不同超声评估方法在左前降支狭窄中的临床价值  

Clinical value of different ultrasound methods in assessing the left anterior descending artery stenosis

作　　者：李星 冯华平 蓝胜峰 李志勇 Li Xing;Feng Huaping;Lan Shengfeng;Li Zhiyong(Department of Electrocardiogram,the Second People's Hospital of Jingdezhen,Jingdezhen 333000,China;Department of Ultrasound,the Second People's Hospital of Jingdezhen,Jingdezhen 333000,China;Department of Cardiovascular Medicine,the Second People's Hospital of Jingdezhen,Jingdezhen 333000,China)

机构地区：[1]景德镇市第二人民医院心电功能科,江西景德镇333000 [2]景德镇市第二人民医院超声科,江西景德镇333000 [3]景德镇市第二人民医院心血管内科,江西景德镇333000

出　　处：《临床荟萃》2024年第8期693-699,共7页Clinical Focus

基　　金：景德镇市科技计划项目心电图联合冠状动脉血流成像在高危人群前降支狭窄筛查中的临床价值(20231SFZC047)。

摘　　要：目的探讨不同超声评估方法在左前降支(left anterior descending,LAD)狭窄中的临床价值。方法回顾性分析我院2023年04月至2024年04月经冠状动脉造影(coronary angiography,CAG)确诊,且行室壁运动分析、速度向量成像(velocity vector imaging,VVI)、冠状动脉血流成像(coronary flow imaging,CFI)3种不同超声评估方法的240例患者的超声资料。按照LAD狭窄程度分为试验组(狭窄≥50%)120例、对照组(狭窄<50%)120例,总结两组室壁运动分析、VVI、CFI超声特征,并以CAG为金标准,分析3种不同超声评估方法的诊断效能。结果室壁运动分析显示试验组室壁运动异常比例高于对照组;VVI显示试验组前间隔和前壁收缩期纵向应变低于对照组;CFI显示试验组LAD的舒张期峰值速度快于对照组,差异均有统计学意义(P<0.05)。以CAG结果为金标准,室壁运动分析诊断LAD狭窄≥50%敏感度为0.467、特异度为0.717、准确度为0.591、阳性预测值为0.622、阴性预测值为0.573;VVI诊断LAD狭窄≥50%敏感度为0.800、特异度为0.817、准确度为0.808、阳性预测值为0.813、阴性预测值为0.803;CFI诊断LAD狭窄≥50%敏感度为0.850、特异度为0.783、准确度为0.817、阳性预测值为0.796、阴性预测值为0.839。一致性检验结果显示,室壁运动分析与CAG一致性一般,Kappa值为0.183,VVI、CFI与CAG一致性较高,Kappa值分别为0.617、0.633。受试者工作特征曲线分析显示室壁运动分析、VVI、CFI的曲线下面积分别为0.592、0.808、0.817。结论前间隔及前壁运动异常、前间隔及前壁收缩期纵向应变减低、LAD的舒张期峰值速度加速是LAD狭窄时室壁运动分析、VVI、CFI的超声特征,均可作为诊断依据,但前者的诊断效能明显低于后两者,VVI和CFI诊断LAD狭窄具有较高的诊断效能,且与CAG一致性较好,值得临床应用与推广。Objective To explore the clinical value of different ultrasound methods in assessing the left anterior descending artery(LAD)stenosis.Methods A retrospective analysis was conducted on the ultrasound data of 240 patients diagnosed as the LAD stenosis by coronary angiography(CAG)in our hospital from April 2023 to April 2024,who underwent three different ultrasound evaluation methods,including ventricular wall motion analysis,velocity vector imaging(VVI),and coronary artery flow imaging(CFI).According to the degree of LAD stenosis,patients were divided into the experimental group(stenosis≥50%,n=120)and control group(stenosis<50%,n=120).The wall motion analysis,VVI,and CFI ultrasound characteristics of patients in the two groups were summarized,and the diagnostic efficacy of three different ultrasound methods was analyzed using CAG as the gold standard.Results Wall motion analysis showed that the proportion of regional wall motion abnormalities in the experimental group was significantly higher than that of the control group(P<0.05).VVI showed that the longitudinal peak strain of the anterior interval and anterior wall contraction period in the experimental group was significantly lower than that of the control group(P<0.05).CFI showed that the diastolic peak velocity of LAD in the experimental group was significantly faster than that of the control group(P<0.05).Using the CAG results as the gold standard,the sensitivity of wall motion analysis for diagnosing LAD stenosis≥50%was 0.467,with the specificity of 0.717,accuracy of 0.591,positive predictive value(PPV)of 0.622,and negative predictive value(NPV)of 0.573.VVI in diagnosing LAD stenosis≥50%had a sensitivity of 0.800,specificity of 0.817,accuracy of 0.808,PPV of 0.813,and NPV of 0.803.CFI in diagnosing LAD stenosis≥50%had a sensitivity of 0.850,specificity of 0.783,accuracy of 0.817,PPV of 0.796,and NPV of 0.839.The consistency test results showed that the consistency between wall motion analysis and CAG was average,with a Kappa value of 0.183.VVI,CFI,an

关 键 词：冠状动脉狭窄 室壁运动分析 速度向量成像 冠状动脉血流成像 

分 类 号：R543.3[医药卫生—心血管疾病]