心肌区域性跨壁纵向应变评价不同冠状动脉狭窄程度  

Evaluation of Coronary Stenosis Severity in Patients with Coronary Artery Disease by 2D Territorial Transmural Longitudinal Strain

作　　者：张妍[1] 马春燕[1] 刘爽[1] 王永槐[1] 关正宇[1] 邹麓[2] 杨军[1] 

机构地区：[1]中国医科大学附属第一医院心血管超声科,沈阳市110001 [2]中国医科大学附属第一医院心内科,沈阳市110001

出　　处：《中国超声医学杂志》2014年第6期520-523,共4页Chinese Journal of Ultrasound in Medicine

基　　金：辽宁省科技厅科学计划项目(No.2011225020)

摘　　要：目的探讨采用2D-STI检测心肌区域性跨壁纵向应变参数,评价不同冠状动脉狭窄程度的临床应用价值。方法根据冠状动脉造影结果,分别将40例冠心病患者左前降支(left anterior descending,LAD)、左回旋支(left circumflex,LCX)及右冠状动脉(right coronary artery,RCA)支配区域心肌分为4组:正常心肌组、轻度狭窄心肌组、中度狭窄心肌组及重度狭窄心肌组。采用2D-STI测量心内膜下心肌纵向应变(LS-endo)、心外膜下心肌纵向应变(LS-epi)及整体心肌纵向应变(LS-global),计算跨壁纵向应变(LS-mural)。结果 LS-mural为-2.65%诊断LCX中度狭窄的灵敏度及特异度分别为56.1%和58.3%(AUC=0.58,P<0.001);LSendo为-16.71%诊断LCX重度狭窄的灵敏度及特异度分别为88.1%和82.4%(AUC=0.90,P<0.001)。结论心肌区域性跨壁纵向应变参数为评价冠状动脉狭窄程度提供了一种新方法,且评价LCX狭窄程度的灵敏度及特异度最佳。Objective To explore the value of territorial transmural longitudinal strain by 2D speckle tracking imaging（2D-STI）in evaluating the severity of coronary stenosis.Methods The territorial myocardial segment of left anterior descending （LAD）,left circumflex （LCX） and right coronary artery （RCA） of 40 patients with coronary heart disease （CHD） were divided into 4 groups according to coronary angiograms：the normal group,the mild stenosis group,the moderate stenosis group and the severe stenosis group.The subendocardial longitudianl strain（LS-endo）,subepicardial longitudianl strain（LS-epi）and the global longitudianl strain（LS-global）were measured,and the transmural longitudianl strain （LS-mural） was calculated respectively.Results The parameters of territorial transmural longitudianl strain can accurately evaluate the moderate and serere stenosis of coronary artery,and the sensitivity and specificity in evaluating the severity of coronary stenosis of LCX was higher than that of RCA and LAD.LS-mural cutpoint of-2.65% had optimal sensitivity and specificity （56.1% and 58.3%） for detecting the moderate stenosis of LCX （area under the ROC,0.58）.A LS-endo cutpoint of-16.71% had the most optimal sensitivity and specificity （88.1% and 82.4%） for detecting the severe stenosis of LCX （area under the ROC,0.90）.Conclusions The parameters of territorial transmural longitudianl strain can accurately evaluate the severity of coronary stenosis,and the sensitivity and specificity of LCX was higher.

关 键 词：二维斑点追踪技术 跨壁 纵向应变 冠状动脉狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]