摘要
目的:探讨二维斑点追踪成像评估儿童心肌病预后、临床疗效及随访指导的价值。方法:本研究纳入我院2018年10月至2020年12月收治并随访的25例心肌病患儿(13例DCM和12例NVM)及健康体检儿童40例(对照组),应用二维斑点追踪成像分析左室整体收缩期纵向应变、圆周应变(GLS、GCS),应变达峰时间标准差(TLS-SD和TCS-SD),比较LVEF不同转归两组心肌病患儿治疗前后以及LVEF恢复正常组治疗后与健康对照组常规心超和应变参数的差异。结果:与LVEF未恢复正常组(n = 12)治疗前相比,LVEF恢复正常组(n = 13)治疗前的GLS、GCS较高,LVEDd-Z、TCS-SD较低(P均P > 0.05)。GLS预测LVEF恢复正常的ROC曲线下面积(AUC)为0.811 (95% CI: 0.640~0.981;P = 0.008),预测LVEF恢复正常的最佳截止点是≥−9.0% (敏感性:83.3%,特异性:76.9%)。GCS预测LVEF恢复正常的AUC为0.878 (95% CI: 0.733~1.000;P = 0.001),预测LVEF恢复正常的最佳截止点是≥−7.9% (敏感性:83.3%,特异性:92.3%)。LVEF未恢复正常组治疗前后相比,LVEF、LVEDd-Z、GLS、TLS-SD无变化(P > 0.05),GCS升高,改良Ross评分、TCS-SD降低(P P P > 0.05)。结论:二维斑点追踪成像较LVEF可更灵敏地评估儿童心肌病的临床疗效,并对其预后具有预测价值,对儿童心肌病随访指导有重要的临床应用价值。Objective: To explore the value of 2D-speckle tracking imaging (STI) in evaluating the prognosis, clinical efficacy and follow-up guidance of children with cardiomyopathy. Methods: This study included 25 pediatric patients with cardiomyopathy (13 cases of DCM and 12 cases of NVM) who were treated and followed up at our hospital from October 2018 to December 2020, as well as a control group of 40 healthy children undergoing routine physical examinations. Utilizing two-dimensional speckle tracking imaging, we analyzed the left ventricular global longitudinal strain (GLS) and global circumferential strain (GCS), along with the standard deviations of the peak strain times (TLS-SD and TCS-SD). We compared the differences in conventional echocardiographic and strain parameters before and after treatment between the cardiomyopathy patients with different LVEF outcomes, as well as between the cardiomyopathy patients with normalized LVEF post-treatment and the healthy control group. Results: Compared with the pre-treatment period in the group with non-normalized LVEF (n = 12), the pre-treatment GLS and GCS were higher, LVEDd-Z and TCS-SD were lower in the group with normalized LVEF (n = 13) (all P P > 0.05). The AUC for GLS predicting normalized LVEF was 0.811 (95% CI: 0.640~0.981;P = 0.008), and the optimal cutoff point for predicting normalization of LVEF was ≥−9.0% (sensitivity: 83.3%, specificity: 76.9%). The AUC for GCS predicting normalization of LVEF was 0.878 (95% CI: 0.733~1.000;P = 0.001), and the optimal cutoff point for predicting normalization of LVEF was ≥−7.9% (sensitivity: 83.3%, specificity: 92.3%). In the group with non-normalized LVEF, there was no significant change in LVEF, LVEDd-Z, GLS, and TLS-SD before and after treatment (P > 0.05), and GCS was higher, and modified ROSS score and TCS-SD were lower (P P P > 0.05). Conclusion: The STI provides a more sensitive assessment of clinical efficacy in pediatric cardiomyopathy than LVEF and has predictive value for prognosis. It holds significant clinical value for guiding follow-up in pediatric cardiomyopathy cases.
出处
《临床医学进展》
2024年第12期1605-1615,共11页
Advances in Clinical Medicine
