TDI联合2D-STI评价ANOCA患者微循环功能障碍及左心功能损伤的应用价值  

Clinical value of TDI combined with 2D-STI on evaluating the microcirculation dysfunction and left ventricular dysfunction in patients with non-obstructive coronary angina

作　　者：刘婷婷 丁明岩[2] 孙丹丹 冀威 张慧慧 李颖[2] 郭丽娟[2] 朱芳[2] Liu Tingting;Ding Mingyan;Sun Dandan;Ji Wei;Zhang Huihui;Li Ying;Guo Lijuan;Zhu Fang(Faculty of Medical Imaging and Nuclear Medicine,Gradute School of Dalian Medical University,Dalian 116044,China;Department of Cardiac Function,People′s Hospital of Liaoning Province,Shenyang 110000,China)

机构地区：[1]大连医科大学研究生院影像医学与核医学系,116044 [2]辽宁省人民医院心功能科,沈阳110000

出　　处：《中华心血管病杂志》2021年第12期1191-1197,共7页Chinese Journal of Cardiology

基　　金：辽宁省科学技术计划项目(20180530109);辽宁省“兴辽英才计划”项目(XLYC2005007);辽宁省科学技术计划项目(2021-MS-063)。

摘　　要：目的初步探讨在静息状态下,组织多普勒(TDI)联合二维斑点追踪技术(2D-STI)评价冠状动脉非阻塞性心绞痛(ANOCA)患者微循环功能障碍(CMD)及左心功能损伤的应用价值。方法本研究为单中心回顾性研究。选取2019年8月至2021年7月在辽宁省人民医院就诊的78例ANOCA患者,所有受试者均行常规超声心动图检查,使用TDI检查、2D-STI检查评价左心功能,使用经胸腺苷负荷超声心动图(SE)测定冠状动脉血流速度储备(CFVR)评价微循环功能。根据CFVR将ANOCA患者分为CMD组(CFVR<2)和对照组(CFVR≥2),收集两组患者的临床资料、常规超声心动图参数。TDI参数包括等容收缩时间(IVCT)、等容舒张时间(IVRT)、射血时间(ET)以及Tei指数,2D-STI参数包括左心室整体纵向应变(GLS)、达峰时间(TTP)、达峰时间离散度(PSD)。采用二元logistic回归分析TDI和2D-STI参数对CMD的预测价值,并采用受试者工作特征(ROC)曲线构建CMD的联合预测模型。结果共纳入78例患者,年龄(55.5±11.2)岁,女性43例(55%),CMD组38例(49%),对照组40例(51%)。与对照组相比,CMD组年龄、高血压、糖尿病、血脂异常、吸烟比例高,Tei指数高、IVCT长、TTP长、PSD高、ET短、GLS绝对值低,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,IVCT延长、Tei指数增高、PSD增高、GLS绝对值降低是CMD的正相关因素。ROC曲线显示,联合以上预测因子对CMD有较高的诊断价值,AUC=0.884,敏感度为82%,特异度为80%。结论TDI联合2D-STI在评价ANOCA患者CMD及左心功能损伤中有较好的应用价值,有助于此类患者诊断、预测以及进一步危险分层。Objective To explore the value of tissue Doppler imaging(TDI)combined with two-dimensional speckle tracking imaging(2D-STI)at rest on evaluating microcirculation dysfunction and left ventricular dysfunction in patients with angina and no obstructive coronary artery disease(ANOCA).Methods This retrospective study recruited 78 ANOCA patients,who hospitalized in the People′s Hospital of Liaoning Province from August 2019 to July 2021.These patients underwent conventional echocardiography examination,including TDI and 2D-STI,to evaluate the left ventricular dysfunction,and adenosine stress echocardiography(SE)to evaluate the coronary flow velocity reserve(CFVR).ANOCA patients were divided into coronary microcirculation dysfunction CMD group(CFVR<2)and control group(CFVR≥2)according to CFVR.Clinical data,routine echocardiographic parameters,TDI parameters including isovolumic contraction time(IVCT),isovolumic relaxation time(IVRT),ejection time(ET),and STI parameters including global longitudinal peak strain(GLS),time to peak(TTP);peak strain dispersion(PSD)were compared between the two groups.Binary logistic regression was used to analyze the risk factors of CMD and the predictive value of each parameter to construct a joint prediction model for the diagnosis of CMD in this patient cohort.Results The mean age was(55.5±11.2)years,43(55%)patients were females in this patient cohort,38(49%)patienst were didvided into the CMD group and 40(51%)into the control group.Age,prevalence of hypertension,diabetes,dyslipidemia,and smokers were significantly higher in the CMD group than in the control group(all P<0.05).Tei index was higher,IVCT and TTP were longer,PSD was higher,ET was shorter,and absolute GLS was lower in the CMD group than in the control group(all P<0.05).The results of logistic regression analysis showed that longer IVCT,higher Tei index,higher time to PSD and lower absolute GLS were the independent risk factors of CMD.The ROC curve revealed that the predicting efficacy on CMD was satisfactiory with the com

关 键 词：负荷超声心动图 冠状动脉微循环功能障碍 冠状动脉血流速度储备 组织多普勒成像 二维斑点追踪成像 

分 类 号：R541.4[医药卫生—心血管疾病]