【摘要】 目的探讨二维斑点追踪(2D-STE)技术鉴别缺血性扩张型心肌病(IDCM)与非缺血性扩张型心肌病(NIDCM)的临床应用价值。方法选取我院经冠状动脉造影证实的41例IDCM患者(IDCM组)和43例NIDCM患者(NIDCM组),另选24例健康者为对照组。行常规超声检测各组左室射血分数(LVEF)、左室舒张末期内径、室间隔厚度及左室后壁厚度;2D-STE检测两组左室整体纵向应变(GLS)、环向应变(GCS)、径向应变(GRS)。比较各组上述各参数差异。绘制受试者工作特征(ROC)曲线分析LVEF及2D-STE参数鉴别NIDCM与IDCM的诊断效能。结果 NIDCM组LVEF较IDCM组明显减低(P<0.05),余常规超声参数两组比较差异均无统计学意义。NIDCM组与IDCM组GLS比较差异无统计学意义,但两组GLS均显著低于对照组(均P<0.05);NIDCM组GCS和GRS均显著低于IDCM组[(-5.4±2.6)%vs.(-7.0±2.5)%,(7.5±4.5)%vs.(10.7±4.7)%],差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,LVEF截断值为33.5%时,鉴别NIDCM与IDCM的曲线下面积为0.620,敏感性为51%,特异性为72%;GLS截断值为-10.1%时,鉴别NIDCM与IDCM的曲线下面积为0.525,敏感性为51%,特异性为63%;GCS截断值为-6.7%时,鉴别NIDCM与IDCM的曲线下面积为0.688,敏感性为65%,特异性为68%;GRS截断值为8.5%时,鉴别NIDCM与IDCM的曲线下面积最大,为0.701,敏感性为66%,特异性为74%。结论 IDCM患者和NIDCM患者左室心肌各节段应变值均明显减低;2D-STE可用于鉴别IDCM与NIDCM,其中GRS检测可用于临床对IDCM与NIDCM的初步分层。更多还原

【Abstract】 Objective To explore the clinical application value of two-dimensional speckle tracking echocardiography(2 D-STE) in the differential diagnosis of ischemic dilated cardiomyopathy(IDCM) and nonischemic dilated cardiomyopathy(NIDCM).Methods According to the results of coronary angiography,41 IDCM patients and 43 NIDCM patients were taken as the research groups,and 24 normal patients were taken as the control group.Conventional ultrasound examination was performed,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,interventival septal thickness and left ventricular posterior wall thickness were obtained.The left ventricular global longitudinal strain(GLS),global circumferential strain(GCS)and global radial strain(GRS) of each group were measured by 2 D-STE.The above parameters among groups were compared.Receiver operating characteristic(ROC) curve was drawn to differentiate NIDCM from IDCM.Results LVEF in the IDCM group was significantly lower than that in the NIDCM group(P<0.05),and there were no statistically significant differences in other conventional ultrasound parameters between the two groups.GLS in the IDCM group and NIDCM group was lower than that in the control group(both P<0.05),but GLS between the NIDCM group and the IDCM group was no significant difference.GCS and GRS in the NIDCM group were significantly lower than those in the IDCM group [(-5.4±2..6)% vs.(-7.0±2.5)%,(7.5±4.5)% vs.(10.7±4.7)%,both P<0.05].The results of ROC curve demonstrated that the GRS has the largest AUC(AUC=0.701),with the cutoff 8.5%,the sensitivity 66%,and the specificity 74%.In addition,the AUC of GLS was 0.525,with the cutoff-10.1%,the sensitivity 51%,and the specificity 63%.The AUC of GCS was 0.688,with the cutoff-6.7%,the sensitivity 65%,and the specificity 68%.And the AUC of LVEF was 0.620,with the cutoff 33.5%,the sensitivity 51%,and the specificity 72%.Conclusion The left ventricular myocardial strain of IDCM and NIDCM patients are significantly decreased,and GRS could be used to help differentiate NIDCM from IDCM.更多还原