应用二维及三维斑点追踪超声心动图评估扩张型心肌病伴心力衰竭终末期患者的心肌纤维化。
Assessment of Myocardial Fibrosis Using Two-Dimensional and Three-Dimensional Speckle Tracking Echocardiography in Dilated Cardiomyopathy With Advanced Heart Failure.
机构信息
Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
出版信息
J Card Fail. 2021 Jun;27(6):651-661. doi: 10.1016/j.cardfail.2021.01.003. Epub 2021 Jan 14.
BACKGROUND
This study aimed to depict strain parameters derived from 2-dimensional (2D)- and 3-dimensional (3D) speckle tracking echocardiography and to explore which may best reflect myocardial fibrosis (MF) in dilated cardiomyopathy with advanced heart failure by comparing with histologic fibrosis.
METHODS AND RESULTS
We analyzed 75 patients with dilated cardiomyopathy with advanced heart failure who underwent echocardiographic examination before heart transplantation. Strain parameters derived from 2D- and 3D speckle tracking echocardiography were as follows: left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and tangential strain (TS). The degree of MF was quantified using Masson's staining in left ventricular myocardial samples obtained from all patients. Seventy-five patients were divided into 3 groups according to the tertiles of histologic MF (mild, moderate, and severe MF groups). Patients with severe MF had lower 3DGLS, 3DGRS, 3DTS, and 2DGLS than those with mild and moderate MF. MF strongly correlated with 3DGLS (r = 0.72, P < .001), weakly with 3DGRS (r = -0.39, P = .001), 3DGCS (r = 0.30, P = .009), 3DTS (r = 0.47, P < .001), and 2DGLS (r = 0.44, P < .001), but did not correlate with 2DGCS and 2DGRS. Receiver operating characteristic analysis revealed that the area under the curve of 3DGLS for detecting severe MF was significantly larger than that of other strain parameters (0.86 vs 0.59-0.70, P < .05 for all). The multivariate linear regression models using 3DGLS (R = 0.76; Akaike information criterion = 331) was found to be a more accurate indicator to predict MF than that with 3DTS (R = 0.65, Akaike information criterion = 354) and 2DGLS (R = 0.66, Akaike information criterion = 352).
CONCLUSIONS
Three-dimensional GLS may be an optimal surrogate marker for reflecting MF in patients with dilated cardiomyopathy with advanced heart failure.
背景
本研究旨在描述二维（2D）和三维（3D）斑点追踪超声心动图得出的应变参数，并通过与组织学纤维化比较，探讨哪些参数最能反映晚期心力衰竭扩张型心肌病中的心肌纤维化（MF）。
方法和结果
我们分析了 75 例接受超声心动图检查后拟行心脏移植的晚期心力衰竭扩张型心肌病患者。2D 和 3D 斑点追踪超声心动图得出的应变参数如下：左心室整体纵向应变（GLS）、整体周向应变（GCS）、整体径向应变（GRS）和切线应变（TS）。所有患者的左心室心肌样本均采用 Masson 染色定量 MF 程度。根据组织学 MF 的三分位数（轻度、中度和重度 MF 组）将 75 例患者分为 3 组。与轻度和中度 MF 组相比，重度 MF 患者的 3DGLS、3DGRS、3DTS 和 2DGLS 较低。MF 与 3DGLS 强烈相关（r=0.72，P<0.001），与 3DGRS 弱相关（r=-0.39，P=0.001），与 3DGCS 中度相关（r=0.30，P=0.009），与 3DTS 强相关（r=0.47，P<0.001），与 2DGLS 中度相关（r=0.44，P<0.001），但与 2DGCS 和 2DGRS 不相关。受试者工作特征分析显示，3DGLS 检测重度 MF 的曲线下面积明显大于其他应变参数（所有 P<0.05，分别为 0.86 比 0.59-0.70）。使用 3DGLS（R²=0.76；赤池信息量准则=331）的多元线性回归模型发现，其是预测 MF 的更准确指标，优于 3DTS（R²=0.65，赤池信息量准则=354）和 2DGLS（R²=0.66，赤池信息量准则=352）。
结论
三维 GLS 可能是反映晚期心力衰竭扩张型心肌病患者 MF 的最佳替代标志物。
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