三维斑点追踪技术结合腺苷负荷试验诊断早期冠心病的临床价值  

Clinical Value of Three-dimensional Speckle Tracking Echocardiography Combined with Adenosine Stress Test in Early Diagnosis of Coronary Heart Disease

作　　者：吴碧君[1] 黄红艳[1] 周苏晋[1] 谢佳佳[2] 崔楠[1] 王珍[1] 刘文芬[1] 

机构地区：[1]广东省第二人民医院超声科,广东省广州市510317 [2]广东省第二人民医院心血管内科,广东省广州市510317

出　　处：《中国全科医学》2017年第18期2274-2278,共5页Chinese General Practice

基　　金：广东省医学科学技术研究基金项目(A2015035)

摘　　要：目的探讨三维斑点追踪技术(3D-STE)结合腺苷负荷试验诊断早期冠心病(缺血心肌节段)的临床价值。方法在2015年7月—2016年9月于广东省第二人民医院心血管内科住院的疑似冠心病患者中采用随机数字表法抽取61例,常规超声心动图未见室壁运动异常,根据冠状动脉造影结果分为冠心病组(45例)与对照组(16例),其中冠心病组又分为缺血心肌节段亚组和非缺血心肌节段亚组。应用3D-STE结合腺苷负荷试验检测左心室各血管节段径向、纵向、环向收缩期峰值应变(RS、LS、CS)及面积收缩期峰值应变(AS)。绘制RS、LS、CS、AS诊断缺血心肌节段的受试者工作特征曲线(ROC曲线),分析其诊断价值。结果缺血心肌节段亚组与非缺血心肌节段亚组、对照组RS、LS、CS、AS比较,差异均有统计学意义(P<0.05),而对照组与非缺血心肌节段亚组间差异均无统计学意义(P>0.05)。RS、LS、CS、AS诊断缺血心肌节段的ROC曲线下面积分别为0.868、0.916、0.786、0.921。结论 3D-STE结合腺苷负荷试验可定量评价心肌收缩功能的微小改变,AS能较好地识别心肌缺血,对诊断早期冠心病具有很高的临床价值。Objective To assess the three - dimensional speckle tracking echocardiography （3D - STE） combined with adenosine stress test in diagnosis of CHD （ischemic heart sarcomere section） . Methods From July 2015 to September 2016, 61 patients suspected with coronary heart disease who were hospitalized in Cardiovascular Department of Guangdong No. 2 Provincial People＇s Hospital were randomly selected in the study accorded table of random number. No abnormal ventricular wall motion was shown in conventional echocardiography, and the subjects were divided into coronary heart disease group （45 cases） and control group （ 16 cases） according to the results of coronary arteriography. Coronary heart disease group was divided into two groups： ischemic heart sarcomere section subgroup and isehemic heart sarcomere section subgroup. D -STE combined with adenosine stress test was used to measure radial peak - systolic strain （ RS ）, longitudinal peak - systolic strain （ LS ）, circumferential peak - systolic strain （CS） and area strain （AS） of each vessel in left ventricle. The RS, LS, CS, AS were drawn to diagnose the receiver operating characteristic curve （ROC curve） of ischemic heart sarcomere section and to analyze its diagnostic value. Results There was significant differenee in RS, I,S, CS and AS among isehemie heart sareomere section subgroup and control group, non - ischemic heart sarcomere section subgroup （ P 〈 0. 05 ） , while there was no significant difference between control group and ischemic heart sarcomere section subgroup （ P 〉 0. 05 ） . Area under the ROC curve of RS, LS, CS and AS in diagnosis of ischemic segment was 0. 868, 0. 916, 0. 786, 0. 921 respeetively. Conclusion 3D - STE combined with adenosine stress test can quantitatively evaluate the small changes of myocardial systolic fimetion, AS can better identify myocardial ischemia, which has a high clinical value for early diagnosis of coronary heart disease.

关 键 词：冠心病 超声心动描记术 三维 心血管造影术 

分 类 号：R541.4[医药卫生—心血管疾病]