Selvester QRS 评分与扩张型心肌病 左心室重构及应变关系的探讨

Relationship of Selvester QRS score with left ventricular remodeling and strain in dilated cardiomyopathy

摘要:

目的 采用Selvester QRS 评分量化评估扩张型心肌病（DCM）的心肌瘢痕，并探讨其与左 心室重构及应变的关系。方法 选取2018 年1 月—2019 年1 月于西南医科大学附属医院心内科住院的扩 张型心肌病患者40 例作为病例组。根据Selvester QRS 评分值将病例组分为阴性组（评分=0）和阳性组 （评分≥ 1）。选取同期该院健康体检者27 例作为对照组。分别获得各组左心室收缩期总体纵向应变、圆 周应变、面积应变及径向应变峰值等指标，比较亚组之间的差异，并分析QRS 评分与各指标的相关性。 结果 阴性组收缩期总体纵向应变、面积应变、径向应变、左心室射血分数（LVEF）均高于阳性组（P <0.05）， 而左心室收缩末期容积、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）均低于阳性组 （P <0.05）。病例组收缩期总体纵向应变、径向应变、LVEF 与QRS 评分均呈负相关（r s =-0.582、-0.473 和 -0.450，均P <0.05），LVEDD、LVESD 与QRS 评分均呈正相关（r s =0.536 和0.514，均P <0.05）。收缩期总 体纵向应变敏感性为0.462（95%CI ：0.266，0.666），特异性为1.000（95% CI ：0.768，1.000）；LVEDD 敏感 性为0.615（95% CI ：0.406，0.798），特异性为1.000（95% CI ：0.768，1.000）；LVESD 敏感性为0.595（95% CI ：0.369，0.766），特异性为1.000（95% CI ：0.768，1.000）。结论 Selvester QRS 评分对DCM 的收缩功能 障碍有一定的指示意义，收缩期总体纵向应变、LVEDD 及LVESD 对Selvester QRS 评分系统识别心肌瘢痕有 一定的预测价值。

Abstract:

Objective To explore the relationship of myocardial “scarring” evaluated by Selvester QRS quantitatively with left ventricular remodeling and strain in dilated cardiomyopathy. Methods Totally 40 patients with DCM and 27 healthy people were recruited to get the echocardiography and ecg imagesconsecutively. According to the QRS score value, case group can be divided into negative group (score=0) and positive group (score=1 or higher), and health people as control group. Left ventricular systolic global longitudinal strain (GLS), global circumferential strain (GCS), global area ostrain (GAS) and global radial strain (GRS) parameters and so on were detected and compared between groups, and their correlation with QRS score were analyzed. Results GLS, GAS,GRS and LVEF of the negative group were all higher than those of the positive group (P < 0.05), while LVESV, LVEDD and LVESD were lower than those of the positive group with statistically significant difference (P < 0.05). In the case group, GLS, GRS and LVEF were negatively correlated with QRS score (r s = -0.582, -0.473 and -0.450, all P < 0.05), while LVEDD and LVESD were positively correlated with QRS score (r s = 0.536 and 0.514, all P < 0.05). The GLS sensitivity of ROC curve was 46.2% (95% CI: 0.266, 0.666), the specificity was 100% (95% CI: 0.768, 1.000); the sensitivity of LVEDd was 61.5% (95% CI: 0.406, 0.798), the specificity was 100% (95% CI: 0.768, 1.000); the sensitivity of LVESD was 59.5% (95% CI: 0.369, 0.766), the specificity was 100% (95% CI: 0.768, 1.000). Conclusions The Selvester QRS score has certain indicative significance for the systolic dysfunction of DCM, and GLS, LVEDD and LVESD have certain predictive value for the myocardial “scar” recognized by the Selvester QRS score system.