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超声心动图评分用于筛选阳性 99m 锝焦磷酸盐闪烁显像结果的心脏淀粉样变性。

Echocardiographic score for the screening of cardiac amyloidosis with positive 99m technetium pyrophosphate scintigraphy result.

机构信息

Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan.

Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan.

出版信息

Echocardiography. 2023 Jul;40(7):634-641. doi: 10.1111/echo.15626. Epub 2023 May 26.

Abstract

INTRODUCTION

Speckle-tracking-derived strains in cardiac chambers may provide better solutions for transthyretin amyloid cardiomyopathy (ATTR-CM) screening. This study aimed to evaluate the efficacy of biventricular strain measurements using speckle tracking for screening Tc-pyrophosphate ( Tc-PYP) scintigraphy-positive cardiomyopathy, which is nearly equivalent to ATTR-CM.

METHODS

We performed a retrospective analysis of transthoracic echocardiographic studies using vendor-independent speckle tracking analysis in older patients (≥65 years) who underwent Tc-PYP scintigraphy to evaluate the etiology of suspected ATTR-CM in our institute between January 2019 and December 2022.

RESULTS

The entire cohort (n = 89) was divided into two subgroups positive Tc-PYP scan results (n = 34) and negative Tc-PYP scan results (n = 55). In the multivariate analysis, posterior wall thickness (p = .003, odds ratio [OR]:1.48, 95% confidence interval [CI]:1.14 -1.92), left ventricular longitudinal strain apical/basal ratio (LVLSapi/bas) (p = .015, OR: 2.78, 95% CI: 1.23-6.32, and right ventricular longitudinal strain (RVLS) (p = .003, OR: 1.15, 95% CI: 1.05 -1.26) were selected to be the most representative echocardiographic findings in Tc-PYP positive cardiomyopathy. The receiver operating characteristic analysis indicated that posterior wall thickness (p < .0001, area under the curve [AUC]: .821, cut-off value: 14.0 mm), LVLSapi/bas (p < .001, AUC: .802, cut-off value: 2,16), and RVLS (p < .001, AUC: .791, cut-off value: -18.7%) could significantly detect Tc-PYP positive results with an excellent credibility. Echocardiographic score points calculated using the summary of these three parameters in each patient revealed that a 2-point score had a fair sensitivity (85%) and an excellent specificity (93%), while a 1-point score had an excellent sensitivity (91%) and a modest specificity (53%).

CONCLUSION

Our proposed echocardiographic screening tool for Tc-PYP scintigraphy-positive cardiomyopathy may help clinicians manage patients with suspected ATTR-CM.

摘要

简介

心脏腔室的斑点追踪衍生应变可能为转甲状腺素淀粉样变性心肌病(ATTR-CM)筛查提供更好的解决方案。本研究旨在评估使用斑点追踪技术测量双心室应变来筛查 Tc-焦磷酸盐( Tc-PYP)闪烁显像阳性心肌病的效果,该方法与ATTR-CM 几乎等效。

方法

我们对 2019 年 1 月至 2022 年 12 月在我院接受 Tc-PYP 闪烁显像以评估疑似 ATTR-CM 病因的老年患者(≥65 岁)进行了经胸超声心动图研究,使用供应商独立的斑点追踪分析进行了回顾性分析。

结果

整个队列(n=89)分为 Tc-PYP 扫描结果阳性亚组(n=34)和 Tc-PYP 扫描结果阴性亚组(n=55)。在多变量分析中,后壁厚度(p=0.003,优势比[OR]:1.48,95%置信区间[CI]:1.14-1.92)、左心室长轴应变心尖/基底比值(LVLSapi/bas)(p=0.015,OR:2.78,95%CI:1.23-6.32)和右心室长轴应变(RVLS)(p=0.003,OR:1.15,95%CI:1.05-1.26)被选为 Tc-PYP 阳性心肌病最具代表性的超声心动图发现。受试者工作特征分析表明,后壁厚度(p<0.0001,曲线下面积[AUC]:0.821,截断值:14.0mm)、LVLSapi/bas(p<0.001,AUC:0.802,截断值:2.16)和 RVLS(p<0.001,AUC:0.791,截断值:-18.7%)可以显著检测 Tc-PYP 阳性结果,可信度较高。根据每位患者这三个参数的总结计算的超声心动图评分点显示,2 分评分具有良好的敏感性(85%)和优秀的特异性(93%),而 1 分评分具有极好的敏感性(91%)和适度的特异性(53%)。

结论

我们提出的用于 Tc-PYP 闪烁显像阳性心肌病的超声心动图筛查工具可能有助于临床医生管理疑似 ATTR-CM 的患者。

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