超声三维斑点成像评价冠心病患者左室心肌特性改变及与冠状动脉狭窄程度间的关系  

Evaluation of left ventricular function of patients with different graded coronary artery stenosis by 3 - dimensional speckle tracking imaging

作　　者：李林[1] 张平洋[1] 冉红[1] 吴文芳[1] 方玲玲[1] 江佩[1] 万林林[1] 张丹丹[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心血管超声科,江苏南京210006

出　　处：《中国急救医学》2016年第3期246-249,共4页Chinese Journal of Critical Care Medicine

基　　金：南京市卫生青年人才培养经费资助（QRX11034）

摘　　要：[摘要]目的应用三维斑点追踪技术（3D—STI）评价冠状动脉不同程度狭窄患者左室心肌特性的变化，并探讨各应变参数诊断冠状动脉狭窄程度的敏感度及特异度。方法选取临床疑诊为冠心病且常规超声心动图未发现室壁运动异常的患者110例，排除图像质量欠佳者后纳入98例，按照冠状动脉造影结果中最大狭窄程度分为四组：轻微狭窄组29例，冠状动脉狭窄率≤25％；轻度狭窄组21例，25％〈冠状动脉狭窄率≤50％；中度狭窄组23例，50％〈冠状动脉狭窄率≤75％；重度狭窄组25例，至少一支冠状动脉狭窄程度〉75％。应用三维斑点软件测得左室整体长轴应变（GLS）、整体径向应变（GRS）、整体圆周应变（GCS）、整体面积应变（GAS）以及三维应变（3D—Strain），并采用双平面Simpson法测得左室射血分数（LVEF）及每搏输出量（SV）。结果①四组间基本临床资料、LVEF及sV的差异均无统计学意义（P〉0．05）。②四组间3D—STI参数两两比较结果：中度狭窄组及重度狭窄组各3D—STI参数与轻微狭窄组比较差异均有统计学意义（P〈0．05）；中度狭窄组的GLS、GRS、GAS、3D—Strain及重度狭窄组各3D—STI参数与轻度狭窄组比较差异有统计学意义（P〈0．05）；重度狭窄组各3D—STI参数与中度狭窄组比较差异有统计学意义（P〈0．05）。3ROC结果：GLS、GRS、GCS、GAS以及3D—Strain诊断中度狭窄时的ROC曲线下面积分别为：0．716、0．697、0．577、0．718及0．711，其中以GAS-30．20％为最佳截断点时，敏感度为95．7％，特异度为64．0％。GLS、GRS、GCS、GAS以及3D—Strain诊断重度狭窄时的ROC曲线下面积分别为：0．928、0．914、0．855、0．943及0．896，其中以GAS-25．80％为最佳截断点时，敏感度为92．0％，特异度为84．9％。结论3D—STI能够较常规超声心动图更早、更敏感地检测到无室壁运动�Objective To evaluate left ventricular global systolic function by three - dimensional speckle tracking imaging （3D - STI ） in patients with different graded coronary artery stenosis, and to determine the clinical value of 3D- STI in diagnosis of coronary heart disease（CHD）. Methods Ninety - eight patients without left ventricular regional wall motion abnormality were divided into four groups according to the coronary stenosis based on the results of coronary artery angiography （CAG） ： 29 cases in slight stenosis group （stenosis rate ≤25% ）, 21 cases in mild stenosis group （25% 〈 stenosis rate≤50% ）, 23 cases in moderate stenosis group （50% 〈 stenosis rate≤75% ）, and 25 cases in severe stenosis group （ stenosis rate 〉 75 % ）. The parameters of longitudinal peak systolic strain（GLS）, circumferential peak systolic strain （GCS）, radial peak systolic strain （GRS）, area peak systolic strain（GAS） and three dimensional peak systolic strain （3D -Strain）were obtained using 3DT analysis software, and the parameters of left ventricular left ventricular ejection fraction （LVEF） and stroke volume （ SV ） were obtained using two dimensional biplane Simpson method. The differences between any two sets of the parameters were analyzed, and the global strains to diagnose different graded coronary artery stenosis were analyzed by the receiver operating characteristic （ ROC ） curve. Results ①There were no significant differences of LVEF and SV in any two groups （P 〈0.05）.②All 3D -STI parameters in the severe stenosis group were significant decreased compared with those of other groups. All 3D - STI parameters except GCS of moderate stenosis group were significant decreased compared with those ofmild group. ③ROC curve showed that the area under the ROC curve （AUC） of GLS, GRS, GCS, GAS and 3D - Strain to diagnosis moderate stenosis was 0. 716, 0. 697, 0. 577, 0. 718 and 0. 711, respectively;the AUC of GLS, GRS, GCS, GAS and 3D - Strain to diagnos

关 键 词：超声心动描记术 三维 斑点追踪显像 应变 冠状动脉狭窄 

分 类 号：R445[医药卫生—影像医学与核医学]