二维斑点追踪成像技术在甲型流感相关心肌炎患儿左室功能评估中的价值

doi:10.12372/jcp.2024.23e0710

Abstract

Abstract:

Objective To evaluate left ventricular function and ventricular wall motion disorder by two-dimensional speckle tracking echocardiography (2D-STE) in children with influenza A-related myocarditis. Methods Thirty children with influenza A-related myocarditis were selected as the case group, and 33 children who came in for routine check-ups were used as the normal control group. Routine ultrasonography was performed on both groups, and two-dimensional speckle tracking technology was used to evaluate cardiac function and global longitudinal strain of the left ventricle. Comparative analysis was conducted between the two groups. Results There was no significant difference in age, body surface area, end-diastolic left ventricular diameter (LVIDd), diastolic interventricular septal thickness (IVSd), early diastolic and late diastolic mitral flow velocity ratio (E/A) and CK-MB between the case group and the normal control group (P>0.05). Compared with the normal control group, the heart rate and hsTnI level were higher, and the left ventricular ejection fraction (LVEF), ratio of early diastolic mitral annulus velocity (E/E') and left ventricular global systolic strain peak (GLPS) were lower in the case group, and the differences were statistically significant (P<0.05). GLPS was positively correlated with LVEF and negatively correlated with IVSd, but not significantly correlated with LVIDd, E/A, E/E’, hsTnI, CK-MB and electrocardiographic parameters. The optimal cutoff value of GLPS for the diagnosis of influenza A-related myocarditis in children was -19.9 %. Conclusions Left ventricular long-axis strain of 2D-STE can accurately reflect the changes of left ventricular myocardial mechanical properties in children with myocarditis caused by influenza A virus infection. It can be used as a simple, safe, reliable and practical new means for early diagnosis, follow-up and prognosis evaluation of influenza A-related myocarditis.

Key words: influenza A virus, myocarditis, two-dimensional speckle tracking echocardiography, child

CHEN Ye, ZHU Shanliang, YANG Shiwei, CHEN Jun, HUA Lichun, TANG Ying. The value of two-dimensional speckle tracking imaging in the assessment of left ventricular function in children with influenza A-related myocarditis[J].Journal of Clinical Pediatrics, 2024, 42(7): 648-653.

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References 13

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项目	病例组（n=30）	对照组（n=33）	统计量	P
年龄/月	92.7±42.0	88.0±30.9	t=0.41	0.684
体表面积/m²	1.1±0.4	1.0±0.3	t=0.41	0.679
心率/次·min^-1	102.5±15.2	94.7±5.8	t=2.28	0.030
LVIDd/mm	40.6±6.0	40.5±5.6	t=0.03	0.979
IVSd/mm	6.1±1.7	6.0±0.9	t=0.43	0.667
LVEF/%	59.7±5.5	63.7±2.9	t=3.37	0.002
E/A	1.9±0.3	2.0±0.3	t=0.58	0.568
E/E'	8.8±1.3	7.0±0.9	t=5.14	<0.001
GLPS/%	-19.2±3.1	-21.8±1.9	t=3.40	0.001
hsTnI/pg·mL^-1	848.9±3527.9	3.1±1.4	Z=5.40	<0.001
CK-MB/ng·mL^-1	22.5±23.9	14.0±39.2	t=0.90	0.371

节段/%	病例组（n=30）	对照组（n=33）	t值	P
前壁基底段	-17.1±4.0	-17.7±1.8	0.79	0.437
前间隔基底段	-15.7±3.2	-18.4±2.2	3.51	0.001
后间隔基底段	-16.9±6.8	-21.0±4.0	2.61	0.012
下壁基底段	-14.3±10.0	-18.4±4.2	1.94	0.059
后壁基底段	-15.0±4.2	-18.9±4.3	3.03	0.005
侧壁基底段	-17.1±4.5	-20.4±4.0	2.65	0.012
前壁中间段	-19.9±4.2	-22.7±2.2	2.55	0.014
前间隔中间段	-19.5±3.6	-21.9±2.5	2.72	0.009
后间隔中间段	-20.4±4.8	-23.4±3.3	2.60	0.013
下壁中间段	-16.6±6.9	-20.3±4.0	2.33	0.025
后壁中间段	-16.9±3.7	-21.0±2.4	4.20	0.001
前侧壁中间段	-18.5±4.8	-22.3±3.2	3.28	0.002
前壁心尖段	-23.2±4.3	-26.2±4.0	2.42	0.021
室间隔心尖段	-22.8±4.3	-25.3±2.7	2.49	0.017
下壁心尖段	-21.6±4.3	-25.0±4.3	2.69	0.011
侧壁心尖段	-21.4±4.4	-25.4±4.5	3.02	0.005
心尖顶段	-22.3±4.0	-25.3±2.8	3.08	0.004

项目	r值	P
hsTnI	-0.089	0.535
CK-MB	-0.154	0.302
LVEF	0.548	<0.001
E/E’	-0.148	0.320
LVIDd	-0.163	0.273
IVSd	-0.422	0.003
E/A	0.225	0.128
ECG结果	-0.240	0.210

项目	例1	例2	例3
年龄/月	176	126	62
性别	男	男	女
心率/次·min^-1	75	120	119
临床表现	发热、腹泻	胸痛	发热、呕吐
体表面积/m²	1.57	1.36	0.76
心电图（阳性结果）	部分导联T波改变	窦性心律不齐	窦性心动过速
hsTnI/pg·mL^-1	18 906.8	3 025.2	1 463.0
CK-MB/ng·mL^-1	94.3	14.8	20.5
EF/%	52.8	57.5	44.1
LVIDd/mm	43.3	47.6	31.3
IVSd/mm	7.7	6.1	9.7
GLPS/%	-9.1	-9.9	-9.9
预后	好转	好转	好转

项目	第1天（术前）	第6天（术中）	第9天（术后）	第26天（术后）
hsTnI/pg·mL^-1	1 463.0	258.1	26.5	23.7
CK-MB/ng·mL^-1	20.5	2.7	1.8	2.0
EF/%	44.1	59.0	66.0	76.3
LVIDd/mm	31.3	30.5	30	28.4
IVSd/mm	9.7	9.1	8.5	8.3
GLPS/%	-9.9	-12.8	-18.7	-19.9

The value of two-dimensional speckle tracking imaging in the assessment of left ventricular function in children with influenza A-related myocarditis

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