二维斑点追踪成像技术评价冠状动脉慢血流患者左室心肌分层应变  

Assessment of left ventricular layer-specific myocardial strain in patients with coronary slow flow by two-dimensional speckle tracking echocardiography

作　　者：邢雨蒙 史静 颜彦[2] 李清[2] 陈海燕 舒先红 潘翠珍[1,2,3] XING Yu meng;SHI Jing;YAN Yan;LI Qing;CHEN Hai-yan;SHU Xian hong;PAN Cui-zhen(Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Cardiovascular Disease,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心脏超声诊断科,上海200032 [2]上海市心血管病研究所,上海200032 [3]上海市影像医学研究所,上海200032

出　　处：《复旦学报（医学版）》2018年第4期467-472,共6页Fudan University Journal of Medical Sciences

摘　　要：目的应用二维斑点追踪成像技术(two-dimensional speckle tracking echocardiography,2D-STE)分析冠状动脉慢血流(coronary slow flow,CSF)患者左室心肌分层应变,研究2D-STE在临床上评估CSF患者左室各层心肌收缩功能的准确性及应用价值。方法设定CSF组41例(CSF患者)及对照组59例(冠状动脉造影检查结果正常者),分别采集存储6个切面观(心尖左室长轴、心尖四腔、心尖两腔及二尖瓣、乳头肌、心尖水平左室短轴)的动态二维超声图像,利用软件于各切面观脱机分析CSF组和对照组左室3层心肌(心内膜下、中层和心外膜下)的分层应变,分别计算出两组左室3层心肌整体纵向应变(global longitudinal strains,GLS)和整体环向应变(global circumferential strains,GCS)以及相应的跨壁应变梯度△GLS、△GCS。结果 CSF组及对照组左室3层心肌(心内膜下层、中层、心外膜下层)GLS和GCS均保持由内向外逐层递减的跨壁梯度特征;CSF组GLS、△GLS较对照组减低,差异有统计学意义(P<0.05),尤以心内膜下层GLS和△GLS降低更为显著(P<0.001);CSF组GCS、△GCS减低,但与对照组相比差异无统计学意义。应用ROC曲线计算分层应变参数预测CSF左室收缩功能,△GLS的曲线下面积最大(AUC=0.766,P<0.001),当△GLS取截断值为-4.87%时,灵敏度及特异度分别可达66.7%及76.3%。结论 2D-STE可通过评估心肌分层应变识别CSF患者左室3层心肌收缩功能受累的差异(心内膜下层为甚)。心肌纵向应变跨壁梯度△GLS可早期识别CSF患者的心肌收缩功能异常,具有临床诊断的应用前景。Objective To discuss the clinical value and accuracy of two dimensional speckle tracking echocardiography （2D STE） for the evaluation of left ventricular systolic function of the coronary slow flow （CSF） by assessing left ventricular laye〉specific myocardial strains in patients with CSF. Methods CSF group contained 41 patients with CSF,and 59 patients with normal coronary angiography results were involved as the control group. All 2 dimensional （2D） echocardiographic images from 6 standard views （apical views of long axis, 4 chamber, and 2 chamber; parasternal short axis views of mitral valve,papillary muscle,and apical level） were acquired for offline analysis. Layer specific strain from endocardium,mid myocardium and epicardium of LV wall was analyzed by 2D STE software. Layer specific global longitudinal strains （GLS） and global circumferential strains （GCS） were assessed at endocardium, midmyocardium and epicardium by 2D STE. The transmural gradient between endocardial and epicardial （△GLS,△GCS） were calculated. Results GLS and GCS of each myocardium showed gradient descent, which is subendocardium〉 midmyocardium〉 subepicardium in both CSF group and control group. As comparing to the control group, GLS and △GLS in CSF group were significantly lower （P〈0.05） ;especially the endocardial GLS and △GLS （P〈0. 001 ）. There were no significant difference in both GCS and △GCS between CSF group and control group. The AUC of △GLS was biggest （AUC 0. 766,P〈0. 001） ,and when the cut off value was 4.87% ,the sensitivity and the specificity was 66.7% and 76.3%, respectively. Conclusions 2D STE can identify left ventricular 3 layer contractility（especially the subendocardium） by assessing left ventricular laye〉specific myocardial strains in patients with CSF. Meantime, lognitudinal transmural gradient △GLS can identify the abnormity of left ventricular contractility in patients with CSF and have the promising prospect of clinical diagnosis.

关 键 词：二维斑点追踪成像 冠状动脉慢血流 左室 分层应变 

分 类 号：R445[医药卫生—影像医学与核医学]