左房时相功能诊断冠状动脉粥样硬化性心脏病患者左室舒张功能障碍的价值  

Value of left atrial phase function in the diagnosis of left ventricular diastolic dysfunction in patients with coronary atherosclerotic heart disease

作　　者：付亚梦 刘昕[2] FU Yameng;LIU Xin(Graduate School,Chengde Medical College,Hebei 067000,China;不详)

机构地区：[1]承德医学院研究生学院,河北省承德市067000 [2]保定市第一中心医院超声科

出　　处：《临床超声医学杂志》2023年第1期39-43,共5页Journal of Clinical Ultrasound in Medicine

基　　金：保定市科技计划项目(2241ZF041)。

摘　　要：目的应用二维斑点追踪(2D-STI)技术评价冠状动脉粥样硬化性心脏病(CHD)患者左房时相功能,探讨其对左室舒张功能障碍(LVDD)的诊断价值。方法将89例左室射血分数(LVEF)≥50%的CHD患者分为左室舒张功能正常者38例(正常组)和LVDD者51例(LVDD组),应用实时三维超声心动图测量心脏结构及功能参数,2D-STI测量左房储存应变(LASr)、左房通道应变(LAScd)、左房收缩应变及左房容积指数,比较两组上述参数的差异。采用二元Logistic回归分析筛选发生LVDD的独立影响因素;绘制受试者工作特征(ROC)曲线评估各参数诊断LVDD的效能。结果正常组与LVDD组室间隔侧和左室侧壁二尖瓣环舒张早期运动速度、左房容积指数、二尖瓣舒张早期峰值流速与二尖瓣环早期运动速度比值、LASr、LAScd比较,差异均有统计学意义(均P<0.05)。二元Logistic回归分析显示,LASr、LAScd为CHD患者发生LVDD的独立影响因素(OR=0.668、0.670,均P<0.001)。ROC曲线分析显示,LASr诊断LVDD的曲线下面积为0.928(95%可信区间0.874~0.982),灵敏度为86.8%,特异度为90.2%,截断值为32.25%;LAScd诊断LVDD的曲线下面积为0.914(95%可信区间0.855~0.973),灵敏度为86.8%,特异度为84.3%,截断值为15.50%,二者曲线下面积比较差异无统计学意义。结论应用2D-STI检测左房时相功能变化对诊断CHD患者发生LVDD有一定的临床价值。Objective To evaluate the left atrial phase function in patients with coronary atherosclerotic heart disease(CHD)by two-dimensional speckle tracking(2D-STI)technique,and to explore its diagnostic value for left ventricular diastolic dysfunction(LVDD).Methods A total of 89 CHD patients with left ventricular ejection fraction(LVEF)≥50%were divided into normal left ventricular diastolic function group(n=38)and LVDD group(n=51).Real-time three-dimensional echocardiography was used to measure cardiac structural and functional parameters,and 2D-STI was used to measure left atrial storage strain(LASr),left atrial channel strain(LAScd),left atrial systolic strain and left atrial volume index,the differences of the above parameters between the two groups were compared.Binary Logistic regression was used to screen the independent influencing factors of LVDD.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of each parameter in the diagnosis of LVDD.Results The differences in early diastolic mitral annular motion velocity,left atrial volume index,ratio of peak early diastolic mitral flow velocity to mean mitral annular motion velocity,LASr,and LAScd between the normal group and the LVDD group were statistically significant(all P<0.05).Binary Logistic regression analysis showed that LASr and LAScd were independent influencing factors for LVDD in CHD patients(OR=0.668,0.670,both P<0.001).ROC curve analysis showed that the area under the curve of LASr in the diagnosis of LVDD was 0.928(95%confidence interval 0.874~0.982),the sensitivity was 86.8%,the specificity was 90.2%,and the cut-off value was 32.25%.The area under the curve of LAScd in the diagnosis of LVDD was 0.914(95%confidence interval 0.855~0.973),the sensitivity was 86.8%,the specificity was 84.3%,and the cut-off value was 15.50%.There was no significant difference in the area under the curve between LASr and LAScd.Conclusion The application of 2D-STI to detect changes in left atrial phase function has a certain clinical val

关 键 词：超声心动描记术 斑点追踪 二维 冠状动脉粥样硬化性心脏病 心房功能 心室功能 左 

分 类 号：R540.45[医药卫生—心血管疾病] R541.4[医药卫生—内科学]