稳定型冠状动脉性心脏病患者心肌纵向应变变化与SYNTAX评分的关系  

Correlation of myocardial longitudinal strain changes with SYNTAX score in patients with stable coronary artery disease

作　　者：林晓燕[1] 屈朝阳[1] 苏津自[2] 林联合[1] 鄢磊[1] 黄春燕[1] 阮琴韵[1] 柴大军[2] 

机构地区：[1]福建医科大学附属第一医院超声影像科,福建福州350005 [2]福建医科大学附属第一医院心血管内科,福建福州350005

出　　处：《中华高血压杂志》2016年第10期932-937,共6页Chinese Journal of Hypertension

基　　金：福建省卫生和计划生育委员会青年科研课题资助项目(2011-2-12);福建省卫生系统中青年骨干人才培养重点项目(2013-ZQN-ZD-18)

摘　　要：目的利用二维斑点追踪技术（2D-STE）探讨稳定型冠状动脉性心脏病（SCAD）患者左心室功能的早期变化,评价左心室心肌纵向应变与SYNTAX评分（SS）的关系。方法入选2013年1月至2015年1月于福建医科大学附属第一医院住院的临床高度怀疑SCAD的患者148例,所有患者均在接受冠状动脉造影前进行心脏超声检查并进行离线2D-STE分析。分别计算各段峰值纵向收缩期应变率（SRs）、峰值纵向舒张早期应变率（SRe）和峰值纵向舒张晚期应变率（SRa）,以左心室16段的收缩期峰值应变均值反映左心室整体收缩期峰值应变（GLS）。依据冠状动脉造影结果计算SS,依据冠状动脉血管直径狭窄是否≥50%分为狭窄性CAD组（n=116）和非狭窄性CAD组（对照组,n=32）,根据SS三分位数将所有狭窄性CAD患者分为3组：低SS组（SS≤8）、中SS组（SS 8~〈17）和高SS组（SS≥17）。结果对照组与狭窄性CAD组患者的左心室舒张末期内径（LVEDd）和左心室收缩末期内径（LVESd）差异无统计学意义。与对照组比较,狭窄性CAD组患者的室间隔厚度（IVST）、左心室后壁厚度（LVPWT）和左心室质量指数（LVMI）增加,且随着SS的增加逐渐加重。狭窄性CAD组患者的左心室射血分数（LVEF）、舒张早期二尖瓣口血流峰值速度（E峰）、E峰减速时间（DT）、GLS（绝对值）、SRs（绝对值）和SRe均较对照组下降,GLS（绝对值）、SRs（绝对值）和SRe随SS的增加呈下降趋势。中SS组的LVEF与对照组和低SS组差异无统计学意义[（62.5±4.3）%比（62.5±3.8）%比（62.9±3.2）%,P〉0.05],但中SS组的GLS、SRs和SRe与对照组比较,差异有统计学意义[GLS：（-16.8±3.2）%比（-19.2±2.4）%;SRs：-1.02±0.30比-1.18±0.20;SRe：1.26±0.40比1.59±0.20;均P〈0.05]。相关分析显示,狭窄性CAD患者的左心室GLS与SS、LVMI、低密度脂蛋白胆固醇（LDL-C）、LVEF、体质量指数（BMI）、冠�Objective To detect the early changes of left ventricular function using two-dimensional speckle tracking imaging（2D-STE）and to evaluate the correlation between left ventricular strain and the SYNTAX score（SS）in patients with stable coronary artery disease（SCAD）. Methods A toal of 148 clinical suspected SCAD inpatients from the First Affiliated Hospital of Fujian Medical University between January 2013 to January 2015 were enrolled. All patients received echocardiography and offline 2D-STE analysis before coronary angiography. Peak systolic longitudinal strain rate（SRs）,peak early diastolic longitudinal strain rate（SRe）and peak longitudinal late diastolic strain rate（SRa）for each segment were calculated. The mean of strain for total 16 section of left ventricle was used to reflect left ventricular peak systolic strain（GLS）. On the basis of coronary angiography,SS was calculated. All subjects were divided into obstructive SCAD group（n=116）and non-obstructive SCAD group（control group,n=32）according to the diameter stenosis of coronary artery≥50% or〈50%. Based on the level of SS,all obstructive SCAD patients were divided into three groups using tertile method：low SS group（SS≤8）,middle SS group（SS 8-〈17）and high SS group（SS≥17）. Results There were no significant difference in left ventricular end-diastolic dimension（LVEDd）and left ventricular end-systolic dimension（LVESd）between obstructive SCAD group and control group. However,interventricular septal thickness（IVST）,left ventricular posterior wall thickness（LVPWT）and left ventricular mass index（LVMI）were significantly increased in SCAD group than in control,which were aggravated with the increase of the SS. Left ventricular ejection fraction（LVEF）,mitral inflow E wave velocity,deceleration time（DT）,GLS（absolute value）,SRs（absolute value）and SRe were significantly decreased in SCAD patients than in control group,GLS（absolute value）,SRs（absolute value）and SRe decrea

关 键 词：冠状动脉疾病 稳定型冠状动脉疾病 二维斑点追踪 应变 SYNTAX评分 

分 类 号：R541[医药卫生—心血管疾病]