Objective: To observe the relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases (AD). Methods: In this retrospective study, 95 AD patients (27 males, (38.6±14.2) years old) were enrolled as AD group and 71 gender and age matched healthy subjects (24 males, (37.6±12.2) years old) were enrolled as control group, all underwent transthoracic echocardiography and two-dimensional speckle-tracking echocardiography (STE) in our hospital between January 2014 and June 2018. Left ventricular untwisting and diastolic function parameters were measured. Multiple logistic regression analysis was used to identify related factors of left ventricular diastolic dysfunction in AD patients. Receiver operating characteristic (ROC) curve was used to identify the diagnosis value of untwisting parameters for left ventricular diastolic dysfunction in AD patients. Results: Compared with control group, left ventricular ejection fraction was lower (58(47, 66)% vs. 67 (62, 71) %, P<0.001), E/e' was higher (10.78 (7.28, 13.65) vs. 6.30 (5.55, 7.25) , P<0.001), isovolumic relaxation time was longer (73.5 (56.5, 88.0) ms vs. 62.0 (58.0, 68.5) ms, P<0.001),and untwist slope during isovolumic relaxation period (USIR) was lower (31.92 (14.09, 54.92) °/s vs. 59.90 (40.09, 87.18) °/s, P<0.001) in AD group than in control group. Multiple logistic regression analysis showed heart rate (OR=0.885, 95%CI 0.840-0.931, P<0.001), E/e' (OR=0.655, 95%CI 0.537-0.798, P<0.001) and USIR (OR=0.986, 95%CI 0.974-0.998, P=0.020) were independently related with left ventricular diastolic dysfunction in AD patients. ROC curve showed that area under the curve (AUC) was 0.919 (P<0.001), sensitivity was 87.6%, and specificity was 88.7%, when combining the heart rate, E/e', and USIR as assessment parameters for the diagnosis of left ventricular diastolic dysfunction in AD patients at a cutoff of 0.51. Conclusions: Impairment of myocardial untwisting indicates the presence of early stage left ventricular diastolic dysfunction in AD patients. USIR may be a sensitive parameter to evaluate early stage left ventricular diastolic dysfunction in AD patients.
目的： 探讨自身免疫病患者心肌解旋受损与早期左心室舒张功能障碍的关系。 方法： 采用回顾性研究方法，入选2014年1月至2018年6月在北京协和医院就诊的自身免疫病患者95例作为自身免疫病组[男性27例，女性68例，年龄（38.6±14.2）岁]，同时入选与自身免疫病组患者性别和年龄相匹配的健康者71名作为对照组[男性24名，女性47名，年龄（37.6±12.2）岁]。研究对象均行经胸超声心动图检查，采用二维超声斑点追踪技术分析左心室解旋指标。采用多因素logistic回归分析自身免疫病患者左心室舒张功能障碍的相关因素。采用受试者工作特征（ROC）曲线分析心肌解旋指标对自身免疫病患者左心室舒张功能障碍的诊断价值。 结果： 与对照组比较，自身免疫病组患者左心室射血分数较小[58（47，66）%比67（62，71）%，P<0.001]，二尖瓣口舒张早期血流峰值速度（E）/二尖瓣瓣环舒张早期速度（e′）较大[10.78（7.28，13.65）比6.30（5.55，7.25），P<0.001]，等容舒张时间较长[73.5（56.5，88.0）ms比62.0（58.0，68.5）ms，P<0.001]，等容舒张期解旋斜率（USIR）较小[31.92（14.09，54.92）°/s比59.90（40.09，87.18）°/s，P<0.001]。多因素logistic回归分析显示，心率（OR=0.885，95%CI 0.840~0.931，P<0.001）、E/e′（OR=0.655，95%CI 0.537~0.798，P<0.001）和USIR（OR=0.986，95%CI 0.974~0.998，P=0.020）与自身免疫病患者左心室舒张功能障碍独立相关。ROC曲线显示，心率、E/e′和USIR三者联合诊断自身免疫病患者左心室舒张功能障的临界点为0.51时，曲线下面积为0.919（P<0.001），敏感度和特异度分别为87.6%和88.7%。 结论： 自身免疫病患者等容舒张期心肌解旋异常提示早期左心室舒张功能障碍。USIR是评估自身免疫病患者早期左心室舒张功能障碍的灵敏指标。.
Keywords: Echocardiography; Immune system diseases; Left ventricular diastolic dysfunction.