三维斑点追踪成像技术评价不同狭窄程度的冠心病患者左心室扭转运动  

Evaluation of Left Ventricular Twist Using There-dimensional Speckle Tracking Echocardiography in Coronary Artery Disease Patients

作　　者：张志凌[1] 刘琳[1] 郭宏怡[1] 赵兰[1] 刘肆仁[1] 

机构地区：[1]北京市第六医院功能检查科,北京市100007

出　　处：《中国超声医学杂志》2016年第10期894-897,共4页Chinese Journal of Ultrasound in Medicine

基　　金：首都临床特色应用研究基金(No.z131107002213167)

摘　　要：目的应用三维斑点追踪成像(3D-STI)技术评价不同狭窄程度的冠心病患者左心室扭转运动,并分析扭转运动与冠心病的关系。方法 346例研究对象(其中冠心病患者204例)依冠状动脉狭窄程度分为轻度病变组、中度病变组、重度病变组、闭塞病变组、正常对照组,应用3D-STI技术获得左室整体、基底段、心尖段扭转角度峰值(PAR、PBR、Ptw)及扭转角度达峰时间(PART、PBRT、PtwT)、左室射血分数(LVEF)等指标,比较各组之间上述指标的差异,评估各指标与冠状动脉狭窄程度关系及对冠状动脉病变的预测价值。结果闭塞病变组与正常组和轻度病变组比较PART、PBRT、PtwT延长而PAR、PBR、Ptw减低,差异有统计学意义(均P<0.01);重度病变组与正常组和轻微狭窄组比较PART、PBRT延长而PAR、Ptw减小,差异有统计学意义(P<0.01)。冠心病患者左心室扭转参数与冠状动脉狭窄率呈正相关(r=0.465、0.23、0.27、0.537、0.19、0.24,P<0.01);Ptw诊断冠状动脉重度狭窄的ROC曲线下面积为0.655±0.029,以Ptw值11°作为检测冠状动脉重度狭窄的截断值时,其灵敏度为60.6%、特异度为51.7%。结论应用3D-STI技术能够评价冠心病患者的左心室扭转功能,对冠心病的诊断也有一定价值。Objective To assess the differences in left ventricular twist function between coronary heart disease （CHD） patients with different degrees of stenosis and healthy controls by using three-dimensional speckle tracking imaging （3D-STI）. Methods 346 subjects （204 cases patients with CHD） were divided into 5 groups （mild stenosis, moderate stenosis, severe stenosis, occlusion, and healthy control） according to the severity of coronary stenosis. Three-dimensional speckle tracking imaging were applied to all subjects and peak of left ventricular global twist （Ptw）, peak of left ventricular basal segment twist （PBR）, peak of left ventricular apical segment twist （PAR）, Ptw time （PtwT）, PBR time （PBRT） and PAR time （PART） were measured with TomTec 4D LV Analysis software. The differences in LV twist function among different groups were analyzed and the relationships between LV 3D-STI parameters and degree of stenosis were investigated. Results Significantly prolonged PART, PBRT and PtwT and decreased PAR, PBR and Ptw in occlusive group were observed in comparison with that in either control group or mild disease group （P〈0.01）. Prolongation of PART and PBRT and reduction of Ptw and PAR were also found in severe disease group as compared with either control group or mild stenosis group （P 〈0.01）. Left ventricle twist parameters and coronary artery stenosis in patients with CHD were positively correlated （values of ＇r＇ were 0. 465, 0.23, 0.27, 0. 537, 0.19 and 0.24 for ART, PBRT, PtwT, PAR, PBR and Ptw, re spectively, P〈0.01） with the highest r value of 0. 537 for PAR （P〈0.05）. The area under Ptw ROC curve served as a diagnostic parameter for severe coronary artery stenosis was 0. 655±0. 029, and while setting 11 ms as Ptw cutoff value the sensitivity and the specificity were 60.6% and 51.7%, respectively. Conclusions Application of 3D-STI technology is feasible in evaluating left ventricular twist function in patients with CHD and could provide valuable

关 键 词：三维斑点追踪成像 扭转 冠心病 左心室 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]