摘要
【目的】本研究通过测定心脏淀粉样变(CA)患者与高血压左室肥厚(HLVH)患者的左室长轴心肌应变相关指标,并比较其差异性,进一步明确左室长轴心肌应变在CA患者早期诊断的价值。【方法】选出确诊为CA的患者41例,按患者既往是否合并原发性高血压分为CA并高血压组14例与单纯CA组27例,同时按性别、年龄及体表面积匹配HLVH患者20例及健康对照组20例。收集患者的临床资料,获取常规超声心动图指标包括室壁厚度(IVST、LVPWT、RWT)、心腔大小(LVEDD、LAVI)、收缩及舒张功能指标(LVEF、平均E/e'),以及左室长轴应变相关指标(GLS、RELAPS、EFSR)。比较4组研究对象的组内差异并进行组间两两比较,进一步测定LVEF保留时各超声心动图指标预测CA的敏感性与特异性。【结果】①超声心动图的常规指标中CA并高血压组和单纯CA组的LVEDD和LVEF均低于HLVH组;而CA并高血压组和单纯CA组的LVPWT、RWT及平均E/e'均高于HLVH组(P均<0.05)。②应变指标中CA并高血压组和单纯CA组的GLS绝对值最低,HLVH组次之,健康对照组最高;同时,CA并高血压组和单纯CA组的RELAPS与EFSR值最高,HLVH次之,健康对照组最低(P均<0.05)。CA并高血压组和单纯CA组的所有超声心动图指标差异均无统计学意义(P均>0.05)。③ROC曲线分析显示在LVEF保留时,GLS绝对值<14.35%或EFSR>4.28时可较好地鉴别CA和HLVH(AUC均>0.9,P均<0.05);GLS诊断的敏感性最高(100%),而EFSR诊断的特异性最高(95%)。【结论】无论CA是否合并高血压,与HLVH相比,其超声心动图的常规及应变指标上均有显著的差异;尤其是应变指标GLS和EFSR在左室肥厚并LVEF保留患者中预测CA的准确性更高。
【Objective】To clarify the value of the left ventricular longitudinal strain(LVLS)parameters in patients with cardiac amyloidosis(CA)and primary hypertension with left ventricular hypertrophy(HLVH).【Methods】Forty-one pa‐tients confirmed with CA were selected and assigned to CA with hypertension group(n=14)and pure CA group(n=27)based on the initial diagnosis with or without hypertension.Twenty patients with primary hypertension-induced left ventric‐ular hypertrophy(HLVH group)and twenty healthy controls were also selected,matching for gender,age,and body sur‐face area.Clinical data,conventional echocardiography parameters were collected and LVLS parameters were measured.Within-group variations were compared among the four groups,and pairwise comparisons were conducted between groups.The sensitivity and specificity of each parameter in predicting CA were judged by the receiver operator characteristic(ROC)curvy in CA and HLVH patients with left ventricular ejection fraction(LVEF)preserved.【Results】Among the con‐ventional echocardiography parameters,LVEF and left ventricular end-diastolic diameter(LVEDD)were lower in the CA with hypertension group and pure CA group compared with the higher values in the HLVH group and control group.Where‐as,left ventricular posterior wall thickness(LVPWT),relative wall thickness(RWT),and average E/e'were higher in the two CA groups compared with the HLVH group(all P<0.05).Among the LVLS parameters,Global longitudinal strain(GLS)was the worst in the CA with hypertension group so as pure CA group,modest in the HLVH group,and highest in the control group.On the contrary,relative longitudinal strain and ejection fraction strain ratio(EFSR)were the highest in the CA with hypertension group so as to pure CA group,modest in the HLVH group,and lowest in the control group(all P<0.05).ROC analysis showed that when LVEF was preserved,the absolute value of GLS less than 14.35%and EFSR higher than 4.28 could effectively distinguish CA from HLVH(all AUCs>0.9,all P<0.05);meanwhile GLS showed high sensitivity(100%)and EFSR showed great specificity(95%).There were not statistically significance in any parameter be‐tween CA with hypertension group and pure CA group(all P>0.05).【Conclusion】Whether CA was complicated with hy‐pertension or not,there were statistically significance among routine echocardiography and LVLS parameters compared with HLVH.In particular,GLS and EFSR are accurate in predicting CA in patients with myocardial hypertrophy and pre‐served LVEF.
作者
冯日清
蒙媛丽
刘英梅
邱琼
郑韶欣
邓冰清
韦育林
FENG Ri-qing;MENG Yuan-li;LIU Ying-mei;QIU Qiong;ZHENG Shao-xin;DENG Bing-qing;WEI Yu-lin(Department of Cardiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2023年第6期1046-1052,共7页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广州市市校(院)联合资助项目(202102010210)。
关键词
心脏淀粉样变
超声心动图
心肌应变
左室肥厚
诊断
cardiac amyloidosis
echocardiography
left ventricular longitudinal strain
left ventricular hypertro‐phy
diagnosis
