ROC曲线评估二维斑点追踪技术在心尖肥厚型心肌病诊断中的价值

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目的:应用受试者工作特征(ROC)曲线评估二维斑点追踪技术在心尖肥厚型心肌病(AHCM)诊断中的应用效果。方法:选取昆山市第一人民医院2014年6月1日至2018年6月30日收治的AHCM患者100例为观察组,另选取同时期进行体检的50例健康志愿者为对照组,均行二维超声心动图检查。获取左心室壁各节段圆周应变峰值(CS)及纵向应变峰值(LS),并测量二尖瓣水平和心尖水平左室短轴平面内膜下心肌旋转(endo-rot)、外膜下心肌旋转(epi-rot)、平面旋转(bulk-rot)、跨壁扭转(mural-tor)及整体扭转角度(G-tor),筛选有效指标并应用ROC曲线评估各指标诊断效果。结果:观察组和对照组EDV、ESV、LADs、E、A、E/A、APd比较差异有统计学意义(n P<0.05)。观察组和对照组二尖瓣水平、心尖水平、乳头肌水平的CS、LS及整体CS(GCS)、整体LS(GLS)比较差异均有统计学意义(n P<0.05),其中心尖水平CS与LS联合诊断价值更高,为0.821(0.791,0.904);观察组和对照组二尖瓣水平及心尖水平endo-rot、epi-rot、bulk-rot、mural-tor及G-tor比较差异具有统计学意义(n P<0.05),其中G-tor诊断价值更高,为0.844(0.771,0.918)。n 结论:二维斑点追踪技术在心尖肥厚型心肌病诊断中具有重要作用,可观察心肌运动形变能力,还可观察左心室心肌旋转及扭转变化,其中心尖水平CS与LS联合检测及G-tor可较好鉴别AHCM。“,”Objective:Evaluation of two-dimensional speckle tracking technique in the diagnosis of apical hypertrophic cardiomyopathy (AHCM) using ROC curve.Methods:100 patients with AHCM admitted to Kunshan First People's Hospital from June 1, 2014 to June 30, 2018 were selected as the observation group, and 50 healthy volunteers who underwent physical examination at the same time were selected as the control group. All subjects underwent two-dimensional echocardiography. Circumferential strain (CS) and longitudinal strain (LS) of each segment of the left ventricular wall were obtained. End-rot, epi-rot, bulk-rot, mural-tor and G-tor were measured at mitral and apical levels. To screen effective indicators and evaluate the diagnostic effect of each indicator by receiver operating characteristic (ROC) curve.Results:There were significant differences in end-diastolic volume, end-systolic volume, diameter of left atrium in end-systole, the height of the early diastolic flow-velocity peak (E), the height of the late diastolic peak (A), E/A and apical thickness in end-diastole between the two groups (n P<0.05). There were significant differences in CS at mitral valve level, apical level, papillary muscle level, global CS, LS and global LS (GLS) between the observation group and the control group (n P<0.05), the diagnostic value of combined CS and LS at apical level was higher, and the area under curve (AUC) was 0.821(0.791, 0.904); There were significant differences in mitral valve level and apical level of endo-rot, epi-rot, bulk-rot, mural-tor and G-tor between the observation group and the control group (n P<0.05); G-tor has higher diagnostic value among them, and the AUC was 0.844 (0.771, 0.918).n Conclusions:Two-dimensional speckle tracking technique plays an important role in the diagnosis of apical hypertrophic cardiomyopathy. It can observe the ability of myocardial movement and deformation, as well as the changes of left ventricular myocardial rotation and torsion. The combined detection of CS and LS at apical level and G-tor can better differentiate AHCM.
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