| 摘要: |
| 摘 要 目的 应用二维斑点追踪（2D-STI）技术分析左室射血分数（LVEF）保留的多发性骨髓瘤（MM）患者左心功能变化，探讨其评估早期心肌损害的临床价值。方法 选取我院临床确诊为MM且LVEF保留的患者72例，分为室间隔增厚组和室间隔非增厚组各36例，另选取健康体检者39例为正常对照组，均行常规超声心动图检查及二维纵向应变（LS）分析，获取并比较左室分层（心内膜层、中层及外膜层）整体纵向应变、心肌各层分段（心尖段、中间段、基底段）LS相关参数的差异。采用Pearson或Spearman相关分析法分析各应变参数与BNP的相关性。以脑钠肽（BNP）增高作为心肌受损标准，绘制受试者工作特征（ROC）曲线分析各应变参数诊断心肌损害的效能。采用组间相关系数（ICC）分析各应变参数在观察者间及观察者内的重复性。结果 与正常对照组、室间隔非增厚组比较，室间隔增厚组心内膜层整体纵向应变（GLS-Endo）绝对值、中层心肌整体纵向应变（GLS-Mid）绝对值及心外膜层整体纵向应变（GLS-Epi）绝对值均降低；室间隔增厚组心内膜层、中层及外膜层基底段、中间段LS绝对值均降低，各层心肌心尖段/（基底段+中间段）LS比值均增大，差异均有统计学意义（均P＜0.05）。相关性分析显示，室间隔增厚组GLS-Endo及心内膜层、中层、外膜层基底段LS与BNP均呈正相关（r=0.458、0.415、0.365、0.429，P=0.010、0.020、0.044、0.016）。ROC曲线分析显示，GLS-Endo截断值为-22.1%，其诊断心肌损害效能最高，ROC曲线下面积为0.825（95%可信区间：0.689~0.962，P=0.001），灵敏度为66.7%，特异度为93.3%。重复性检验显示，GLS-Endo、GLS-Mid、GLS-Epi在观察者内及观察者间的重复性及可信度均较高（均ICC＞0.75，均P＜0.05）。结论 应用2D-STI技术获得的心肌各层整体及分段LS能敏感识别LVEF保留的MM患者心肌损害情况，心内膜层基底段LS更能早期评估局部心肌损害及收缩功能异常，可为临床早期干预提供参考依据。 |
| 关键词: 超声心动描记术 二维斑点追踪成像技术 纵向应变 多发性骨髓瘤 心肌损害 |
| DOI： |
| 投稿时间：2022-12-22修订日期：2023-03-05 |
| 基金项目:陆军军医大学优秀人才库重点扶持对象 |
|
| Clinical value of two-dimensional speckle tracking technique in evaluating myocardial injury associated with multiple myeloma |
| guanxue,xumin,zuohao,chenguo,lihaiyan,liaoyiyi,gaoli,xuyali |
| () |
| Abstract: |
| ABSTRACT Objective The changes of left ventricular function in patients with multiple myeloma（MM） with left ventricular ejection fraction（LVEF） reservation were analyzed by two-dimensional speckle tracking imaging（2D-STI） to explore its clinical value in evaluating early myocardial injury. Methods 72 patients with preserved LVEF who were clinically diagnosed as MM in our hospital were divided into two groups：the ventricular septal thickening group and non-thickening group（36 cases each），and 39 healthy controls were selected,Echocardiography and 2D-STI LS analysis were performed to obtain and compare the LS-related parameters of the myocardial segments (apical, middle and basal segments)and left ventricular layer-specific strain（endocardial, mid-myocardial and epicar-dial）.Pearson or Spearman correlation analysis was used to analyze the correlation between each strain parameter and BNP.The increase of brain natriuretic peptide（BNP） was taken as the standard of myocardial injury，receiver operating characteristic (ROC) curves were drawn to analyze the potency of each strain parameter to diagnose myocardial injury.Inter -and intraobserver reproducibility of each strain parameter was analyzed using the intraclass correlation coefficient (ICC)..Results The absolute value of global longitudinal strain in the endocardial layer(GLS-endo), Mid-myocardial layer(GLS-mid) and epicardial layer (GLS-Epi) were decreased in the interventricular septum thickening group compared with the normal control group or the non thickened interventricular septum group.The absolute values of LS values in the endocardial，middle and epicardial basal segments and middle segments of the thickening ventricular septum group decreased，The ratio of apical LS /（basal LS + middle LS） in each layer of myocardium increased .The differences were significant ( P< 0.05).The results of correlation analysis showed that in the septum thickening group，there was a positive correlation with BNP between GLS-Endo and LS in the basal segment of the endocardial，middle and epicardial layers（r=0.458，0.415，0.365，0.429，p=0.010，0.020，0.044，0.016）. The ROC curve analysis showed that the GLS-endo cutoff value of - 22.1% had the highest potency for diagnosing myocardial injury, with an area under the ROC curve of 0.825 (95% CI: 0.689-0.962, P = 0.001), sensitivity of 66.7% and specificity of 93.3%. The repeatability test showed high inter- and intraobserver reproducibility and reliability for GLS-Endo, GLS-Mid and GLS -Epi.
.Conclusion The global and segmented LS of each layer of myocardium obtained by 2D-STI technology can sensitively identify myocardial injury in MM patients with LVEF preservation.LS in the basal segment of endocardial layer is more able to evaluate local myocardial injury and abnormal systolic function early, which can provide a reference for early clinical intervention. |
| Key words: Echocardiography Two-dimensional speckle tracking imaging technique Longitudinal strain Multiple myeloma Myocardial injury |
