三维斑点追踪成像在诊断AL淀粉样变性病人心脏受累中的价值

目的分析三维斑点追踪成像图像采集及分析对系统性免疫球蛋白轻链型(AL)淀粉样变性病人心脏受累的诊断价值。方法选择左心室射血分数(LVEF)正常的AL淀粉样变性病人80例,按照心脏受累情况分成心脏未受累组(A组)35例和心脏受累组(B组)45例;对比2组病人临床基础资料、血清学指标、常规超声心动图参数以及三维斑点追踪成像参数的差异,并通过受试者工作特征曲线(ROC)分析三维斑点追踪成像参数对诊断AL淀粉样变性心脏受累的特异度和敏感度。结果B组氨基末端B型脑钠肽前体(NT-proBNP)水平明显高于对照组,差异有统计学意义(P < 0.01);2组常规超声参数比较,差异均无统计学意义(P>0.05);B组左心室整体纵向应变(LVGLS)、左心室整体面积应变(LVGAS)及左心室整体径向应变(LVGRS)均明显比A组更低,差异有统计学意义(P < 0.05~P < 0.01);ROC曲线分析结果表明,当LVGLS以16.12%为诊断AL心肌淀粉样变性的截断点时,其曲线下面积、灵敏度、特异度及约登指数最高,分别为0.798、94.18%、86.84%及0.619;LVGLS、LVGAS及LVGRS的检查者组内相关系数分别为0.908、0.837及0.839。结论超声三维斑点追踪成像对AL淀粉样变性病人心脏受累具有一定诊断价值,且简单无创,值得推荐。

Value of three-dimensional speckle tracking imaging in the diagnosis of cardiac involvement in patients with AL amyloidosis

ObjectiveTo analyze the diagnostic value of the three-dimensional speckle tracking imaging in cardiac involvement in patients with systemic immunoglobulin light chain(AL) amyloidosis.MethodsEighty AL amyloidosis patients with normal left ventricular ejection fraction(LVEF) were investigated.According to whether the heart was involved, the patients were divided into the non-heart-affected group(group A, 35 cases) and heart-affected group(group B, 45 cases). The clinical data, serological parameters, conventional echocardiographic parameters and three-dimensional speckle tracking imaging parameters were compared between two groups, and the receiver operating characteristic curve(ROC) was used to analyze the specificity and sensitivity of three-dimensional speckle tracking imaging parameters in the diagnosis of AL amyloidosis.ResultsThe level of amino-terminal B-type natriuretic peptide precursor(NT-proBNP) in group B was significantly higher than that in group A(P < 0.01). There was no statistical significance in the conventional ultrasound parameters between two groups(P>0.05). The overall left ventricular longitudinal strain(LVGLS), overall left ventricular area strain(LVGAS) and overall left ventricular radial strain(LVGRS) in group B were significantly lower than those in group A(P < 0.05 to P < 0.01). The results of ROC curve analysis showed that when the 16.12% of LVGLS was used as the cut-off point for diagnosing AL myocardial amyloidosis, the area under curve, sensitivity, specificity and Yuden index were the highest, which were 0.798, 94.18%, 86.84% and 0.619, respectively. The intra-group correlation coefficients of LVGLS, LVGAS and LVGRS were 0.908, 0.837 and 0.839, respectively.ConclusionsThe ultrasound three-dimensional speckle tracking imaging has certain diagnostic value in cardiac involvement in patients with AL amyloidosis, is simple, non-invasive and worthy of recommending.