无节段性室壁运动异常冠心病患者左心室三维应变与冠状动脉造影的对比研究  

The contrast research between left ventricular three dimensional strain and coronary angiography for coronary disease patients without segmental ventricular wall motion abnormalities

作　　者：刘昕[1] 薛娜[1] 高磊[1] 张志强[2] 

机构地区：[1]保定市第一中心医院超声科,071000 [2]保定市第一中心医院心胸外科,071000

出　　处：《中华超声影像学杂志》2015年第12期1028-1032,共5页Chinese Journal of Ultrasonography

摘　　要：目的应用实时三维斑点追踪成像（real-timethree-dimensionalspecketrackingimaging，RT3D-STI）技术评价无节段性室壁运动异常的冠状动脉狭窄患者的左室整体舒张功能，探讨RT3D-STI诊断冠心病的价值。方法疑诊为冠心病但无节段性室壁运动异常的患者92例，根据冠状动脉造影结果分为2组：对照组42例，即冠状动脉无狭窄组；病例组50例，即冠状动脉狭窄组。经胸采集常规二维及三维全容积图像，获得常规参数及收缩末期的纵向应变（globlelongitudinalstrain，GLS）、径向应变（globleradialstrain，GRS）、面积应变（globleareastrain，GAS）、圆周应变（globlecircumferentialstrain，GCS）及相应方向的舒张期前1／3时点的应变，根据公式计算各方向应变显像舒张指数（strainimagingdiastolicindex，SI-DI），分析各参数对冠状动脉狭窄的诊断价值。结果对照组与病例组相比，常规参数及三维应变参数GLS、GRS、GAS、GCS之间差异无统计学意义（P〉0．05）；两组间纵向应变显像舒张指数（L-SI-DI）、面积应变显像舒张指数（A-SI-DI）、径向应变显像舒张指数（R-SI-DI）及圆周应变显像舒张指数（C-SI-DI）差异有统计学意义（P〈0．05）；ROC曲线显示L-SI-DI、A-SI-DI、R-SI-DI及C-SI-DI的灵敏性分别为90．5％、81．0％、85．7％、81％，特异性分别为82．0％、78．0％、68％、56％，L-SI-DI的灵敏度和特异度均最高；冠状动脉Gensini积分与L-SI-DI、A-SI-DI、R-SI-DI有相关性（P〈0．05），r分别为-0．706、-0．547、-0．410。结论RT-3D-STI技术可以定量评价冠状动脉病变患者左室舒张功能的改变，对早期诊断冠心病有重要意义。Objective To evaluate the left ventricular diastolic function in coronary artery disease （CAD） patients without regional wall motion abnormality by real-time three-dimensional specke tracking imaging（RT3D-STI）,and to investigate the value of RT3D-STI in detecting CAD. Methods According on coronary angiography,92 patients without regional wall motion abnormality were divided into two groups： control group（ n = 21 ）, without coronary artery stenosis; case group （ n = 50）, coronary stenosis group. Two dimensional images and the three-dimensional full volume dynamic images of left ventricle were collected. Routine parameters and end-systolic left ventricular globle longitudinal strain （GLS）, globle circumferential strain （GCS）,globle area strain （GAS）,globle radial strain （GRS） and corresponding strain imaging diastolic index （SI-DI） were aquired,respectively. The parameters by RT3D-STI were analyzed to diagnose coronary artery stenosis. Results Compared with control group, there were no significant difference in routine parameters, GLS, GRS, GAS and GCS （ P 〉 0.05 ）. Longitudinal SI-DI （ L-SI-DI）, area SI-DI（A-SI-DI）, radial SI-DI（R-SI-DI）, circumferential SI-DI （C-SI-DI） in case group were significantly reduced compared with control group （ P 〈0.05）. The sensitivity of L-SI-DI,A-SI-DI,R-SI-DI and C-SI-DI were 90.5%, 81.0%, 85.7%, 81.0%, and the specificity of them were 82.0%, 78.0%, 68%, 56%, respectively,L-SI-DI was the best in sensitivity and specificity. L-SI-DI,A-SI-DI,R-SI-DI were significantly correlated with Gensini score （r = -0. 706,-0. 547〈0. 410 P 〈 0.05）. Conclusions RT3D-STI can quantitatively assess the early changes of left ventricular diastolic function,which has important significancefor early diagnosis of coronary artery stenosis.

关 键 词：超声心动描记术 实时三维 冠状动脉疾病 心室功能 左 斑点追踪显像 

分 类 号：R540.45[医药卫生—心血管疾病] R543.3[医药卫生—内科学]