| Aimstwo-dimensional speckle tracking(2D-STI)was used to analyze the longitudinal strain of left ventricle,left and right atrium in patients with plasma cell disease,and to explore the correlation between longitudinal strain of left ventricle and atrium and amyloidosis.MethodsThis study included patients who were diagnosed as plasma cell disease and underwent 2D-STI in the Department Hematology of the first affiliated Hospital of Soochow University from June 2017 to November 2019.According to the presence of amyloidosis and left ventricular wall thickening,the patients were divided into non-amyloid plasma cell disease group(group A),amyloidosis left ventricular wall thickening group(group B1)and normal left ventricular wall group(group B2).Left ventricular longitudinal strain,right and left atrial longitudinal strain were analyzed by EchoPAC software.Univariate model in logistic regression analysis was used to explore the correlation between echocardiographic longitudinal strain index and plasma cell disease.The specificity and sensitivity of echocardiographic longitudinal strain indexs in the diagnosis of amyloid degeneration of plasma cell disease were evaluated by receiver Operating characteristic curve(ROC).Results1.Comparison of conventional echocardiographic parametersThe first part showed that the left and right atrial diameter,ventricular wall thickness,left ventricular mass index(LVMI),E/A and E/e' in group B1 were higher than those in group A and B2,but the left ventricular ejection fraction(LVEF),peak A,lateral wall e' and septum e' were significantly lower in group B1 than those in group A and group B2(P<0.05);The difference was statistically significant(P<0.05);There was no significant difference between group A and group B2 in internal diameter of left and right atrium,thickness of ventricular wall,EF,A peak,E/A,lateral wall e' and septum e'.There was no significant difference in aortic root diameter,pulmonary artery systolic pressure,left and right ventricular diameter and E peak among the three groups.The second part showed that the left and right atrial diameter,wall thickness,left ventricular end-systolic diameter,LVMI and E/e' in group B1 were higher than those in group A and group B2,while the LVEF,lateral wall e' and septum e' were lower in group B1 than those in group A and group B2(P<0.05).The difference was statistically significant(P<0.05);There was no significant difference in left and right atrial diameter,wall thickness,left ventricular end-systolic diameter,LVMI,E/e',LVEF,lateral wall e' and septum e' between group A and group B2(P>0.05).2.Comparison of strain parameters1)Compared with group A,the average values of longitudinal strain of left ventricular basal segment,middle segment,apical segment,endometrium,middle-level,epiblast,global longitudinal strain and wall displacement velocity in group B1 were significantly lower than those in group A(P<0.001);The average values of longitudinal strain and wall displacement velocity of corresponding segments and 3-layer in group B2 were significantly increased,which were in the order of group B1<group A<group B2,and the longitudinal strain of left and right atrium was consistent with its change.the longitudinal strain was the highest in the atrial reserve period,the second in the atrial contraction phase and the lowest in the channel phase.2)Univariate model in logistic regression analysis of myocardial longitudinal strain is an important index for differential diagnosis of plasma cell disease.3)When the overall average longitudinal strain absolute value of the left ventricular basal segment<14%,endometrium<22.1%,epiblast<14.7%,the overall<18.1%,and the longitudinal strain absolute value of the right atrium during the reserve period<30.8%,all of them are highly sensitive and specific for the diagnosis of left ventricular wall thickening amyloidosis;When the overall average longitudinal strain absolute value of the left ventricular basal segment>17.4%,endometrium>26.0%,epiblast>18.0%,the overall>21.9%,and the longitudinal strain of the right atrium during the reserve period>41.1%,both have high sensitivity and specificity for the diagnosis of normal left ventricular wall thickness amyloidosis.Conclusions1.Myocardial longitudinal strain is an important index to distinguish the three groups of plasma cell disease.with the thickening of ventricular wall,the absolute value of myocardial longitudinal strain decreases and the myocardial involvement is aggravated,atrial enlargement;and the absolute value of left ventricular longitudinal strain increases sequentially from the basal segment to the apical segment.and the absolute value of left ventricular stratified longitudinal strain decreased from the inside to the outside.2.The early manifestation of amyloidosis may be the elevation of the absolute value of the longitudinal strain of the myocardium,and the myocardial injury existed when the thickness of the ventricular wall was normal.3.Myocardial longitudinal strain has high sensitivity and specificity for differential diagnosis of plasma cell disease and higher sensitivity and specificity for left ventricular wall thickening amyloidosis.4.Myocardial longitudinal strain is a sensitive index to reflect the damage of cardiac function in early plasma cell disease.it can be used as a non-invasive method for early diagnosis of myocardial involvement and has a certain value in the differential diagnosis of all kinds of plasma cell disease. |
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