二维斑点追踪成像评价冠状动脉慢血流患者左心室收缩同步性  

Left Ventricle Systolic Synchronicity in Patients with Coronary Slow Flow Using Two-Dimensional Speckle Tracking Echocardiography

作　　者：黎瑶 陈新云[2] 卢聪 LI Yao;CHEN Xinyun;LU Cong(Department of Cardiovascular Medicine,Chengdu First People's Hospital,Chengdu 610041,China;不详)

机构地区：[1]成都市第一人民医院心功能科,四川成都610041 [2]成都市第一人民医院心血管内科,四川成都610041 [3]四川省人民医院心血管内科,四川成都610072

出　　处：《中国医学影像学杂志》2022年第10期1013-1019,共7页Chinese Journal of Medical Imaging

摘　　要：目的应用二维斑点追踪成像(2D-STI)评价冠状动脉慢血流(CSF)患者左心室收缩同步性,为临床诊断和治疗提供可靠的量化评价和疗效观察指标。资料与方法前瞻性选取2017年7月—2019年7月于成都市第一人民医院行冠状动脉造影确诊为CSF患者44例,另选取40例年龄、性别相匹配且冠状动脉造影结果正常者为对照组。行常规超声心动图,获取左心室壁厚度、整体收缩及舒张功能相关参数;应用2D-STI获得左心室18个节段的收缩期纵向应变达峰时间、径向应变达峰时间、周向应变达峰时间(PTcs)和峰值应变离散指数(PSD),计算左心室18个节段PTrs、PTcs的标准差(PTrs-SD、PTcs-SD)。采用受试者工作特征曲线评价不同步指数对CSF患者左心室收缩同步性的预测价值。结果CSF组舒张早期二尖瓣口前向血流速度(E)及E/A低于对照组(t=−3.27,P<0.01;t=−2.45,P=0.02)。CSF组左前降支、左回旋支及右冠状动脉的校正心肌梗死溶栓帧数(cTFC)及平均cTFC均高于对照组(t=7.05~10.35,P<0.01)。CSF组左心室心肌收缩不纵向应变达峰时间同步指数PSD、PTrs-SD、PTcs-SD大于对照组(t=8.32~8.71,P<0.01);与对照组比较,CSF组前壁基底段及前间隔基底段的纵向应变达峰时间,前壁基底段的PTcs,前壁基底段、前间隔基底段、前侧壁基底段及下侧壁中间段的PTrs均发生延迟(t=2.28~3.85,P均<0.05)。受试者工作特征曲线显示,PSD、PTrs-SD及PTcs-SD均能预测CSF的左心室收缩同步性(P<0.05),其中PTcs-SD的曲线下面积最大(0.932,95%CI 0.881~0.982),最佳截断值为48.07 ms,敏感度为84.1%,特异度为90%,约登指数为0.741。结论CSF患者左心室存在收缩不同步,2D-STI能有效观察其左心室收缩运动同步性,为临床评价CSF患者的心脏功能及疗效观察提供依据。Purpose To evaluate the left ventricle synchronicity in patients with coronary slow flow(CSF)using two-dimensional speckle tracking imaging(2D-STI).To provide more reliable and in-depth quantitative evaluation and efficacy indicators for clinical diagnosis and treatment.Materials and Methods Forty-four patients with CSF confirmed by coronary angiography were prospectively selected in Chengdu First People's Hospital from July 2017 to July 2019,while 40 age and gender-matched controls with normal coronary angiography results were also enrolled.Parameters related to left ventricular wall thickness,global systolic and diastolic function were measured by routine echocardiography.The time to peak longitudinal strain,the time to peak radial strain(PTrs),time to peak circumferential strain(PTcs)and peak strain dispersion(PSD)were derived including 18 myocardial segments by 2D-STI.The standard deviation of PTrs,PTcs(PTrs-SD,PTcs-SD)of 18 left ventricular segments were calculated.Receiver operating characteristic curve was used to evaluate the predictive value of left ventricular asynchronization index in CSF patients.Results Compared with control group,E and E/A were decreased in CSF group(t=−3.27,P<0.01;t=−2.45,P=0.02).Compared with the control group,corrected TIMI frame count(cTFC)of left anterior descending branch,1eft circumflex artery,right coronary artery and average cTFC in CSF group were significantly higher(t=7.05-10.35,P<0.01).Compared with the control group,left ventricular asynchronization index in CSF group increased,PTrs-SD,PTcs-SD and PSD with significant difference(t=8.32-8.71,P<0.01).Compared with the control group,In CSF group the time to peak longitudinal strain of basal anterior and basal anteroseptal walls,PTcs of basal anterior wall and PTrs of basal anterior,basal anteroseptal,basal anterolateral and md inferolateral walls delayed(t=2.28-3.85,P<0.05).PSD,PTrs-SD and PTcs-SD could predict left ventricle synchronicity(P<0.05).The area under the curve of PTcs-SD was the biggest(0.932,95%CI 0.881-0.

关 键 词：冠状动脉慢血流 斑点追踪成像 超声心动描记术 心室功能 左 心肌收缩 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.3[医药卫生—诊断学]