三维应变成像评价非ST段抬高型心肌梗死患者左室心肌力学的价值  

Evaluation of left ventricular myocardial mechanics in non-ST-segment elevation myocardial infarction patients by three-dimensional strain imaging

作　　者：卿顺华 龚元淑[1] 戴法辉 梁柏松 张平洋[2] QING Shunhua;GONG Yuanshu;DAI Fahui;LIANG Baisong;ZHANG Pingyang(Department of Ultrasound,Pukou Hospital of Jiangsu Provincial People’s Hospital,Nanjing 210000,China)

机构地区：[1]江苏省人民医院浦口分院超声科,南京市210000 [2]南京医科大学附属南京医院超声科

出　　处：《临床超声医学杂志》2020年第10期732-736,共5页Journal of Clinical Ultrasound in Medicine

基　　金：南京医科大学科研发展项目(2016NJMUZD098)。

摘　　要：目的探讨三维应变成像(3D-STI)评价无节段性室壁运动异常(RWMA)的非ST段抬高型心肌梗死(NSTEMI)患者左室心肌力学改变的临床应用价值。方法选择常规超声心动图检查未发现RWMA的NSTEMI患者38例为病例组,健康成人30例为对照组,两组均行心脏超声、心肌酶谱及血生化实验室检查。获得左室舒张末内径(LVED)、左室短轴缩短率(FS)、左室射血分数(LVEF)及每搏量(SV),应用3D-STI分析软件获得左室收缩期纵向应变(GLS)、径向应变(GRS)、圆周应变(GCS)及面积应变(GAS);比较两组上述参数的差异。分析心肌应变参数与临床资料和实验室指标的相关性;绘制心肌应变参数诊断心肌梗死的受试者工作特征(ROC)曲线,并计算其诊断效能。结果两组间年龄、血压、血脂、血糖、血肌酐、血尿酸、血浆N末端B型钠尿肽前体(NT-proBNP)、肌酸激酶(CK-MB)水平比较,差异均无统计学意义。与对照组比较,病例组GAS减小[(-31.27±1.87)%vs.(-42.02±1.26)%],血心肌钙蛋白I(hs-CTnI)增高[(2.11±1.78)%vs.(0.07±0.01)%],差异均有统计学意义(t=17.02、6.25,均P=0.000);而GLS、GRS、GCS、LVED、FS、LVEF及SV比较差异均无统计学意义。相关性分析表明:病例组患者GAS与LVEF、FS、hs-CTnI均呈正相关(r=0.45、0.25、0.61,均P<0.05)。ROC曲线分析显示:GAS绝对值<18.15%判断NSTEMI的敏感性92.1%,特异性80.0%,曲线下面积0.91。结论3D-STI能定量分析NSTEMI患者左室心肌力学改变,为临床评判NSTEMI提供无创、简便的新方法。Objective To investigate the value of three-dimensional strain imaging(3D-STI)in evaluating left ventricular myocardial mechanics in non-ST-segment elevation myocardial infarction(NSTEMI)patients without regional wall motion abnormality(RWMA).Methods Thirty-eight NSTEMI patients without RWMA detected by routine ultrasonography were selected as the case group,and thirty healthy subjects with matched age and sex were enrolled as the control group.Echocardiography,blood myocardial enzymes examination and blood biochemical testing were performed on two groups.The left ventricular end-diastolic diameter(LVED),the left ventricular fractional shortening(FS),the left ventricular ejection fraction(LVEF)and the stroke volume(SV)were measured.And the global longitudinal peak systolic strain(GLS),the global radial peak systolic strain(GRS),the global circumferential peak systolic strain(GCS)and the global area peak systolic strain(GAS)were obtained by 3D-STI.The correlation between myocardial strain parameters and clinical data,laboratory indexes were analyzed.ROC curve was drawn to analyze the diagnostic efficacy of myocardial strain parameters in myocardial infarction.Results There were no significant differences in age,blood pressure,blood lipids,blood glucose,blood creatinine,blood uric acid,blood CK-MB and NT-proBN between the two groups.Compared with control group,the GAS in case group was reduced[(-31.27±1.87)%vs.(-42.02±1.26)%,t=17.02,P=0.000],and the blood hs-CTnI was increased[(2.11±1.78)%vs.(0.07±0.01)%,t=6.25,P=0.000],but there were no significant differences in GLS,GRS,GCS,LVED,FS,LVEF and SV.Correlation analysis showed that there were positively correlation between GAS and LVEF,FS,hs-CTnI(r=0.45,0.25,0.61,all P<0.05).ROC curve showed that the sensitivity of evaluating NSTEMI was 92.1%and the specificity was 80%according to the absolute value of GAS<18.15%,and the area under the curve was 0.91.Conclusion 3D-STI can quantitatively analyze the mechanical changes of left ventricular myocardium in NSTEMI patient

关 键 词：斑点追踪 三维 应变 心肌梗死 非ST抬高型 左室 心肌力学 

分 类 号：R540.45[医药卫生—心血管疾病] R542.2[医药卫生—内科学]