Hu Xin, Bao Yuwei, Zhu Ying, Zheng Kangchao, Zhang Jun, Zhou Wei, Deng Youbin, Liu Yani
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ultrasound Med Biol. 2023 May;49(5):1309-1317. doi: 10.1016/j.ultrasmedbio.2023.01.020. Epub 2023 Mar 1.
The study was performed to explore the predictive value of multiple strain parameters for myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) by using speckle tracking automated functional imaging (AFI).
A total of 61 patients diagnosed with HCM were finally enrolled in this study. All patients completed transthoracic echocardiography and cardiac magnetic resonance late gadolinium enhancement (LGE) within 1 month. Twenty age- and sex-matched healthy participants were included as the control group. Multiple parameters, including segmental longitudinal strain (LS), global longitudinal strain (GLS), post-systolic index and peak strain dispersion, were automatically analyzed by AFI.
A total of 1458 myocardial segments were analyzed according to the left ventricular 18-segment model. Among the 1098 segments from HCM patients, segments with LGE had a lower absolute value of segmental LS than those without LGE (p < 0.05). The cutoff values of segmental LS for predicting positive LGE in the basal, intermediate and apical regions were -12.5%, -11.5% and -14.5%, respectively. GLS could predict significant myocardial fibrosis (≥2 positive LGE segments) at a cutoff value of -16.5% with a sensitivity of 80.9% and specificity of 76.5%. As an independent predictor of significant myocardial fibrosis, GLS was substantially associated with the severity of myocardial fibrosis and 5 years sudden cardiac death risk score in HCM patients.
Speckle tracking AFI could efficiently identify left ventricular myocardial fibrosis in patients with HCM by multiple parameters. GLS predicted significant myocardial fibrosis at a cutoff value of -16.5%, which may indicate the adverse clinical outcomes in HCM patients.
本研究旨在通过斑点追踪自动功能成像（AFI）探讨肥厚型心肌病（HCM）患者多种应变参数对心肌纤维化的预测价值。
本研究最终纳入61例确诊为HCM的患者。所有患者在1个月内完成经胸超声心动图和心脏磁共振延迟钆增强（LGE）检查。纳入20名年龄和性别匹配的健康参与者作为对照组。AFI自动分析包括节段纵向应变（LS）、整体纵向应变（GLS）、收缩后指数和峰值应变离散度在内的多个参数。
根据左心室18节段模型共分析了1458个心肌节段。在HCM患者的1098个节段中，有LGE的节段的节段LS绝对值低于无LGE的节段（p<0.05）。预测基底段、中间段和心尖段LGE阳性的节段LS截断值分别为-12.5%、-11.5%和-14.5%。GLS在截断值为-16.5%时可预测显著心肌纤维化（≥2个LGE阳性节段），敏感性为80.9%，特异性为76.5%。作为显著心肌纤维化的独立预测因子，GLS与HCM患者心肌纤维化的严重程度和5年心脏性猝死风险评分密切相关。
斑点追踪AFI可通过多个参数有效识别HCM患者的左心室心肌纤维化。GLS在截断值为-16.5%时可预测显著心肌纤维化，这可能提示HCM患者的不良临床结局。
