三维斑点追踪成像定量评价不同狭窄程度冠心病患者左心室收缩功能的应用价值  

Value of three-dimensional speckle tracking imaging for quantitative assessment of global left ventricular systolic function in patients with coronary heart disease

作　　者：刘佳霓[1] 刘佳升[2] 白文娟[1] 魏薪[1] 王芳[1] 唐红[1] 

机构地区：[1]四川大学华西医院心内科,成都610041 [2]四川大学华西医院心外科,成都610041

出　　处：《中华超声影像学杂志》2015年第1期1-5,共5页Chinese Journal of Ultrasonography

基　　金：四川省科技支撑计划（2014SZ0004-8）

摘　　要：目的应用三维斑点追踪成像（3I）IsTI）技术评价冠心病患者的左心室整体收缩功能，探讨3D-STI定量的准确性。方法纳入冠心病患者68例，根据造影结果分为重度狭窄组32例，中度狭窄组23例，轻度狭窄组13例。30例健康志愿者作为对照组。所有受试者行二维和三维超声心动图检查。3D-STI测量左室整体长轴应变（GLS）、左室整体径向应变（GRS）、左室整体圆周应变（GCS）、左室整体面积应变（GAS）、左室整体面积应变变化率（GASrate）、三维左室整体应变（3D-Strain）。绘制各参数ROC曲线，并将3D-STI参数与Simpson法、三维测得的左室射血分数（LVEF、3D-LVEF）行相关性分析。结果重度狭窄组各应变参数均较其他三组明显减低，中度狭窄组GLS、GRS、GCS、GAS、3D-Strain较轻度狭窄组及对照组减低，差异有统计学意义（P〈0．05）。ROC曲线表明GLS、GAS诊断冠心病中-重度狭窄患者的敏感性及特异性高于其他应变参数，各应变参数与3D-LVEF、LVEF均有良好相关性，重度狭窄组GAS与3D-LVEF的相关性最高（r=-0．910，P〈0．05）。结论3D-STI各指标能较敏感地定量评价冠心病患者左心室整体收缩功能的变化，GAS较其他指标敏感，重复性高。Objective To explore the accuracy of three-dimensional speckle tracking imaging （3D- STI） in quantitative coronary evaluation of （CHD） patientsr left ventricular global systolic function. Methods Sixty-eight CHD patients were divided into three groups according to the coronary artery angiography （CAG） results：32 cases in severe stenosis group,23 cases in moderate stenosis group, and 13 cases in mild stenosis group. Thirty gender-age-matched healthy subjects（control group） were enrolled in this study. All patients underwent 2D-echocardiography and real-time three-dimensional echocardiography （3DE）. The global longitudinal strain（GLS）, global radial strain（GRS）, global circumferential strain（GCS）, global area strain（GAS）, global area strain rate（GASrate） and 3D global LV strain（3D-Strain） were analyzed using 3D-STI. Correlation between strain measurements and left ventricular ejection fraction （LVEF） by simpson method,3D-LVEF by 3DE were assessed using linear regression analysis. Results All 3D-STI parameters in the severe stenosis group were significant decreased compared with the other groups. GLS, GRS, GCS, GAS,3D-Strain of moderate stenosis group shown more significant decrease than both mild stenosis group and control group （P 〈 0.05 ）. Strong correlations were demonstrated in all 3D-STI parameters between 3D-LVEF and LVEF. The strongest correlation was observed between GAS with 31）- LVEF in severe stenosis group（ r = -0.910, P 〈0.05）. Intraobserver and interobserver reliability of GAS was better than other parameters. Conclusions Global strain of 3D-STI can quantitatively evaluate the global LV function in CHD patients,and GAS is more sensitive and reproducible than other parameters.

关 键 词：超声心动描记术 三维 冠状动脉狭窄 心室功能 左 三维斑点追踪显像 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]