关键词: 肝硬化, 肝硬化性心肌病, 三维斑点追踪成像, 应变参数, 诊断

Abstract: Objective The aim of this study was to explore the application of three-dimensional speckle tracking imaging (3D-STI) in the early diagnosis of cirrhotic cardiomyopathy (CCM) in patients with decompensated cirrhosis. Methods 82 patients with decompensated cirrhosis and 30 healthy individuals at the same time were enrolled in our hospital between February 2020 and February 2022. The scores of model for end-stage liver disease (MELD) were calculated for evaluation of liver functions. The left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs) and ratio of early and late peak diastolic velocity of mitral valve (E/A) were measured by routine two-dimensional ultrasound. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction ( LVEF) and left ventricular mass index (LVMI) were measured by real-time three-dimensional ultrasound. The left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) were measured by 3D-STI. Results The E/A ratio in patients with liver cirrhosis was (1.0±0.2), significantly lower than [(1.2±0.3), P<0.05] in healthy individuals, while the LVDd and LVDs were (46.5±5.0) mm and (31.1±4.3) mm, both not significantly different compared to [(45.3±4.2) mm and (30.9±4.1) mm, respectively, P>0.05] in healthy persons; out of the 82 patients with liver cirrhosis, the CCM was found in 58 cases; there were no significant differences as respect to the LVEF, LVEDV, LVESV and LVMI among patients with, or without CCM and healthy persons(P＞0.05); the absolute GLS, GCS, GRS and GAS in cirrhotics with CCM were (14.5±3.8)%, (17.1±3.5)%, (40.7±6.0)% and (24.3±4.0)%, significantly lower than [(17.9±2.6)%,(19.5±2.9)%,(44.8±8.5)% and (27.7±4.2)%, respectively, P<0.05] in those without CCM or [(18.7±2.2)%, (19.7±3.0)%, (45.4±6.1)% and (28.7±3.4)%, respectively, P<0.05] in healthy persons. Conclusion The incidence of CCM is not uncommon in patients with decompensated cirrhosis, and the 3D-STI could help sensitively reflect the changes of left ventricular systolic functions and diagnose CCM, which warrants further clinical investigation.

Key words: Liver cirrhosis, Cirrhotic cardiomyopathy, Three-dimensional speckle tracking imaging, Strain parameter, Diagnosis