基于AFI的无室壁运动异常冠心病患者左室心肌运动及其与冠脉狭窄程度间关系的研究  

Study on The Relationship Between Myocardial Characteristics of Left Ventricle and The Degree of Coronary Stenosis in CHD Patients Without Regional wall Motion Abnormalities based on AFI

作　　者：江业慧 张平洋[1] 冉红[1] 董静[1] 马小五[1] 李林[1] 李妙[1] Jiang Yehui;Zhang Pingyang;Ran Hong;Dong Jing;Ma Xiaowu;Li Lin;Li Miao(Department of Cardiovascular Ultrasound.Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院心血管超声科,南京市210006

出　　处：《中国超声医学杂志》2020年第2期125-128,共4页Chinese Journal of Ultrasound in Medicine

基　　金：南京市科技发展计划(医学及南京市医学科技发展重点)项目(No.ZKX17026)。

摘　　要：目的应用自动功能成像技术(AFI)评价无节段性室壁运动异常(RWMA)的冠心病(CHD)患者左室心肌运动的改变并探讨其与冠状动脉狭窄程度间的关系。方法选择有临床症状并经造影证实的CHD患者58例作为研究对象,且所有受试者行二维超声心动图检查未发现RWMA。采用Teich法测量每搏输出量(SV)及左心室射血分数(LVEF),运用AFI获得左室整体长轴收缩峰值应变(GLPS)、峰值应变离散度(PSD),并计算纵向应变差(LSD)、纵向应变差与整体纵向应变之比(LSR)。按Gensini积分分为三组,Gensini积分<20分为轻度病变组(21例),20分≤Gensini积分<45分为中度病变组(19例),Gensini积分≥45分为重度病变组(18例)。将三组参数进行比较,与Gensini积分进行相关性分析。结果(1)轻、中、重三组之间的常规参数比较,差异均无统计学意义(P>0.05);与轻度病变组相比,中度病变组及重度病变组的GLPS绝对值均显著减小(P均<0.01);重度病变组与中度病变组相比,差异具有统计学意义(P<0.01)。三组之间LSD、LSR、PSD差异均无统计学意义(P>0.05)。(2)相关性分析表明GLPS、LSD、PSD与Gensini积分呈正相关(r分别为0.871、0.595、0.271,P<0.01或0.05),而LSR与Gensini积分的相关性无统计学意义。(3)ROC表明,>-19.100的GLPS值诊断Gensini积分≥20分的冠心病患者的灵敏度为89.2%、特异度为90.5%,AUC=0.944;>-17.850的GLPS诊断Gensini积分≥45分的冠心病患者的灵敏度为100%、特异度为85%,AUC=0.966。结论GLPS可以作为评价冠心病患者冠脉的狭窄程度的重要参考依据,AFI有助于临床医师评估患者病情并选择合适的治疗方案。Objective To evaluate the changes of left ventricular myocardial motion in patients with CHD without RWMA using AFI and to explore its relationship with coronary artery stenosis.Methods 58 patients with clinically symptomatic and coronary angiographically confirmed CHD were enrolled in the study.All subjects underwent two-dimensional echocardiography without RWMA.The Teich method was used to measure SV and LVEF.AFIwas used to obtain the GLPS,PSD,LSD,LSR.Gensini score<20 was divided into mild lesion group(21 cases),20 points≤Gensini score<45 was divided into moderate disease group(19 cases),Gensini score≥45 was classified as severe disease group.(18 cases).Comparing the three groups of parameters and analyzing the correlation with Gensini scores.Results(1)There were no significant differences in the conventional parameters between the light,middle and heavy groups(P>0.05).Compared with the mild disease group,the GLPS of the moderate disease group and the severe group were absolute.The values were all decreased,and the difference was statistically significant(P<0.01).There was also a statistically significant difference between the patients with severe disease and the moderate disease group(P<0.01).There were no significant differences in LSD,LSR and PSD between the three groups(P>0.05).(2)Correlation analysis showed that GLPS,LSD,PSD were positively correlated with Gensini scores(r=0.871,0.595,0.271,P<0.01 or 0.05),and the correlation between LSR and Gensini score was not statistically significant.(3)ROC showed that the sensitivity,specificity and specificity of GLPS greater than-19.100 for diagnosing CHD patients with Gensini score(>20)were 89.2%,90.5%,and AUC=0.944.The sensitivity and specificity of GLPS greater than-17.850 for diagnosing CHD patients with Gensini score(>45)were 100%,85%,and AUC=0.966.Conclusions GLPS can be used as an important reference for the evaluation of coronary artery stenosis in patients with CHD,AFI can help clinicians to evaluate patients′conditions and choose appropriate treatm

关 键 词：自动功能成像 冠心病 心肌应变 GENSINI积分 

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]