三维斑点追踪在评估缺血性二尖瓣反流患者左心房功能中的应用  

Clinical application of three-dimensional speckle tracking imaging in assessing left atrial function in patients with ischemic tricuspid regurgitation

作　　者：程晓萍 万野 张清连[1] 祝春梅 邱敏 Cheng Xiaoping;Wan Ye;Zhang Qinglian;Zhu Chunmei;Qiu Min(Department of Ultrasound Medicine,First People’s Hospital of Neijiang City,Neijiang 641100,China;不详)

机构地区：[1]内江市第一人民医院超声医学科,内江641100

出　　处：《中国循证心血管医学杂志》2024年第8期965-968,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：四川省医学科研课题(2019TG12)。

摘　　要：目的 探讨三维斑点追踪(3D-STI)技术评估缺血性二尖瓣反流(IMR)患者左心房功能变化中的价值。方法 选择2021年2月至2023年6月于内江市第一人民医院行3D-STI检查的冠状动脉粥样硬化性心脏病(冠心病)患者143例,根据超声检查是否合并IMR分为冠心病组(55例)和IMR组(88例),另选择62例健康体检者为对照组。比较各组3D-STI参数差异,分析3D-STI参数与左心房射血功能相关性以及诊断IMR的价值。结果 IMR组左心房前后径、左房左右径及左房上下径、左心室舒张末期内径及收缩末期内径、最大左心房容积,波谷点为最小左心房容积,收缩前左心房容积大于冠心病组和对照组(P<0.05),左室射血分数(LVEF)、左心房总射血分数(LATEF)、左心房被动排空分数(LAVpEF)、左心房主动射血分数(LAaEF)、左心房整体纵向应变(GLS)、圆周应变(GCS)及径向应变(GRS)低于冠心病组和对照组(P<0.05)。IMR组患者GLS、GCS、GRS与LATEF、LAVpEF、LAaEF均呈正相关(P<0.05)。GLS诊断IMR的曲线下面积(AUC)为0.715(95%CI:0.633~0.787,P<0.001);GCS诊断IMR的AUC为0.644(95%CI:0.559~0.722,P<0.001);GRS诊断IMR的AUC为0.643(95%CI:0.558~0.721,P<0.001);三者联合诊断IMR的AUC为0.882(95%CI:0.818~0.930,P<0.001);三者联合诊断IMR的AUC高于GLS、GCS、GRS单独诊断(P<0.001)。结论 3D-STI可准确评估冠心病IMR患者左房功能变化,GLS、GCS、GRS可作为鉴别IMR的指标。Objective To discuss the value of three-dimensional speckle tracking imaging(3D-STI)in assessing changes of left atrial function in patients with ischemic tricuspid regurgitation(IMR).Methods The patients with coronary heart disease(CHD)undergone 3D-STI examination(n=143)were chosen from the First People’s Hospital of Neijiang City from Feb.2021 to June 2023.The patients were divided,according to ultrasound examination results,into CHD group(n=55)and IMR group(n=88).Meanwhile the volunteers with physical examination(n=62)were selected into control group.The difference in 3D-STI parameter were compared among 3 groups,and correlation between 3D-STI and left atrial ejection function(LAEF)and value of 3D-STI parameter in IMR diagnosis were analyzed.Results In IMR group,left atrial anteroposterior diameter(LAAPD),left atrial mediolateral diameter(LAMLD),left atrial suproinferior diameter(LASID),left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),maximum left atrial volume(LAVmax),minimum left atrial volume(LAVmin)at trough point and pre-systolic left atrial volume were higher than those in CHD group and control group(P<0.05),and left ventricular ejection fraction(LVEF),left atrial total ejection fraction(LATEF),left atrial passive ejection fraction(LAVpEF),left atrial active ejection fraction(LAaEF),and global longitudinal strain(GLS),global circumferential strain(GCS)and global radial strain(GRS)of left atrium were lower(P<0.05)than those in CHD group and control group.GLS,GCS and GRS were positively correlated to LATEF,LAVpEF and LAaEF in IMR group(P<0.05).In IMR diagnosis,AUC of GLS was 0.715(95%CI:0.633-0.787,P<0.001),AUC of GCS was 0.644(95%CI:0.559-0.722,P<0.001),AUC of GRS was 0.643(95%CI:0.558-0.721,P<0.001),and AUC of combination of GLS,GCS and GRS was 0.882(95%CI:0.818-0.930,P<0.001).AUC of combination of GLS,GCS and GRS was higher than that of single GLS,GCS and GRS in IMR diagnosis(P<0.001).Conclusion 3D-STI can accurately assess the changes of left atrial functio

关 键 词：冠心病 三维斑点追踪技术 缺血性二尖瓣反流 左房射血分数 心肌应变 

分 类 号：R541.4[医药卫生—心血管疾病]