FH) patients. We recruited 28 patients clinically diagnosed with homozygous familial hypercholesterolemia (HoFH) and subjected them to 2D-STI, gated transthoracic Doppler echocardiography (TTDE), and Tc-methoxyisobutylisonitrile myocardial perfusion imaging (Tc-MIBI MPI). The sensitivity, specificity and diagnostic accordance rate of TTDE and 2D-STI for myocardial ischemia in HoFH patients were compared with the Tc-MIBI scores. According to the diagnosis of ischemia in the three main coronary arteries (LAD, LCX, and RCA) by MPI, patients were further divided into different groups for comparing segmental strain by 2D-STI. The total correlation between TTDE and Tc-MIBI MPI for evaluation of myocardial ischemia was r=0.483 and between 2D-STI and Tc-MIBI MPI was 0.786. The total correlation index for ejection fraction (EF) between TTDE and Tc-MIBI MPI was r=0.606 and for 2D-STI and Tc-MIBI MPI was r=0.919. TTDE indicated that differences among LVDd, LVDs, IVS, LVPW, AO Vmax, PG, E/e', and DT were statistically significant. STI indicated that the total strain of the ischemia group was lower than that of the non-ischemia group. The total systolic strain and total early diastolic strain of the ischemia group were lower than that of the non-ischemia group. TTDE can be used for primary observation and evaluation of ventricular wall ischemia for HoFH patients. Ultrasound 2D-STI is better than TTDE in the evaluation of myocardial ischemia in HoFH patients. Ultrasound 2D-STI shows the same effectiveness as Tc-MIBI MPI for the detection of myocardial ischemia, serving as good tool for prognosis and treatment evaluation in HoFH patients.
本研究旨在探讨超声二维斑点追踪成像（2D-STI）评估家族性高胆固醇血症（FH）患者心肌缺血的可靠性。我们招募了28例临床诊断为纯合子家族性高胆固醇血症（HoFH）的患者，并对其进行2D-STI、门控经胸多普勒超声心动图（TTDE）以及锝-甲氧基异丁基异腈心肌灌注显像（Tc-MIBI MPI）检查。将TTDE和2D-STI诊断HoFH患者心肌缺血的敏感性、特异性及诊断符合率与Tc-MIBI评分进行比较。根据MPI对三支主要冠状动脉（左前降支、左旋支和右冠状动脉）缺血的诊断结果，将患者进一步分组，通过2D-STI比较节段应变。TTDE与Tc-MIBI MPI评估心肌缺血的总相关性r=0.483，2D-STI与Tc-MIBI MPI的总相关性为0.786。TTDE与Tc-MIBI MPI之间射血分数（EF）的总相关性指数r=0.606，2D-STI与Tc-MIBI MPI之间的r=0.919。TTDE显示左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、室间隔厚度（IVS）、左室后壁厚度（LVPW）、主动脉峰值流速（AO Vmax）、压力阶差（PG）、E/A比值（E/e'）及减速时间（DT）之间的差异具有统计学意义。STI显示缺血组的总应变低于非缺血组。缺血组的总收缩期应变和总舒张早期应变低于非缺血组。TTDE可用于HoFH患者心室壁缺血的初步观察和评估。超声2D-STI在评估HoFH患者心肌缺血方面优于TTDE。超声2D-STI在检测心肌缺血方面与Tc-MIBI MPI具有相同的有效性，可作为HoFH患者预后及治疗评估的良好工具。
