三维斑点追踪成像评价冠心病患者左心室缺血心肌节段应变  

Assessment of left ventricular ischemic segmental strain in coronary heart disease with three-dimensional speckle tracking imaging

作　　者：黄红梅[1] 刘艳午[2] 曹礼庭[2] 熊云涛 赵亚西[2] 苟连平[2] 吕湛[2] 

机构地区：[1]鄂州市中心医院超声诊断科,湖北鄂州436000 [2]川北医学院附属医院超声诊断科,四川南充637000

出　　处：《中国医学影像技术》2015年第8期1202-1206,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨应用三维超声斑点追踪成像(3D-STI)技术心肌节段应变值评价冠心病(CHD)患者心肌缺血的临床应用价值。方法将79例临床疑诊CHD但常规二维超声心动图检查室壁运动无异常的患者,以冠状动脉造影检查任意一支冠状动脉主干或主要分支狭窄≥50%作为CHD诊断标准,分为两组,其中CHD组40例,对照组39名。回顾性分析两组超声心动图及临床资料,包括体质量指数(BMI),常规二维超声心动图指标[左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、心输出量(CO)]和三维斑点追踪成像(3D-STI)指标[左心室各节段面积应变(AS)、圆周应变(CS)、纵向应变(LS)、径向应变(RS)]。并以冠状动脉造影结果为金标准,绘制ROC曲线,分析各应变值对心肌缺血的诊断效能。结果冠状动脉造影结果显示,左前降支供血区缺血心肌节段共252段,左回旋支供血区缺血心肌节段共95段,右冠状动脉供血区缺血心肌节段共110段。两组间BMI及常规二维超声心动图指标差异均无统计学意义(P均>0.05)。对照组牛眼图颜色均一,各节段曲线分布规律,形态一致;CHD组牛眼图可见缺血节段颜色变浅,应变曲线紊乱、变形、峰值前移、后移或倒置。CHD组左前降支、左回旋支及右冠状动脉供血区AS、CS、LS及RS均较对照组明显减低(P均<0.01)。ROC曲线分析结果显示,LS诊断左前降支、左回旋支、右冠状动脉心肌缺血的敏感度最高,分别为90.1%、89.5%、89.1%,而AS的诊断特异度最高,分别为90.8%,83.1%、89.2%。结论 CHD患者各缺血节段应变值均减低。采用3D-STI可定量评价左心室节段运动异常,在诊断心肌缺血的应变指标中,LS敏感度最高,AS特异度最高。Objective To investigate the clinical application of three-dimensional speckle tracking （3D-STI） imaging re- gional strain value in evaluating myocardial ischemia of coronary heart disease （CHD） patients. Methods Seventy-nine sus- pected CHD patients without ventricular segmental wall motion abnormality by two-dimensional echocardiography were di- vided into 2 groups according to the stenosis of main or branch coronary artery ≥50% by coronary arteriography. There were 40 CHD cases （CHD group） and 39 healthy＂ controls （control group）. Ultrasonic and clinical data including body mass index （BMI）, two-dimensional echocardiographic parameters （left ventricular end-diastolic volume [LVEDV], left ventric- ular end-systolic volume [LVESV], left ventricular ejection fraction [LVEF] and cardiac output [CO]） and 3D-STI param- eters （left ventricular area strain [AS], circumferential strain [CS], longitudinal strain [LS] and radial strain [RS]） were retrospectively analyzed. Taking the results of coronary angiography as gold standard, the ROC curve was obtained and the efficiency of strain values in diagnosing myocardial ischemia was studied. Results Coronary angiography showed segments of ischemic myocardium in the left anterior descending, left circumflex and right coronary artery were 252, 95 and 110. There was no statistical difference of BMI and two-dimensional echocardiographic parameters between the two groups （all P〉0. 05）. In control group, colour of the bull eye image was uniform and the curves distributed regularly. In CHD group, the colour of ischemic myocardium became light and curves had no regular rules with the peak of curve shift forward, back- ward or inversion. AS, CS, LS and RS of the left anterior descended, left circumflex and right coronary aretery supplying areas in CHD group decreased compared with control group （all P〈0. 01）. ROC curve showed the LS had the highest sen- sitivity in diagnosing myocardial ischemia of the left anterior descending （90.1%）

关 键 词：超声心动描记术 三维 冠状动脉疾病 心肌缺血 应变 

分 类 号：R540.45[医药卫生—心血管疾病] R543.5[医药卫生—内科学]