二维斑点追踪成像技术评价不同程度冠状动脉狭窄对左心室功能的研究  

Evaluation of the Left Ventricular Function in Patients with Different Degrees of Coronary Artery Stenosis Using 2D Speckle Tracking Imaging

作　　者：郭艳杰[1] 孙品[1] 张芬[1] 马兰[1] 王志斌[1] 

机构地区：[1]青岛大学附属医院心脏超声科,山东省青岛市266003

出　　处：《中国超声医学杂志》2016年第6期507-510,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的应用二维斑点追踪成像技术(2D-STI)评价不同程度冠状动脉狭窄对左心室功能的影响,探讨临床诊断价值。方法选取门诊或住院治疗可疑冠心病(CHD)患者146例,采用标准Judkins法行冠状动脉造影。根据冠状动脉造影结果分为4组:正常对照组、轻度狭窄组、中度狭窄组和重度狭窄组。应用2D-STI获取左心室整体纵向应变(LS)、径向应变(RS)及圆周应变(CS)。通过绘制受试者工作特征曲线(ROC)评价不同程度冠状动脉狭窄检出的灵敏度和特异度,探讨2DSTI技术在冠心病诊断中的临床价值。结果与对照组比较,轻度狭窄组LS、RS、CS均无统计学意义(P>0.05),中度狭窄组较对照组、轻度狭窄组LS降低(P<0.05),重度狭窄组较对照组LS、RS、CS均降低(P<0.05),且随着冠状动脉病变程度的加重,LS进行性减小。ROC曲线表明以LS为-17.8作为筛选中度狭窄组的截断值,其诊断灵敏度为57.7%、特异度59.6%,AUC=0.59;以LS为-16.8作为筛选重度狭窄组的截断值时诊断价值最佳,其诊断灵敏度为84.6%、特异度为83.3%,AUC=0.85。结论 CHD患者左心室收缩功能均有不同程度受损,且随狭窄程度增加而加重,尤其在重度狭窄组尤为显著。2D-STI可以定量评价冠状动脉狭窄患者的左心室应变,为早期客观预测冠脉病变程度及评估CHD患者左心室功能提供了一个无创、准确、简便的新途径。Objective To evaluate the left ventricular function in patients with different degrees of coronary artery stenosis by 2D speckle tracking imaging and to explore its clinical significance.Methods 146 cases of patients with suspected coronary artery disease were enrolled.According to the coronary angiography results,the patients were divided into four groups：normal control group,mild stenosis group,moderate stenosis group and severe stenosis group.Using 2D-STI to obtain LS,RS and CS.The sensitivity and specificity of different degrees of coronary artery stenosis were evaluated by ROC and discussed the value of clinical diagnosis of coronary heart disease（CHD）with 2D-STI.Results The LS,RS and CS in mild stenosis group had no statistical significance compared with those of control group（P0.05）.LS were decelined in moderate stenosis group than that in the control group and mild stenosis group（P0.05）.The LS,RS and CS in severe stenosis group were obviously decreased（P0.05）and LS were progressive decreased with the degree of coronary artery stenosis.The cutoff value of LS for diagnose mild stenosis was -17.8（area under ROC curve[AUC]=0.59,P0.05）,with the sensitivity 57.7% and specificity 59.6 % respectively.The cutoff value of LS for diagnose severe stenosis was -16.8（area under ROC curve[AUC]=0.85,P0.01）,with the sensitivity 84.6% and specificity 83.3% respectively.Conclusions Dysfunction exists in patients with CHD and with the degree of stenosis increasing,the function is aggravating.2D-STI can reflect and predict the degree of coronary artery stenosis objectively and provide a new noninvasive,simple and reliable approach for the assessment of left ventricular function in patients with CHD.

关 键 词：二维斑点追踪成像 冠状动脉狭窄 左心室功能 

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