CAJ | 학술논문

目的探讨二维斑点追踪显像评价左室旋转和扭转运动在早期心尖肥厚型心肌病(PAHCM)患者诊断过程中的准确性.方法选择26例PAHCM患者、26例高血压左心室肥厚(HLVH)患者和26例健康志愿者,分别行二维超声心动图检查,记录二尖瓣和心尖水平左室短轴及心尖四腔、二腔心切面的二维超声图像.使用QLAB 9.1软件测量各短轴平面内膜下心肌旋转(endo-rot)、外膜下心肌旋转(epi-rot)、跨壁扭转(mural-tor)及平面旋转(bulk-rot),计算出整体扭转角度(G-tor).筛选出诊断效力的指标,并绘制受试者工作特征(ROC)曲线来评价诊断的效果.结果在二尖瓣水平,PAHCM组与正常对照组相比,endo-rot、epi-rot、mural-tor及bulk-rot指标的差异无统计学意义(P>0.05);PAHCM组与HLVH组相比,这些指标的差异有统计学意义(P<0.05).HLVH组与正常对照组相比,endo-rot、epi-rot、mural-tor及bulk-rot指标的差异有统计学意义(P<0.05).在心尖水平,3组间epi-rot的差异无统计学意义(P>0.05).PAHCM组与正常对照组相比,endo-rot、mural-tor及bulk-rot指标的差异有统计学意义(P<0.05);PAHCM组与HLVH组相比,这些指标的差异有统计学意义(P<0.05).与正常对照组相比,HLVH组在endo-rot、mural-tor及bulk-rot指标上的差异有统计学意义(P<0.05).各组间G-tor的差异均有统计学意义(P<0.05).ROC曲线分析显示,G-tor鉴别诊断PAHCM的准确性高(ROC曲线下的面积为0.89),敏感度为73.08%,特异度为92.31%.结论二维斑点追踪显像技术可以准确定量测量PAHCM患者左室心肌旋转和扭转的变化.使用G-tor可精确地识别和鉴别高血压心肌肥厚和PAHCM.
목적 탐토이유반점추종현상평개좌실선전화뉴전운동재조기심첨비후형심기병(PAHCM)환자진단과정중적준학성.방법 선택26례PAHCM환자、26례고혈압좌심실비후(HLVH)환자화26례건강지원자,분별행이유초성심동도검사,기록이첨판화심첨수평좌실단축급심첨사강、이강심절면적이유초성도상.사용QLAB 9.1연건측량각단축평면내막하심기선전(endo-rot)、외막하심기선전(epi-rot)、과벽뉴전(mural-tor)급평면선전(bulk-rot),계산출정체뉴전각도(G-tor).사선출진단효력적지표,병회제수시자공작특정(ROC)곡선래평개진단적효과.결과 재이첨판수평,PAHCM조여정상대조조상비,endo-rot、epi-rot、mural-tor급bulk-rot지표적차이무통계학의의(P>0.05);PAHCM조여HLVH조상비,저사지표적차이유통계학의의(P<0.05).HLVH조여정상대조조상비,endo-rot、epi-rot、mural-tor급bulk-rot지표적차이유통계학의의(P<0.05).재심첨수평,3조간epi-rot적차이무통계학의의(P>0.05).PAHCM조여정상대조조상비,endo-rot、mural-tor급bulk-rot지표적차이유통계학의의(P<0.05);PAHCM조여HLVH조상비,저사지표적차이유통계학의의(P<0.05).여정상대조조상비,HLVH조재endo-rot、mural-tor급bulk-rot지표상적차이유통계학의의(P<0.05).각조간G-tor적차이균유통계학의의(P<0.05).ROC곡선분석현시,G-tor감별진단PAHCM적준학성고(ROC곡선하적면적위0.89),민감도위73.08%,특이도위92.31%.결론 이유반점추종현상기술가이준학정량측량PAHCM환자좌실심기선전화뉴전적변화.사용G-tor가정학지식별화감별고혈압심기비후화PAHCM.
Objective To discuss the diagnostic value of two-dimensional speckle tracking imaging in the evaluation of left ventricular rotation and torsion in pre-apical hypertrophic cardiomyopathy(PAHCM)patients. Methods A total of 26 patients with PAHCM,26 patients with hyperten-sive left ventricular hypertrophy(HLVH)and 26 healthy volunteers were recruited for the study. Two-dimensional echocardiographs were performed carefully. Two-dimensional images were obtained from the left ventricular apical four-chamber section,two-chamber section and two short-axis sec-tions,including mitral valve and apical levels. The peak subendocardial rotation(endo-rot),epicardial rotation(epi-rot),transmural torsion(mural-tor)and bulk rotation(bulk-rot)of each short-axis section were measured and analyzed using QLAB 9.1 software. Results In the mitral level, there was no statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the PAHCM group and normal control group (P>0.05). There was statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the PAHCM group and HLVH group (all P<0.05). There was statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the HLVH group and normal control group(all P<0.05). In the apical level,there was no statistically significant difference in epi-rot among three groups(P>0.05). There was statisti-cally significant difference in endo-rot,mural-tor and bulk-rot between each two groups(P<0.05). There was statistically significant difference in G-tor between each two groups(P<0.05). The receiver operating characteristic curve analysis showed that the accuracy of differential diagnosis of G-tor PAHCM was high(the area under the receiver operating characteristic curve is 0.89),the sensitivity was 73.08%,and the specificity was 92.31%. Conclusion Two-dimensional speckle tracking imaging could accurately and quantitatively measure the left ventricular rotation and tor-sion in PAHCM patients. The G-tor could accurately screen and identify between PAHCM and HLVH.