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目的探讨斑点追踪成像(STI)评价心脏淀粉样变性(CA)与其他引起左室肥厚的疾病心肌收缩功能的价值及鉴别诊断价值。方法对24例CA、21例HLVH、15例HCM及28例对照组行超声心动图检查,记录心尖四腔、三腔、二腔心切面高帧频图像,应用QLAB 8.1软件测量左室壁18节段收缩期纵向应变峰值(LS),计算各水平LS及整体LS(GLS);最后对各参数绘制ROC曲线。结果 (1)与对照组及HLVH比,CA各节段,各水平及GLS明显减低(P<0.005)。(2)与HCM比,CA各水平及GLS减低(P<0.05),各壁基底段LS减低(P<0.05),侧壁中间段、下壁中间段及心尖段LS减低(P<0.05)。(3)ROC曲线分析:相对心尖LS[平均心尖段LS/(平均基底段LS+平均中间段LS)]鉴别CA和HLVH,CA和HCM准确性高(AUC分别0.81,0.87),以相对心尖LS>0.76及其>0.80为界值鉴别CA和HLVH,CA和HCM具有较高的灵敏度及特异度(CA vs HLVH:85%和71%;CA vs HCM:87%和100%)。结论 STI可以评价CA和其他引起左室肥厚疾病左室纵向心肌收缩功能,相对心尖LS可作为鉴别CA较为准确实用的方法。
Objective To investigate the value and differential diagnosis of myocardial systolic function in patients with cardiac amyloidosis (CA) and other diseases that cause left ventricular hypertrophy by speckle tracking imaging (STI). Methods 24 cases of CA, 21 cases of HLVH, 15 cases of HCM and 28 cases of control group underwent echocardiography, recording apical four-chamber, three-chamber, two-chamber heart rate high frame rate image, QLAB 8.1 software was used to measure the left ventricular wall 18 Segmental systolic longitudinal strain peak (LS), calculate the level of LS and the overall LS (GLS); Finally, the ROC curve for each parameter. Results (1) Compared with the control group and HLVH, the levels of CA and the levels of GLS were significantly decreased (P <0.005). (2) Compared with HCM, the levels of CA and the GLS decreased (P <0.05), the LS of each wall decreased (P <0.05), the middle segment of middle wall, . (3) ROC curve analysis: The accuracy of CA and HLVH, CA and HCM was high in relative apical LS [mean apical section LS / (average base section LS + mean middle section LS)] (AUC 0.81 and 0.87, respectively) > 0.76 and> 0.80 for CA and HLVH. CA and HCM had higher sensitivity and specificity (CA vs HLVH: 85% and 71%; CA vs HCM: 87% and 100%). Conclusions STI can evaluate left ventricular longitudinal myocardial systolic function in patients with left ventricular hypertrophy induced by left ventricular hypertrophy, and relative apex LS can be used as a more accurate and practical method to identify CA.