实时三维超声心动图评价右冠状动脉病变的研究  

Evaluation of right coronary artery stenosis by real-time three-dimensional echocardiograph

作　　者：陆夏敏 常琳[1] 周长钰[1] 

机构地区：[1]天津医科大学第二医院心脏科,天津300211

出　　处：《天津医科大学学报》2015年第3期199-202,共4页Journal of Tianjin Medical University

摘　　要：目的:应用实时三维超声心动图(RT-3DE)检测冠心病患者右冠状动脉供血心肌节段的运动、时间及容积参数改变,探讨对该动脉狭窄程度的判断价值。方法:选取冠状动脉造影(CAG)显示右冠脉病变的患者87例,分为右冠脉狭窄<75%组(A组)47例;狭窄≥75%组(B组)40例;3支冠脉均未见明显狭窄者68例作为对照组(N组)。所有入选者行RT-3DE检查,记录右冠状动脉供血的心肌节段平均运动幅度(EA)、收缩期心室运动峰值时间(TS)、节段舒张末容积(s EDV)、节段收缩末容积(s ESV)并计算左室节段射血分数。对所得部分参数进行ROC曲线分析及判别分析。结果:(1)B组下壁、后间隔基底段、中间段和后壁基底段EA值及下壁、后间隔、后壁基底段s EF值明显小于A及N组(P<0.05);A组与N组间无明显差异(P>0.05)。TS在3组间未见明显差异(P>0.05);(2)以右冠脉狭窄程度≥75%为分组变量,以下壁基底段EA、s EF为自变量行判别分析,得右冠脉狭窄≥75%判别函数Y=0.830s EF+0.481EA,判别临界值Y0=0.653,交互检验敏感度82.5%,特异度91.49%,准确率87.36%。结论:RT-3DE可定量测定节段心肌的运动幅度和收缩功能;选择适宜参数建立的判别函数可推断相应供血冠脉的病变程度。Objective： To detect myocardial segment motion,time and volume parameters of right coronary artery in patients with coronary heart disease by three-dimensional ultrasound（RT-3DE）. Methods：Eighty-seven patients with unstable angina were diagnosed with right coronary stenosis by coronary angiograph. According to the conditions of coronary arteriostenosis, patients were divided into group A（47 patients, coronary stenosis 75%） and group B（40 patients, coronary stenosis ≥ 75%）. Coronary angiography showed no marked stenosis in 68 patients of control group. All candidates underwent RT-3DE to get left ventricular 17 segments range of motion（EA）,the peak systolic ventricular momotion time（TS）,segmental end diastolic volume（s EDV）,segmental end systolic volume（s ESV）, and calculated left ventricular segmental ejection fraction. Some parameters were obtained by ROC curve analysis and discriminant analysis. Results：（1）Compared with group A and group N, the EA of inferior, posterior septal basal segment, middle segment and posterior basal segment and the s EF of inferior, posterior septal and posterior basal segmentin of group B were significantly lower（P〈 0.05）. However,no significant difference between group A and group N was found in EA and s EF. And no significant difference in TS was found among three groups.（2）.s EF and EA of inferior basal segment were taken as independent variables to establish discriminant function Y=0.830 s EF＋0.481EA（P〈0.001）. The critical value was Y0=0.653, with total accuracy rate of 87.36%, a sensitivity of 82.5% and a specificity of 91.4%. Conclusion：RT-3DE can accurately assess segmental myocardial range of motion and systolic function, and choosing the appropriate parameters to establish the discriminant function may be useful to predict the pathological change of coronary arteriostenosis.

关 键 词：实时三维超声 局部室壁运动 节段射血分数 冠状动脉狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]