超声四维应变技术结合实时心肌超声造影技术评价冠心病患者左心室心肌灌注及运动功能改变的价值  

The value of evaluation on the left ventricular myocardial perfusion and movement function of patients with coronary artery disease by four dimentional strain imaging combined with myocardial contrast echocardiography

作　　者：胡劼[1] 李华[1] 努斯来提·外力[1] 高海燕[1] 香丽萍 HU Jie;LI Hua;NUSILAIT;GAO Hai-yan;XIANG Li-ping(Department of Echocardiography t Affiliated Traditional Chinese Medicine Hospitalt Xinjiang Medical University, Urumqi 8300001 China)

机构地区：[1]新疆医科大学附属中医医院心脏超声科,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《中国心血管病研究》2019年第8期732-736,共5页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区自然科学基金资助项目(2015211C147).

摘　　要：目的探索四维应变技术(four-dimensional strain imaging,4D-SI)结合实时心肌超声造影技术(myocardial contrast echocardiography,MCE)评价冠心病(coronary heartdisease,CHD)患者心肌灌注及运动功能的临床价值.方法选取经冠状动脉造影确诊为CHD的患者30例,血供异常的心肌节段按供血冠状动脉狭窄程度分为轻度、中度和重度狭窄组,并选取15名健康体检者作为正常对照组.所有分组均进行MCE和4D-SI检查,得出长轴应变(four-dimensional-global longitudinal peak strain,4D-GLPS)、环向应变(four-dimensional-circumferential peak strain,4D-GCPS)、面积应变(four-dimensional-area peak strain,4D-GAPS)及径向应变(four-dimensional-radial peak strain,4D-GRPS)参数指标分析左心室各节段心肌运动功能,并应用MCE再灌注充盈曲线获得A值和β值分析各节段心肌血流灌注情况.结果在异常冠状动脉供血区,中度和重度狭窄组的β值分别为0.63±0.25、0.49±0.23,4D-GLPS值分别为-8.5±1.6、-5.6±1.8,4D-GCPS值分别为-11.5±2.0、-7.3±2.8,4D-GAPS值分别为-19.1±3.2、-11.6±4.1,4D-GRPS值分别为23.3±5.3、17.1±5.3,β值和各应变值均低于对照组(P<0.05),而轻度狭窄组的4D-GLPS值为-11.7±2.5、4D-GAPS值为-22.7±3.0,该两项参数值低于对照组(P<0.05).单参数ROC曲线分析结果显示,4D-GLPS参数评价早期心肌损伤价值较高,其AUC为0.944,灵敏度为91.3%,特异度为93.8%,多参数联合ROC曲线分析结果显示,MCE联合4D-SI技术评价中、重度冠状动脉狭窄灵敏度及特异度较高,其AUC为0.969,灵敏度为95.7%,特异度为90.6%.结论 MCE的再灌注参数β值和4D-SI技术参数4D-GLPS、4D-GCPS、4D-GAPS和4D-GRPS均可发现静息状态下>75%的冠状动脉狭窄引起的心肌缺血,其中4D-GLPS、4D-GAPS能够发现轻度狭窄组早期的心肌损伤改变,且两种技术结合诊断中、重度冠状动脉狭窄的价值明显高于仅应用单一技术.Objective To investigate the value of evaluation on the left ventricular myocardial perflision and movement function in patients with CHD by 4D-SI combined with MCE. Methods 30 patients diagnosed with CHD by coronary angiography and 15 healthy subjects were recruited as control group. The myocardial segments with abnormal blood supply were divided into three groups: mild (50%-75%), moderate (76%-89%) and severe (^ 9 0 %), based on coronary stenosis. 4D-GLPS, 4D-GCPS, 4D-GRPS and 4D-GAPS by 4D-SI were measured for functional analysis;value A and value p by reperfusion filling curve from MCE were calculated for perfusion analysis. Results In the abnormal coronary artery supply area, the p values of moderate and severe stenosis groups were 0.63士0.25 and 0.49土0.23;the values o f 4D-GLPS were -8 .5 土 1.6 and -5 .6 士 1.8;the values o f 4D-GCPS were - 1 1.5±2.0 and -7.3±2.8;the values of 4D-GAPS were -19.1 ±3.2 and - 1 1.6±4.1;the values of 4 D -G R P S w ere23.3± 5.3andl7.1± 5.3;thevaluesof4D -G L P S and4D -G A P S ofm ildstenosisgroupw ere-11.7± 2.5 and - 2 2 .7 ± 3.0. Compared with normal control group, p value and all strain values were significantly decreased in the context o f moderate and severe coronary stenosis ( P <0.05);4D-GLPS and 4D-GAPS were significantly decreased in the mild stenosis group ( P<0.05). The single parameter mode of ROC curve analysis showed that 4D-GLPS was relatively higher than other strain parameters when evaluating the early left ventricular dysfunction, the AUC was 0.944;the sensitivity was 91.3% and the specificity was 93.8%. The Multiple parameter mode o f ROC curve analysis showed that 4D-SI combined with MCE have relatively higher sensitivity and specificity when evaluating the moderate and severe left ventricular dysfunction;the AUC was 0.969;the sensitivity was 95.7% and the specificity was 90.6%. Conclusion All the p value from MCE and 4D-GLPS, 4DG CPS, 4D-GAPS and 4D-GAPS from 4D-SI can detect the left ventricular myocardial dysfunction induced by > 75% coronar

关 键 词：冠状动脉疾病 四维应变 心肌声学造影 心肌运动功能 心肌灌注 

分 类 号：R541.4[医药卫生—心血管疾病]