超声心动图自动心肌运动定量技术评估川崎病患儿左心室收缩功能

目的 观察超声心动图自动心肌运动定量（aCMQ）技术评估川崎病（KD）患儿左心室收缩功能的应用价值。方法 回顾性分析53例入院后接受常规静脉注射免疫球蛋白（IVIG）治疗的KD患儿（KD组），包括22例冠状动脉扩张（A亚组）、31例冠状动脉未扩张（B亚组）；以同期58名健康儿童作为对照组。对KD组分别于治疗前12 h内（急性期）、治疗后1周（亚急性期）及6~10周（恢复期）行超声心动图检查，以M型超声测量左心室常规参数，获得左心室心尖两腔、三腔及四腔观二维动态图像并以QLab 13.0软件进行脱机aCMQ分析，获取左心室局部纵向应变（LS）、整体纵向应变（GLS）及组织运动二尖瓣环位移（TMAD）相关参数。结果 急性期KD患儿与健康儿童间，左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）、舒张末期室间隔厚度（IVSD）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）差异均无统计学意义（P均>0.05）。急性期、亚急性期KD患儿基底段LS、中间段LS、心尖段LS、心尖两腔观LS （LS_AP2）、心尖三腔观LS （LS_AP3）、心尖四腔观LS （LS_AP4）、GLS及恢复期基底段LS、LS_AP4均较健康儿童降低（P均<0.05）；亚急性期、恢复期KD基底段LS、中间段LS、心尖段LS、LS_AP2、LS_AP3、LS_AP4、GLS均较急性期升高（P均<0.05）；恢复期中间段LS、心尖段LS、LS_AP3、GLS较亚急性期升高（P均<0.05）。急性期A亚组与B亚组左心室LS及TMAD参数差异均无统计学意义（P均>0.05）；恢复期A亚组基底段LS和心尖四腔观二尖瓣环平均位移率（AP4 Midpt％）较B亚组降低（P均<0.05）。结论 超声心动图aCMQ技术可早期评估KD患儿左心室收缩功能；冠状动脉扩张影响KD患儿恢复期左心室功能。

Echocardiographic automatic cardiac motion quantification technique for assessment of left ventricular systolic function in children with Kawasaki disease

Objective To explore the value of echocardiographic automatic cardiac motion quantification (aCMQ) for evaluating left ventricular (LV) systolic function in children with Kawasaki disease (KD). Methods Totally 53 children with KD (KD group) who underwent routine intravenous immunoglobulin (IVIG) after admission were enrolled, including 22 with coronary artery ectasia (subgroup A) and 31 without coronary artery ectasia (subgroup B). Fifty-eight healthy children were used as the controls (control group). Echocardiography was performed for KD children within 12 h before treatment (acute phase), 1 week after treatment (subacute phase) and 6-10 weeks after treatment (recovery phase), respectively. Conventional parameters of the left ventricle were measured using M-mode echocardiography, and the apical two-chamber, three-chamber and four-chamber 2D dynamic images of the left ventricle were obtained. The QLab 13.0 software was used for offline aCMQ analysis to obtain parameters related to left ventricular local longitudinal strain (LS), global longitudinal strain (GLS) and tracking of mitral annular displacement (TMAD) related parameters. Results There was no significant difference of the left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), interventricular septum thickness at end-diastole (IVSD), left ventricular end-diastolic dimension (LVEDD) nor left ventricular end-systolic dimension (LVESD) between acute KD children and controls (all P>0.05). In children with acute and subacute KD, LS of basal segment, LS of middle segment, LS of apical segment, apical two chamber view LS (LS_AP2), apical three chamber view LS (LS_AP3) and apical four chamber view LS (LS_AP4) were all lower than those in controls, while LS of basal segment and LS_AP4 in recovery phase of KD were lower than that in controls (all P<0.05). In children with subacute and recovery phase KD, LS of basal segment, LS of middle segment, LS of apical segment, LS_AP2, LS_AP3, LS_AP4 and GLS of KD group were all higher than those in acute stage KD (all P<0.05), and LS of middle segment, LS of apical segment, LS_AP3 and GLS in recovery phase were higher than those with subacute phase KD (all P<0.05). In acute stage, there was no significant difference of LS nor TMAD parameters of left ventricle between subgroup A and B (all P>0.05). In convalescent KD children, basal segment LS and average displacement rate of mitral valve annulus in apical four-chamber view (AP4 Midpt%) in subgroup A were lower than those in subgroup B (both P<0.05). Conclusion Echocardiographic aCMQ technique could be used to assess early left ventricular systolic function in KD children. Coronary artery ectasia affected left ventricular function in children with convalescent KD.