三维斑点追踪结合多巴酚丁胺负荷超声诊断非ST段抬高性急性冠脉综合征的价值  

Diagnostic value of quantitative low-dose dobutamine stress echocardiography with three-dimensional speckle-tracking for non-ST-elevation acute coronary syndrome

作　　者：刘峻松[1] 徐勇[1] 王晶[1] 张波[1] 刘博罕 吕文青[1] 智光[1] 

机构地区：[1]解放军总医院心血管内科,北京100853

出　　处：《南方医科大学学报》2015年第7期947-953,共7页Journal of Southern Medical University

基　　金：国家自然科学基金(30970836)~~

摘　　要：目的应用三维斑点追踪技术(3D-STE)结合多巴酚丁胺负荷超声(DSE)评估非ST段抬高性急性冠脉综合征(NSTEACS)患者左室心肌形变,探讨其诊断价值及意义。方法 49例初诊NSTE-ACS的患者行DSE和冠脉造影。多巴酚丁胺初始剂量5μg·kg-1·min-1,间隔3 min剂量加倍,峰值剂量20μg·kg-1·min-1。应用3D-STE对静息和峰值负荷时实时三维图像进行分析,获取左室收缩期心内膜下心肌整体长轴应变(GLS),整体环向应变(GCS),灌注区长轴应变(TLS),灌注区环向应变(TCS)等参数。比较分析DSE前后常规超声、3D-STE参数及其变化,应用ROC曲线评价各参数对NSTE-ACS的诊断价值。结果患者均完成负荷试验,3D-STE参数具有满意重复性。静息状态下,NSTE-ACS患者与非NSTE-ACS患者相比,左室心肌形变功能明显减低,以环向功能减低更为显著(P<0.05),各参数ROC曲线比较无明显差异(P>0.05)。峰值负荷时,两组间左室形变功能的差异进一步增大(P值均小于0.01),峰值负荷参数诊断价值明显增加。各参数ROC曲线比较中,峰值负荷TLS和TCS诊断NSTEACS价值最高。结论 3D-STE结合小剂量DSE是安全有效的NSTE-ACS无创检查和诊断方法,DSE明显增加3D-STE诊断价值。s：Objective To access left ventricular global deformation abnormalities during low-dose dobutamine stress test （DSE） by three-dimensional speckle-tracking echocardiography （3D-STE）in patients with non-ST-elevation acute coronary syndrome （NSTE-ACS）, and explore the diagnostic value of 3D-STE combined with DES for NSTE-ACS. Methods Forty-nine patients with suspected NSTE-ACS underwent DSE and coronary angiography with an initial dobutamine dose of 5μg·kg-1·min-1, which was doubled at 3-min intervals to the peak dose of 20 μg ·kg-1 ·min-1. The global longitudinal strain （GLS）, global circumferential strain （GCS）, territory longitudinal strain （TLS）, and territory circumferential strain （TCS） of the left ventricular subendocardial myocardium were measured with 3D-STE at rest and at the peak-dose stage. Conventional echocardiography and 3D-STE parameters and their changes during DSE were evaluated, and their diagnostic values were analyzed according to the receiver-operating characteristic （ROC） curves. Results All the patients completed DSE uneventfully and 3D-STE showed a good reproducibility of the results. Compared with patients with non-NSTE-ACS, NSTE-ACS patients showed obviously reduced resting left ventricular global deformation function especially in terms of circumferential deformation （P〉0.05）;the ROC curves for the parameters were similar between the two groups （P〈0.05）. During DSE, the global deformation differences between the two groups further increased （P〉0.01）, and the diagnostic values of the peak-dose stage parameters were significantly greater than those of the resting parameters. ROC curves analysis showed that TLS and TCS at peak-dose stage had the highest diagnostic value for NSTE-ACS. Conclusion 3D-STE combined with low-dose DSE is a safe and effective noninvasive technique for accessing and identifying NSTE-ACS, and DSE can significantly enhance the diagnostic value of 3D-STE.

关 键 词：三维斑点追踪 多巴酚丁胺负荷试验 非ST段抬高性急性冠脉综合征 应变 超声心动图 

分 类 号：R541.4[医药卫生—心血管疾病]