摘要
目的:应用斑点追踪技术对心肌运动进行二维应变分析,评价暴发性心肌炎(FM)患者左心室功能和心肌收缩同步性。方法:回顾性分析30例急性心肌炎患者,其中轻型心肌炎组(MM) 21例,FM组9例。应用Vivid 9超声诊断仪对患者进行常规超声检查,并运用二维斑点追踪技术评价心功能及左室整体纵向应变。结果:FM组较MM组收缩压更低(95±13) mmHg,心率更快(101±23)次/min,血C反应蛋白(CRP)、肌钙蛋白和N末端脑钠肽前体(NT-proBNP)水平也较MM组显著增加(均P <0. 05)。FM组左室射血分数(EF)、左室短轴缩短率(FS)显著下降,舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度的比值(E/E')明显增加(均P <0. 05),但舒张末期左室长轴内径(LVEDD)、左房内径(LAD)、室间隔(IVS)、左室后壁(LVPW)与MM组比较差异无统计学意义(均P>0. 05)。FM组心肌应变显著下降,尤其以基底段和中间段心肌应变下降更为明显(-15. 6±2. 9%vs-7. 8±4. 5%,P=0. 008;-19. 5±3. 0%vs-9. 7±4. 8%,P=0. 004)。结论:FM较轻型心肌炎易出现严重的左室收缩、舒张功能下降和显著的节段室壁运动异常。基于斑点追踪技术的整体长轴应变(GLS)检测对诊断FM具有较高价值。
Objective: To evaluate the left ventricular function and the left ventricular systolic synchrony in patients with fulminant myocarditis(FM) by two-dimensional speckle tracking technique with strain analysis of myocardial motion. Methods: A retrospective analysis was performed on 30 cases of myocarditis,including 21 mild myocarditis(MM) patients and 9FM patients. Vivid 9 ultrasound diagnostic apparatus was used to perform ultrasound examination. The data were further analyzed by two-dimensional speckle-tracking echocardiography(2D STE),and the diagnostic value of left ventricular global longitudinal strain(GLS) in FM was measured. Results: As compared with the MM group,the systolic pressure in the FM group was reduced [(95 ± 13) mm Hg],and the heart rate was increased [(101 ± 23) beats/min]. The CRP,troponin and NT-proBNP levels were significantly increased in the FM group(P < 0. 05). The levels of EF and FS were decreased and E/E’ was increased in the FM group(P < 0. 05),but there was no significant difference in left ventricular end diastolic diameter(LVEDD),left atrial diameter(LAD),interventricular septum(IVS) and left ventricular postwall(LVPW) between two groups(P > 0. 05). Left ventricular longitudinal peak systolic longitudinal strain in the FM groups was decreased,especially the decreased myocardial strain in basal and middle segments(-15. 6% ± 2. 9% vs-7. 8% ± 4. 5%,P = 0. 008;-19. 5% ± 3. 0% vs-9. 7% ± 4. 8%,P = 0. 004). Conclusions: The FM patients demonstrated significantly decreased left ventricular systolic and diastolic function and more wall motion abnormalities. GLS taken by 2D STE can provide a diagnostic value to identify FM.
作者
左后娟
周宁
蒋建刚
陈琛
李瑞
马飞
苗琨
汪道文
王红
ZUO Hou-juan;ZHOU Ning;JIANG Jian-gang;CHEN Chen;LI Rui;MA Fei;MIAO Kun;WANG Dao-wen;WANG Hong(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《内科急危重症杂志》
2018年第6期451-455,共5页
Journal of Critical Care In Internal Medicine
基金
国家自然科学基金项目(No:81873535)
关键词
斑点追踪
二维应变
暴发性心肌炎
心功能
Speckle tracking
Two-dimensional strain
Fulminant myocarditis
Myocardial function
