脉冲组织多普勒成像对冠心病诊断价值的研究  

Study on assessing coronary artery stenosis in patients with coronary artery disease by pulsed-wave Doppler tissue imaging

作　　者：李丽霞[1] 王捷[1] 杜凤和[1] 

机构地区：[1]首都医科大学附属北京天坛医院心内科,北京100050

出　　处：《中国医学影像技术》2008年第6期892-895,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨脉冲组织多普勒成像技术评价非心肌梗死的冠心病患者冠脉病变的价值。方法选择临床诊断冠心病或可疑冠心病而行冠脉造影检查的患者75例。其中25例除外冠心病者为对照组,冠脉造影证实左前降支病变的冠心病患者50例,依据狭窄程度不同分为轻、中、重三组。所有入选者在行冠脉造影检查前行前降支供血相关室壁节段(即左室前壁、前间隔)心肌组织多普勒成像技术检查,测量收缩期峰值运动速度(VS)、舒张早期运动峰速度(VE)、舒张晚期运动峰速度(VA)以及舒张早晚期速度比值(VE/VA)等速度指标,并分别比较结果。结果随着冠脉狭窄程度加重,大部分前降支供血节段心肌的VS、VE和VE/VA显示有统计学意义的逐渐下降。以冠脉造影为金标准,对VS判断前降支中重度狭窄的价值进行分析发现,对于前壁基底段,以VS≤7.5cm/s为诊断标准,诊断准确性较高,其敏感性为80%,特异性为97%;在前间壁基底段以VS≤7.0cm/s作为标准,诊断的敏感性为76%,特异性为92%,诊断的准确性也高。结论脉冲组织多普勒成像对冠心病患者冠脉狭窄病变的诊断有肯定的价值。同时建议,在前壁、前间壁基底段以VS≤7.0cm/s作为前降支可能存在中度以上狭窄性病变的判断依据。Objective To explore the value of pulsed-wave Doppler tissue imaging（PW-DTI）in assessing coronary artery stenosis in patients with non-MI coronary artery disease.Methods Seventy-five patients with suspicious coronary artery disease（CAD）underwent coronary artery angiography were enrolled in this study.Fifty patients with LAD stenosis ≥50% were divided into mild,moderate and severe groups according to the severity of the LAD stenosis and twenty-five patients with no coronary artery stenosis ≥50% as control group.Myocardial motion velocity in myocardial anterior wall and anterior-septal wall was measured with PW-DTI before coronary angiography.DTI parameters included systolic peak velocity（VS）,early and late diastolic peak velocity（VE and VA）,and the ratio of the early/late diastolic velocity（VE/VA）.Results The VS,VE and VE /VA were significantly decreased when the percentage of the coronary artery stenosis increased（P〈0.05）.DTI showed a higher consistency in assessment of moderate to severe LAD stenosis as compared to coronary angiography,when using VS≤7.5 cm/s in basal segment of anterior wall（sensitivity 80%,specificity 97%）and VS≤7.0 cm/s in basal segment of anterior-septal wall（sensitivity 76%,specificity 92%）as the diagnosis criterion.Conclusion PW-DTI is available for diagnosing the coronary artery stenosis non-invasively.It could be used as the criterion that VS ≤7.0 cm/s in basal segment of anterior wall and anterior-septal wall for assessing moderate to severe LAD stenosis.

关 键 词：脉冲组织多普勒成像 冠状动脉疾病 冠状动脉血管造影术 左前降支 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]