二维斑点追踪成像技术评估无心肌梗死冠心病三支血管病变患者的右心室功能的临床应用价值  

The evaluation of right ventricular function in patients with triple vessels coronary artery disease without myocardial infarction in two-dimensional speckle tracking echocardiography

作　　者：王一凡 李祯 张思然 马乐礼 广森 WANG Yi-fan;LI Zhen;ZHANG Si-ran;MA Le;LI Guang-sen(Department of Ultrasound,the Second Hospital of Dalian Medical University,Dalian Liaoning 116027,China)

机构地区：[1]大连医科大学附属第二医院超声科,辽宁大连116027

出　　处：《中国临床医学影像杂志》2024年第7期480-483,489,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:利用二维斑点追踪成像技术(2D-STE)评价有冠心病三支血管病变但不合并心肌梗死的病人右心室功能初期变化。方法:随机采集30例行健康检查的体检者设为对照组(A组)。另选取本院已行冠状动脉造影且结果显示为冠状动脉三支血管发生病变的患者60例,根据其三支血管的狭窄程度分为两组,32例狭窄率为50%~<75%划入B组。28例狭窄率≥75%划入C组。收集患者一般资料;常规超声得到三尖瓣环平面收缩位移(TAPSE)、收缩期峰值速度(s’)、舒张早期和舒张晚期峰值速度(e’,a’)、右心室收缩末期、舒张末期容积(RVESV、RVEDV)计算得到右室射血分数(RVEF);利用2D-STE获得右室收缩期整体应变(GS)、收缩期、舒张早晚期应变率(SRs、SRe、SRa)。利用Pearson线性相关,分析受检者GS和N末端B型脑钠肽前体(NT-pro BNP)及之间的相关性。结果:与A组相比,B组e’、e’/a’减小(P<0.05),而s’、E/A、FAC、TAPSE、LVEF及RVEF无明显统计学差异(均P>0.05);与A、B两组相比,C组RVEF、LVEF、E/A、e’、e’/a’、s’、FAC及TAPSE均减低(均P<0.05)。2D-STE参数:与A组相比,B、C两组GS、SRe、SRa、S、SRs均减低,且C组各参数较B组降低更明显(均P<0.05);相关性分析显示B、C组GS与血清NT-pro BNP有较强的负相关关联性(r=-0.91,r=-0.64,P<0.05)。结论:2D-STE是评估无心肌梗死型冠心病三支血管病变患者的右心室早期功能改变的可行方法。Objective:To evaluate right ventricular function in patients with triple vessels disease without myocardial infarction by using the two-dimensional speckle tracking technique(2D-STE).Methods:Thirty cases were randomly selected from health check-ups into group A.According to the results of coronary arteriography,60 individuals of coronary artery disease without myocardial infarction were chosen and split into two groups.32 patients with stenosis of 50%~<75%were classified into group B.28 patients with stenosis of≥75%were classified into group C.General clinical data were collected;TAPSE,end-systolic and end-diastolic area(RVESA,RVEDA),peak systolic velocity(s'),peak early and late diastolic velocities(e',a')of the tricuspid annulus were measured by conventional 2D echocardiography.2D-STE was used to measure the global peak systolic strain(GS),peak early and late diastolic strain rate(SRe,SRa),as well as peak systolic strain rate(SRs).Correlation between GS and NT-pro BNP in subjects was assessed using Pearson linear correlation.Results:Compared with group A,e',e'/a'were reduced in group B(P<0.05),while s',E/A,RVEF,LVEF,FAC and TAPSE had no significantly difference(all P>0.05).RVEF,LVEF,E/A,e'/a',s',FAC and TAPSE were reduced(all P<0.05).2D-STE parameters:GS,SRe,SRa,SRs were reduced in groups B and C compared with group A(all P<0.05);correlation analysis showed that the correlation between GS and serum NT-pro BNP in group B and group C showed a negative correlation(r=-0.91,r=-0.64,P<0.05).Conclusion:2D-STE can effectively recognize the early functional changes in the right ventricle in patients with triple vessels disease in coronary artery disease without myocardial infarction.

关 键 词：冠心病 心室功能 右 超声心动描记术 

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