经胸冠状动脉血流显像确定左前降支狭窄部位的价值  

Value of transthoracic color Doppler echocardiography for the location of the left anterior descending coronary artery stenosis

作　　者：陈斌[1] 邓又斌[2] 胡元平[1] 倪显达[1] 

机构地区：[1]温州医学院附属第一医院超声影像科,325000 [2]华中科技大学同济医学院附属同济医院超声影像科

出　　处：《中华超声影像学杂志》2007年第6期474-476,共3页Chinese Journal of Ultrasonography

摘　　要：目的：探讨经胸冠状动脉（冠脉）血流显像技术确定左前降支狭窄部位的准确性。方法：应用冠脉血流显像技术检查12．5例拟行冠脉造影患者的左前降支各段血流信号及前室间隔内血流信号。以局部血流加速、左前降支及前间隔内逆向血流信号作为判断左前降支狭窄的标准，以局部血流加速处作为确定左前降支狭窄部位的标准。分析记录狭窄部位及节段数，并与随后的冠脉造影结果比较。结果：超声诊断左前降支狭窄程度≥60％患者的准确性为88．0％（110／125），特异性为88．7％（47／53），敏感性为87．5％（63／72）。确定狭窄部位的准确性为88．5％（332／37．5），特异性为95．2％（2．59／272），敏感性为70．9％（73／103）。经胸冠脉血流显像与冠状动脉造影判断左前降支狭窄高度一致（Kappa值=0．756），确定狭窄部位的一致性良好（Kappa值=0．697）。对单节段狭窄的检出率与对多节段狭窄的检出率差异无统计学意义（P：0．084）。结论：经胸冠脉血流显像检测左前降支局部血流加速能准确定位冠脉左前降支程度≥60％的狭窄部位，且不受病变节段数目的影响。Objective To evaluate the accuracy of transthoracic color Doppler echocardiography for the location of the left anterior descending coronary artery（LAD） stenosis. Methods Transthoracic color Doppler echocardiography were carried out in 125 consecutive patients who suspected to have coronary artery disease and planned coronary artery angiography. Retrograde LAD flow was defined as a direction from the apex to the base of the left ventricle in the anterior groove area,and retrograde septal branch flow as a direction from inferior to anterior in the anterior interventricular septum. Either the localized acceleration flow or the retrograde flow was regarded as the criterion to predicate the LAD stenosis. The localized acceleration flow was used to locate the stenosis. All patients were performed angiography subsequently. Results Compared with coronary artery angiography, the accuracy for diagnosis of stenotic LAD by echocardiography was 88.0 % （ 110/125 ）, it＇ s specificity was 88. 7 % （47/53） and sensitivity was 87.5%（63/72）. The accuracy for locating the stenotic site in the LAD by echocardiography was 88.5% （332/375）,it＇s specificity was 95.2% （259/272） and sensitivity was 70.9% （73/103）. Transthoracic diagnosis of stenotic LAD and location of stenotic site correlated well with invasive detection （Kappa value = 0. 756,0. 697, respectively）. There was no significant difference in the rate of locating stenotic site between signal segment lesion and multi-segments stenosis（ P = 0. 084）. Conclusions Transthoracic color Doppler echocardiography is a reliable noninvasive method to detect localized acceleration flow in the LAD to locate the stenosis accurately and less influenced by the number of stenotic segments.

关 键 词：超声心动描记术 冠状动脉狭窄 冠状血管造影术 

分 类 号：R686[医药卫生—骨科学]