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目的应用斑点追踪成像(STI)技术测量心脏淀粉样变(CA)与其他引起左心室肥厚的疾病左心室短轴方向旋转和扭转角度,探讨STI评价CA患者左心室旋转和扭转运动的临床价值。方法 24例CA患者(CA组),其中男性15例,女性9例;年龄42~70岁,平均57.25岁。21例高血压左心室肥厚(HLVH)患者(HLVH组),其中男性13例,女性8例;年龄39~73岁,平均年龄54.24岁。15例肥厚型心肌病(HCM)患者(HCM组),其中男性9例,女性6例;年龄41~69岁,平均年龄55.07岁。健康志愿者28例(对照组),其中男性17例,女性11例;年龄42~72岁,平均年龄54.75岁。对24例CA、21例HLVH、15例HCM及28例健康志愿者,分别行二维超声心动图检查,分别采集左心室短轴图像,测量各平面的内膜下心肌旋转(endo-rot)、外膜下心肌旋转(epi-rot)、平面旋转(bulk-rot)及跨壁扭转(mural-tor)峰值。计算左心室整体扭转(lv-tor)峰值。结果 1与对照组比,CA组各个水平旋转及扭转峰值、lv-tor峰值均减低(P<0.05);HLVH组心尖水平endo-rot、epi-rot、bulk-rot峰值减低(P<0.05);HCM组二尖瓣水平endo-rot、mural-tor峰值减低(P<0.05),心尖水平endo-rot、epi-rot、bulk-rot峰值明显减低(P<0.005)。2CA组二尖瓣水平各旋转及扭转峰值低于HLVH组及HCM组(P<0.05),lv-tor峰值低于HLVH组(P<0.05)。3HCM组与HLVH组比较,各旋转及扭转峰值差异无统计学意义(P>0.05)。结论 CA、HCM、HLVH患者心功能受损,左心室旋转及扭转运动发生变化,CA表现在全部水平及整体减低,HCM组及HLVH组主要集中在心尖水平减低,与HCM及HLVH组相比,CA旋转及扭转运动主要集中在基底水平,示二维STI能够从短轴各平面心肌旋转和扭转运动的角度更准确及敏感反映CA患者心肌功能变化。
Objective To measure the rotation and torsion angles of left ventricular short axis in patients with cardiac amyloidosis (CA) and other diseases that cause left ventricular hypertrophy by speckle tracking imaging (STI). To investigate the clinical value of STI in evaluating left ventricular rotation and torsion in CA patients. Methods Twenty-four patients with CA (CA group), including 15 males and 9 females, aged from 42 to 70 years (average 57.25 years). Twenty-one hypertensive patients with left ventricular hypertrophy (HLVH) (HLVH group), including 13 males and 8 females, aged from 39 to 73 years with an average age of 54.24 years. 15 cases of hypertrophic cardiomyopathy (HCM) patients (HCM group), including 9 males and 6 females; aged 41 to 69 years, mean age 55.07 years. Healthy volunteers in 28 cases (control group), of which 17 males and 11 females; aged 42 to 72 years, mean age 54.75 years. 24 cases of CA, 21 cases of HLVH, 15 cases of HCM and 28 healthy volunteers were examined by two-dimensional echocardiography, respectively, left ventricular short axis images were collected to measure the intima of each plane myocardial rotation (endo-rot) Epi-rot, bulk-rot, and mural-tor peak. The left ventricular total lv-tor peak was calculated. Results 1 Compared with the control group, the levels of lv-tor peak and peak rotation were all decreased in CA group (P <0.05); the peak of endo-rot, epi-rot and bulk-rot in HLVH group was decreased (P <0.05). The peak value of endo-rot, epi-rot, and bulk-rot in apex decreased significantly in HCM group (P <0.005). The peak values of mitral valve rotation and torsion in 2CA group were lower than those in HLVH group and HCM group (P <0.05), and the lv-tor peak was lower than HLVH group (P <0.05). 3HCM group and HLVH group, the rotation and torsion peak difference was not statistically significant (P> 0.05). Conclusions CA, HCM, HLVH patients with impaired cardiac function, left ventricular rotation and torsion movement changes, CA performance in all levels and the overall reduction, HCM group and HLVH group mainly in the apical level decreased, compared with HCM and HLVH group, CA rotational and torsional movements are mainly at the basal level, showing that the two-dimensional STI can reflect more accurately and sensitively the changes of myocardial function in patients with CA from the angles of rotation and torsion of the myocardium on each plane of the short axis.