A Compared Study Of Different Ultrasonic Methods In Diagnosis Of Left Ventricular Non-compaction Cardiomyopathy

Objective: Through a comparative analysis of different methods and a study of the new index in diagnosis of LVNC by ultrasound,the paper in order to improve the value of ultrasound in diagnosing LVNC.Method:1.30 patients with isolated left ventricular non-compaction cardiomyopathy,25 with dilated cardiomyopathy(DCM)and 25 healthy volunteers were included in the study from January 2013 to February 2015.All patients had to fulfill CMR criterion as well as additional clinical criterion.2.Ultrasonic images of patients with LVNC were collected.The thickness of non-compacted myocardium(NC) and compacted myocardium(C) were measured, the ratios of NC to C(NC/C)in end-systole and end-diastole were calculated respectively;NC/C ratios were measured by CMR in end-diastole;The parameters measured by ultrasonic cardiogram(UCG) in different phases and NC/C ratios measured by UCG and CMR were compared,then a statistical comparison in numbers of non-compacted segments diagnosed by UCG and CMR criteria was made.3.Counted the most commonly affected segments of patients with LVNC,and analyzed the correlation between left ventricular eject fraction(LVEF) and NC/C ratios,LVEF and numbers of affected segments.4.All subjects of three groups were collected images by UCG.Measured the maximum thickness of ventricular walls and basal anteroseptal segments,calculated the W/AS ratios and compared LVNC group with the other two groups about parameters above.A receiver operating characteristic(ROC) curve was built with W/AS ratios to analyze cut-off ratio for LVNC.The correlation between W/AS ratios measured by UCG and NC/C ratios measured by CMR was analyzed.Result:1.Of 30 patients with LVNC, LVEF was depressed in 26(86.7%)patients,electrocardiogram was abnormal in 25(83.3%)patients.LVNC was diagnosed by UCG in 26(86.7%)patients, 3 patients whose cardiac function were normal misseddiagnose,there was one case misdiagnosed as DCM.2.In LVNC group,mean NC measured by UCG in end-systole and end-diastole had no significant difference(P>0.05),mean C and mean NC/C ratios measured by UCG in end-systole and end-diastole respectively both had significant differences(P< 0.05).Mean NC/C ratios measured by UCG in end-systole and CMR had a significant difference(P<0.05),mean NC/C ratios measured by UCG in end-diastole and CMR had no significant difference(P>0.05).3.The consistency of numbers of non-compacted segments diagnosed by UCG in end-systole and CMR was poor(Kappa=0.389),no significant difference of affected segments was observed except in the mid-anterolateral,apical anterior segments and apical cap.The consistency of numbers of non-compacted segments diagnosed by UCG in end-diastole and CMR was well(Kappa=0.809).4.The most commonly affected segments of LVNC were apical cap, apical inferior and apical anterior segments, conversely,none of basal anteroseptal and basal inferoseptal segments was affected.There were significantly negative correlation between LVEF and NC/C ratios(r=-0.704,P< 0.05),LVEF and numbers of affected segments(r=-0.702,P<0.05).5.There were statistical differences in mean W and mean W/AS ratios between LVNC group and DCM group, LVNC group and healthy control group( P <0.05).Mean AS had a statistical difference between LVNC and DCM groups(P<0.05).but it had no statistical difference between LVNC and healthy control groups(P> 0.05).When cut-off ratio of W/AS was identified as 2.1,its sensitivity and specificity for diagnosing LVNC were 93.3%, 88.0% respectively. The correlation coefficient between W/AS ratios measured by UCG and NC/C ratios measured by CMR was 0.776(P<0.05).Conclusion:1.The ultrasonic criterion for diagnosing LVNC,NC/C≥2.0measured in end-diastole was more reasonable than in end-systole.2.Most commonly affected segments of patients with LVNC were apical cap and apical segments, but none of the basal segments of interventricular septum wasaffected, there were significantly negative correlations between LVEF and NC/C ratios, LVEF and numbers of affected segments.3. W/AS ratio can be used as the new index to diagnose LVNC.