实时三维斑点追踪成像评价前降支病变患者左室局部心肌功能  

Evaluation of regional left ventricular myocardial function in patients with anterior descending lesion by realtime three-dimensional speckle tracking imaging

作　　者：梁慧青[1] 刘昕[1] 薛娜[1] 

机构地区：[1]保定市第一中心医院超声科,071000

出　　处：《中华超声影像学杂志》2018年第1期17-22,共6页Chinese Journal of Ultrasonography

摘　　要：目的应用实时三维斑点追踪成像（RT3D-STI）技术评价前降支病变患者的左心室局部心肌的收缩与舒张功能，并探讨RT3D-STI对前降支狭窄程度的诊断价值。方法疑诊为冠心病并进行冠状动脉造影的患者112例，根据冠状动脉造影结果分为4组：前降支无狭窄组（20例），前降支轻度狭窄组（冠脉狭窄〈50%，30例），前降支中度狭窄组（冠脉狭窄50%～75%，26例），前降支重度狭窄组（冠脉狭窄〉75%，36例）。经胸采集常规二维及实时三维全容积图像，获得常规参数及前降支供血区收缩末期的纵向应变（GLS）、径向应变（GRS）、圆周应变（GCS）、面积应变（GAS）及相应方向的舒张期前1/3时点的应变，计算纵向应变显像舒张指数（L-SI-DI）、径向应变显像舒张指数（R-SI-DI）、圆周应变显像舒张指数（C-SI-DI）、面积应变显像舒张指数（A-SI-DI），分析各参数对前降支狭窄程度的诊断价值。结果前降支无狭窄组、轻度狭窄组、中度狭窄组、重度狭窄组之间相比，常规超声参数左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）、E、A、E/A、E/e差异均无统计学意义（P〉0.05）；轻度狭窄组与无狭窄组相比GLS、GRS、GCS及GAS差异均无统计学意义（P〉0.05），L-SI-DI、R-SI-DI、C-SI-DI及A-SI-DI差异均有统计学意义（P〈0.05）；ROC曲线显示前间隔中段L-SI-DI的敏感性、特异性最高，分别为90.0%、81.5%。结论RT3D-STI技术能够定量评价前降支病变患者心肌功能的改变，前间隔中段L-SI-DI可以在一定程度上反映前降支的狭窄程度，对临床诊断前降支狭窄程度有重要的指导意义。ObjectiveTo evaluate the systolic and diastolic function of the left ventricular regional myocardium in patients with anterior descending lesion by real-time three-dimensional speckle tracking imaging （RT3D-STI） and investigate the value of RT3D-STI in the diagnosis of anterior descending stenosis.MethodsAccording to coronary angiography, 112 patients were divided into four groups： normal group （20 coronary artery branches without stenosis）, mild stenosis group （30 coronary artery branches with stenosis〈50%）, moderate stenosis group （26 coronary artery branches with stenosis 50%-75%） and sever stenosis group （36 coronary artery branches with stenosis〉75%）. Transthoracic acquisition of conventional 2D and full-volume real-time three-dimensional image, the routine parameters and the globle longitudinal strain （GLS）, globle radial strain （GRS）, globle circumferential strain （GCS） and globle area strain （GAS） at the end of the anterior descending blood supply area and corresponding strain of 1/3 of pre-diastolic period were obtained to calcute L-SI-DI, R-SI-DI, C-SI-DI, and A-SI-DI. The diagnostic value of each parameter to the stenosis degree of the anterior descending branch was analyzed.ResultsCompared among the anterior descending group without stenosis group, mild stenosis group, moderate stenosis group and severe stenosis group, there were no significant differences in conventional ultrasonic parameters such as LVEDV, LVESV, LVEF, E, A, E/A and E/e （all P〉0.05）. There was no significant difference in GLS, GRS, GCS and GAS between mild stenosis group and no stenosis group （all P〉0.05）, but the difference in L-SI-DI, R-SI-DI, C-SI-DI and A-SI-DI were statistically significant （all P〈0.05）. The ROC curve showed that the sensitivity and specificity of the middle anterior segment L-SI-DI were the highest, with 90.0% and 81.5%.ConclusionsRT3D-STI can quantitative evaluate myocardial function changes in patients with anterior descending lesion, the anterior s

关 键 词：超声心动描记术 实时三维 冠状动脉狭窄 心室功能 左 斑点追踪显像 前降支 

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]