超声二维心肌应变的变化与心肌梗死范围的相关性研究  

Relation between myocardial strain and infarction size detected by two-dimensional echocardiography

作　　者：张梅青[1] 王秋霜[1] 黄党生[1] 张丽伟[1] 欧阳巧红[1] 王宇玫[1] 安秀芝[1] 

机构地区：[1]解放军总医院第一附属医院心内科,北京100048

出　　处：《中华老年心脑血管病杂志》2013年第1期22-25,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的评价心肌梗死患者超声二维心肌应变的变化与心肌梗死范围的相关性。方法选择71例急性心肌梗死患者,于心肌梗死后3～6个月行超声心动图和单光子发射计算机断层摄影(SPECT)检查,根据心肌梗死面积将患者分为A组28例(心肌梗死面积<12%),B组43例(心肌梗死面积≥12%)。所有患者行超声二维斑点追踪分析,测量心肌收缩期整体纵向应变(GLS)、收缩期整体径向应变(GRS)、收缩期整体圆周应变(GCS),对心肌应变与SPECT检测的左心室壁缺血坏死心肌的面积占左心室壁的百分比(Extent)进行相关分析,并应用ROC曲线评价3种心肌应变检测心肌梗死范围的价值。结果 B组的GLS、GCS及GRS均低于A组(P<0.05)。GLS、GCS与Extent均相关(r=0.721、r=0.504,P<0.01),GLS、GCS及GRS的ROC曲线下面积分别为0.818、0.749、0.678,诊断心肌梗死面积≥12%对应的界值分别为-13.83%、-11.65%、26.64%,敏感性和特异性分别为72.7%、88.9%,63.6%、88.9%,81.8%、55.6%。结论超声二维心肌应变的变化能够反映心肌梗死范围的改变,其中GLS能够较好地评价心肌梗死范围。Objective To assess the relation between myocardial strain and infarction size detected by two dimensional echocardiography in patients with myocardial infarction. Methods Seventy one acute myocardial infarction patients, who underwent echocardiography and single photon emission computed tomography（SPECT） 3--6 months after onset of the disease,were divided into group A with its myocardial infarction size〈12%（n=28）and group B with its myocardial infarction size≥12 % （n=43）. Their cardiac global longitudinal strain（GLS）,global radial strain（GRS） and global circumference strain（GCS） were detected by two-dimensional echocardiography and compared with the left ventricular ischemic size detected by SPECT. ROC curves were plotted for the GI.S,GCS and GRS. Results The incidence of GLS,GCS and GRS was significantly lower in group B than in group A（P〈0.05） and closely related with the left ventricular ischemic size（r= 0. 721 and 0. 504,P〈0.01）. The area under the ROC curves for GLS,GCS and GRS was 0. 818, 0. 749 ,and 0. 678 ,respectively. The cut-off value of GLS,GCS and GRS for the diagnosis of myocardial infarction size≥12% was -13.83%, 11. 65%,26.64%,respectively. Their sensibility and specificity were 72.7% and 88.9% ,63.6% and 88.9%,81.8% and 55.6% ,respectirely. Conclusion Myocardial strains,especially GLS detected by two-dimensional echocardiography can reflect the myocardial infarction size in myocardial infarction patients.

关 键 词：心肌梗死 超声心动描记术 体层摄影术 发射型计算机 单光子 ROC曲线 

分 类 号：R542.22[医药卫生—心血管疾病]