定量组织速度成像技术评价冠心病心肌缺血及冠脉支架植入术疗效的研究  

Evaluation of myocardial ischemia and the efficacy of stenting in patients with coronary heart disease using quantitative tissue velocity imaging

作　　者：夏思良[1] 张颖[1] 周建松[1] 张小兵[1] 高翔[1] 嵇平[1] 

机构地区：[1]东南大学附属南京江北人民医院心脏科,南京市210048

出　　处：《中国临床研究》2011年第5期362-365,共4页Chinese Journal of Clinical Research

基　　金：南京市医学科技发展项目(YKK07100)

摘　　要：目的探讨定量组织速度成像(QTVI)技术在冠心病患者心肌缺血评价中的价值,同时采用QTVI技术观察冠状动脉(冠脉)支架植入术后左室局部心肌功能变化,以评价其疗效。方法 53例临床诊断冠心病或可疑冠心病行冠脉造影检查(CAG)的患者纳入本研究。在行CAG检查前作QTVI检查,根据节段室壁运动速度情况(以心底部5cm/s,中段3cm/s界定)分为无心肌缺血组(n=26)和心肌缺血组(n=27)。测定左室6个壁的基底段和中段运动的收缩期峰流速(Vs)与峰值位移(Ds),比较2组的Vs及Ds,并与CAG结果对照,以评价QTVI对冠心病的诊断价值。其中8例单纯左前降支(LAD)病变患者分别于支架植入前1天、植入后1周、4周采用QTVI技术分析室壁的运动速度指标(Vs),以评价支架植入术的疗效。结果在左室长轴切面、心尖四腔切面、心尖两腔切面心肌缺血组左室相应节段的Vs和Ds均低于无心肌缺血组(P<0.05);QTVI发现的有心肌缺血的27例患者,CAG均能发现2支或以上主要冠脉狭窄;8例LAD病变患者冠脉支架植入术前LAD供血区各节段心肌Vs均明显低于无心肌缺血组(P<0.01或P<0.05),与冠脉支架植入前相比,治疗后1周及4周,LAD供血区各节段心肌Vs明显增快(P<0.01或P<0.05)。结论 QTVI技术通过定量测定节段性室壁运动失调及局域性心功能不良,可以评价冠心病严重冠脉狭窄患者的心肌缺血,且可作为一种测定冠脉支架植入前后局部心肌速度的无创技术,用以评价冠脉支架植入术的疗效。Objective To evaluate the clinical value of quantitative tissue velocity imaging （QTVI） in detecting myocardial ischemia and assessing the efficacy of stening in patients with coronary artery disease.Methods A total of 53 patients with coronary heart disease or suspected coronary heart disease underwent coronary artery angiography （CAG） were included in this study.QTVI were performed before CAG.The patients were categorized into no myocardial ischemia group （Group A） and myocardial ischemia group（Group B） according to segmental ventricular wall motion velocity by QTVI （cut off values of 5 cm/s in basal segment and 3 cm/s in middle segment）.The peak systolic velocity（Vs） and the peak displacement（Ds） of basal segment and middle segment of left ventricular 6-wall were detected by QTVI.The Vs and Ds were compared in two groups,and the results of QTVI were compared with CAG for assessing the diagnostic value of QTVI.Stenting procedures were performed in 8 patients with isolated left anterior descending artery （LAD） stenosis.QTVI was performed one day before stenting,a week and four weeks after stenting for assessing the efficacy of stenting.Results The Vs and Ds of basal segments and middle segments in Group B were lower than those in Group A（all P 〈 0.05）.All 27 patients with myocardial ischemia assessed by QTVI had severe coronary artery stenosis of two or more main branches identified by CAG.Before stenting,the Vs of all segments of LAD territory were significantly lower than those of corresponding segments in group A （P 〈0.01 or P 〈0.05）,and the Vs of above segments significantly increased in a week and 4 weeks post stenting procedure（P 〈 0.01 or P 〈 0.05）.Conclusions QTVI could evaluate myocardial ischemia in patients with severe coronary arterial stenosis via quantitatively detecting segmentalventricular wall motion abnormalities and regional ventricular dysfunction,and it might serve as a useful tool for assessing the therapeutic effects of intracoronary st

关 键 词：定量组织速度成像 冠心病 心肌缺血 冠脉支架植入 

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]