Contrast echocardiography for evaluation of coronary microcirculation function in patients with hypertrophic cardiomyopathy: application and influencing factors

doi:10.3877/cma.j.issn.1672-6448.2020.04.009

Abstract

Abstract:

Objective

To explore the application of contrast echocardiography in the evaluation of coronary microcirculation function in patients with hypertrophic cardiomyopathy (HCM), and identify the possible influencing factors.

Methods

From September 2013 to July 2019, 82 patients with HCM were selected at the First Affiliated Hospital of Harbin Medical University. All patients were examined by two-dimensional transthoracic echocardiography (2D-TTE) and left ventriculography (LVO) to evaluate their diagnosis rates for HCM. Myocardial contrast echocardiography (MCE) was used to evaluate the coronary microcirculation function of HCM patients. Univariate analysis and multivariate Logistic regression analysis were used to screen independent predictors of coronary microcirculation dysfunction in HCM patients.

Results

Among 82 patients with HCM, the diagnosis rate by 2D-TTE was 75.6% (62/82), and that by LVO was 91.5% (75/82); the difference between them was statistically significant (P<0.001). In 13 patients with apical HCM, the diagnostic rate by 2D-TTE was 61.5% (8/13), and that by LVO was 77.0% (10/13); the difference between them was statistically significant (P=0.035). Among 82 patients with HCM, 60 (60/82, 73.1%) were diagnosed with coronary microcirculation dysfunction by MCE. According to the results of MCE, 82 patients were divided into two groups: normal coronary microcirculation function group (22 cases) and abnormal coronary microcirculation function group (60 cases). Multivariate Logistic regression analysis showed that the increase of high sensitivity troponin I (hs-cTnI) was an independent predictor of coronary microcirculation dysfunction in HCM patients (OR=1.13, 95%CI: 1.01-1.34, P=0.03).

Conclusion

LVO can improve the diagnosis rate of HCM patients. MCE is a feasible and effective method to evaluate the coronary microcirculation dysfunction of HCM patients. Hs-cTnI has independent predictive value for the coronary microcirculation dysfunction of HCM patients.

Key words: Hypertrophic cardiomyopathy, Contrast-enhanced ultrasonography, Coronary artery, Microcirculation, Troponin I

Yafen Su, Xiaomei Fang, Wei Han, Ning Yang. Contrast echocardiography for evaluation of coronary microcirculation function in patients with hypertrophic cardiomyopathy: application and influencing factors[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(04): 341-346.

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References 22

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项目		正常组（22例）	异常组（60例）	统计值	P值
年龄（岁，±s）		60.0±11.3	54.2±13.4	t=1.46	0.23
性别				χ²=0.33
	男［例（%）］	11/22（50.0）	39/60（62.9）		0.29
NYHA分级［例（%）］				χ²=1.94	0.16
	I级	8/22（35.5）	10/60（16.7）
	II级	12/22（55.5）	41/60（68.3）
	III级	2/22（9.0）	9/60（15.0）
高血压病史［例（%）］		11/22（50.0）	19/60（31.7）	χ²=0.05	0.46
SBP［mmHg，M（Q_R）］		143（110，155）	129（117，147）	Z=-1.35	0.53
DBP［mmHg，M（Q_R）］		80（74，98）	80（71，85）	Z=-1.39	0.30

项目		正常组（22例）	异常组（60例）	统计值	P值
年龄（岁，±s）		60.0±11.3	54.2±13.4	t=1.46	0.23
性别				χ²=0.33
	男［例（%）］	11/22（50.0）	39/60（62.9）		0.29
NYHA分级［例（%）］				χ²=1.94	0.16
	I级	8/22（35.5）	10/60（16.7）
	II级	12/22（55.5）	41/60（68.3）
	III级	2/22（9.0）	9/60（15.0）
高血压病史［例（%）］		11/22（50.0）	19/60（31.7）	χ²=0.05	0.46
SBP［mmHg，M（Q_R）］		143（110，155）	129（117，147）	Z=-1.35	0.53
DBP［mmHg，M（Q_R）］		80（74，98）	80（71，85）	Z=-1.39	0.30

因素		微循环功能正常组（22例）	微循环功能异常组（60例）	统计值	P值
TC（mmo/L，±s）		5.00±0.90	4.75±1.13	t=-0.83	0.54
TG［mmHg，M（Q_R）］		1.43（0.90，2.77）	1.50（1.20，2.52）	Z=-1.41	0.67
HDL（mmo/L，±s）		1.30±1.24	0.90±1.11	t=2.20	0.02
LDL（mmo/L，±s）		3.08±0.96	2.97±0.89	t=0.39	0.74
ALT ［U/L，M（Q_R）］		22.45（14.93，63.30）	21.60（16.75，34.15)	Z=-0.39	0.68
AST ［U/L，M（Q_R）］		20.50（13.95，34.30）	22.60（19.30，26.80）	Z=-0.59	0.38
hs-cTnI ［ng/ml，M（Q_R））］		0.22（0.10，3.24）	8.12（1.41，20.26）	Z=-2.24	<0.05
HCM分型				χ²=1.41	0.24
	心尖肥厚型［例（%）］	6/22（27.3）	7/60（11.7）
	非心尖肥厚型［例（%）］	16/22（72.7）	53/60（88.3）
LVEDD（mm，±s）		49.22±2.28	47.38±4.33	t=1.13	0.08
IVSd（mm，±s）		14.42±3.31	14.10±3.27	t=-1.97	0.79
LVPWd ［mm，M（Q_R）］		10.70（8.75，12.75）	10.60（9.78，11.33）	Z=-0.67	0.83
最大室壁厚度（mm，±s）		16.30±3.24	15.45±3.57	t=-1.43	0.65
LVEF ［%，M（Q_R）］		66（58，70）	67（63，70）	Z=-0.16	0.40

因素		微循环功能正常组（22例）	微循环功能异常组（60例）	统计值	P值
TC（mmo/L，±s）		5.00±0.90	4.75±1.13	t=-0.83	0.54
TG［mmHg，M（Q_R）］		1.43（0.90，2.77）	1.50（1.20，2.52）	Z=-1.41	0.67
HDL（mmo/L，±s）		1.30±1.24	0.90±1.11	t=2.20	0.02
LDL（mmo/L，±s）		3.08±0.96	2.97±0.89	t=0.39	0.74
ALT ［U/L，M（Q_R）］		22.45（14.93，63.30）	21.60（16.75，34.15)	Z=-0.39	0.68
AST ［U/L，M（Q_R）］		20.50（13.95，34.30）	22.60（19.30，26.80）	Z=-0.59	0.38
hs-cTnI ［ng/ml，M（Q_R））］		0.22（0.10，3.24）	8.12（1.41，20.26）	Z=-2.24	<0.05
HCM分型				χ²=1.41	0.24
	心尖肥厚型［例（%）］	6/22（27.3）	7/60（11.7）
	非心尖肥厚型［例（%）］	16/22（72.7）	53/60（88.3）
LVEDD（mm，±s）		49.22±2.28	47.38±4.33	t=1.13	0.08
IVSd（mm，±s）		14.42±3.31	14.10±3.27	t=-1.97	0.79
LVPWd ［mm，M（Q_R）］		10.70（8.75，12.75）	10.60（9.78，11.33）	Z=-0.67	0.83
最大室壁厚度（mm，±s）		16.30±3.24	15.45±3.57	t=-1.43	0.65
LVEF ［%，M（Q_R）］		66（58，70）	67（63，70）	Z=-0.16	0.40

变量	b	SB	Wald χ²	P值	OR值（95 %CI）
HDL	-2.80	1.65	2.80	0.12	0.45（0.00~1.60）
hs-cTnI	0.12	0.04	5.67	0.03	1.13（1.01~1.34）

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