致心律失常性右室心肌病患者右心室壁运动功能评估薛社亮1姚静2雍永宏2尹红丽3邹建刚2(1常州市武进人民医院心脏科江苏常州213002)(2南京医科大学第一附属医院心脏科江苏南京210029)(3江苏省省级机关医院心脏科江苏南京210024)【摘要】目的定量评估致心律失常性右室心肌病(ARVC)患者右心室壁运动功能。方法应用斑点追踪成像技术测量26例ARVC患者、24例特发性右室室速(IRVT)患者及28例正常人的右室游离壁各节段心肌应变、应变率、速度及位移,分别记录基底段、中间段及心尖段纵向收缩期峰值应变(St＞、收缩期峰值应变率(SrS)、收缩期峰值速度(Vs)及峰值位移(D),比较不同实验组间及不同室壁节段间的差异。结果正常人右室游离壁各节段的Vs、D存在明显的梯度分布，基底部值最大，中间段次之，心尖部最低，St、SrS亦存在类似梯度，但除心尖段St外，差异无统计学意义。在IRVT及ARVC病人中，Vs、D的梯度分布依然存在。IRVT组与正常对照组比较，右室游离壁各节段St、SrS、Vs、D均无统计学差异。ARVC组各节段St、SrS均低于正常对照组ARVC组右室游离壁中间段及心尖段St低于IRVT组。ROC(receiveroperatingcharacteristic｝曲线表明，运用右室游离壁中间段应变值诊断ARVC,当取-23.01%为截断值时，诊断敏感性为83.3%，特异性为87.5%,若以中间段应变率-1.27为截断值时，诊断敏感性为83.3%,特异性为93.8%。若以右室游离壁中间段应变值鉴别ARVC与IRVT,当取-21.39%为截断值时，诊断敏感性为83.3%,特异性为100%。结论二维斑点追踪法应变率检查发现ARVC患者右室游离壁各节段运动减弱，选择合适的截断值，可以为ARVC的诊断与鉴别诊断提供帮助。【关键词】斑点追踪致心律失常型右室心肌病特发性右室室性心动过速右室【文献标识码】A【文章编号】2095-1752(2014)23-0071-02Assessmentofrightventricularfreewallmovefunctionusingspeckletracking【中图分类号】R541imaginginpatientswitharrhythmogenicrightventricularcardiomyopathyXuesheliangl,Yaojing2，Yongyonghong2，Yinhongli3,ZOUjian-gang21Departmentofcardiology，ChangzhouWujinpeople’sHospital，Changzhou2100032Departmentofcardiology，TheFirstAffiliatedHospital，NanjingMedicalUniversity,Nanjing2100293Departmentofcardiology，JiangsuProvinceOfficialHospital,Nanjing210024【Abstract】Objective:Toassessrightventricularfreewallmovefunctioninpatientswitharrhythmogenicrightventricularcardiomyopathy(ARVC)byspeckletrackingimaging(STI)Methods:Peakmyocardialsystolicstrain(St)，strainrate(SrS)，Peaksystolicvelocity(Vs)anddisplacement(D)weremeasuredrespectivelyinrightventricularfreewallbasal,midandapicalsegmentin26patientswithARVC,24patientswithIRVTand28healthyvolunteersbySTI.Results:ThevaluesofStandSrSinallsegmentswerelowerinARVCgroupthanthoseincontrolgroup(P<0.05).ThevaluesofStinmidandapicalsegmentwerelowerinARVCgroupthanthoseinIRVTgroup(P<0.05).TherewasnosignificantdifferencebetweenIRVTandcontrolgroupinallsegments(P>0.05).Thereceiver-operatingcharacteristics(ROC)curvesforStvalueofmidsegmentshowedthatthesensitivityandspecificityforpredictingARVCwas83.3%and87.5%,respectively,whenthe-23.01%waschosenascutpointofSt.Meanwhile，thesensitivityandspecificityfordistinguishARVCfromIRVTwas83.3%and100%respectivelywhenthe-21.39%waschosenascutpointofSt.Conclusions:ItshowsadecreasedmovefunctionofrightventricularfreewallinpatientswithARVCbyspeckletrackingimaging.AnappropriatecutpointvaluewouldmakeuseforthediagnosisanddifferentialdiagnosisofARVC.【Keywords]speckletracking；arrhythmogenicrightventricularcardiomyopathy；idiopathicrightventriculartachycardia；rightventricular；致心律失常性右心室心肌病(arrhythmogenicrightventricularcardiomyopathy,ARVC),又称致心律失常性右心室发育不良(arrhythmogenicrightventriculard...
