超声测量心外膜脂肪厚度联合二维纵向应变预测冠状动脉粥样硬化性心脏病  

Predictive value of echocardiographic epicardial fat thickness combination with two-dimension longitudinal strain for coronary artery disease

作　　者：陈菲[1,2] 卢岷[1,2,3] 冉海涛[1,2,3] 朱叶锋[1,2,3] 

机构地区：[1]重庆医科大学超声影像学研究所,重庆400010 [2]重庆医科大学附属第二医院超声科,重庆400010 [3]超声分子影像重庆市重点实验室,重庆400010

出　　处：《中国介入影像与治疗学》2016年第1期42-46,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：国家自然科学基金项目(81471713);重庆市科委基础与前沿研究计划项目(cstc2013jcyjA10052);重庆高校创新团队建设计划(KJTD201303)

摘　　要：目的探讨常规超声心动图测量的心外膜脂肪(EAT)厚度联合二维纵向应变对冠状动脉粥样硬化性心脏病(CAD)的预测价值。方法将106例疑诊为CAD的患者根据CAG检查结果分为CAD组(n=60)和对照组(n=46),采用二维超声测量收缩末期EAT厚度(EAT_S)、舒张末期EAT厚度(EAT_D),采用二维应变软件分析左心室心尖三个切面的图像,获取左心室17节段心肌纵向应变均值(GLS_(17))和12节段(除外5个心尖节段)纵向应变均值(GLS_(12))。绘制ROC曲线,根据最大Youden指数确定EAT_S、GLS_(12)最佳预测截断值,分析EAT_S、GLS_(12)及二者联合诊断CAD的曲线下面积(AUC),并比较3种方法对CAD的预测价值。结果CAD组EAT_S、EAT_D均大于对照组(P均<0.05);EAT_S(OR=1.79)、GLS_(12)(OR=1.20)均为CAD的独立危险因素(P均<0.05),其对CAD的最佳预测截断值分别为5.55mm、-16.95。EAT_S、GLS_(12)及二者联合预测CAD的AUC分别为0.67±0.05、0.64±0.06及0.71±0.05,差异有统计学意义(P<0.05)。结论 EAT_S与GLS_(12)均可以作CAD预测评估的有效指标,二者联合对CAD的预测价值更高。Objective To explore the predictive value of echocardiographic epicardial adipose thickness（EAT） and the left ventricular longitudinal 2 Dstrain at rest for coronary artey disease（CAD）.Methods According to the results of CAG,106 consecutive patients with clinically suspected CAD were divided into CAD group（n=60）and control group（n=46）.EAT were measured by transthoracic echocardiography during end-systole（EATS）and end-diastole（EAT_D）respectively.Two-dimensional strain echocardiography was performed in the 3 apical projections of left ventricle（LV）.Peak regional longitudinal systolic strain of LV was measured in 17 segments and averaged to provide global longitudinal peak systolic strain（GLS_（17））,the average longitudinal peak systolic strain of 12 segments（GLS_（12）,excluded the 5 apical segments）.Drawing ROC curve,according to the maximal Youden index obtained the optimal predictive cut-off value of EAT_S and GLS_（12）,analyzed the area under the curve（AUC） of EATS,GLS_（12）,combined indicator of EAT_S and GLS_（12）,and compared the predictive value of the three methods.Results The EAT_S and EAT_D in CAD group was significantly higher than that in control group（both P〈0.05）.The EAT_S（OR=1.79） and GLS_（12）（OR=1.20）were independent predictors of significant CAD（both P〈0.05）,and the optimal cut-off value for the EAT_S and GLS_（12） was 5.55 mm and-16.9,respectively.AUC of EAT_S,GLS_（12） and the combined indicator was 0.67±0.05,0.64±0.06 and 0.71±0.05,respectively,and the difference was statistically significant（P〈0.05）.Conclusion EAT_S and GLS_（12） may serve as an useful predictive marker of CAD separately,while combining the two indicator,the predictive performance is significantly improved.

关 键 词：超声心动描记术 心外膜脂肪厚度 纵向应变 冠状动脉粥样硬化性心脏病 

分 类 号：R540.45[医药卫生—心血管疾病] R541.4[医药卫生—内科学]