2D-STI联合RT-3DE对无心肌梗死的冠心病三支血管病变患者右心房功能的评价  

Evaluation of right atrial function by 2D-STI combined with RE-3DE in patients with triple vessel coronary artery disease without myocardial infarction

作　　者：张思然 李希娅 王一凡 马乐[1] 礼广森[1] ZHANG Siran;LI Xiya;WANG Yifan;MA Le;LI Guangsen(Department of Ultrasound,the Second Affiliated 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,辽宁省大连市116027

出　　处：《中国动脉硬化杂志》2025年第2期144-150,共7页Chinese Journal of Arteriosclerosis

摘　　要：[目的]探讨二维斑点追踪技术(2D-STI)联合实时三维超声心动图(RT-3DE)在评价无心肌梗死的冠心病三支血管病变(TVCAD)患者右心房功能中的价值。[方法]选取无心肌梗死的TVCAD患者56例,根据冠状动脉造影结果分两组:狭窄率50%~75%组28例、狭窄率≥75%组28例。另外,筛选健康志愿者30例作为对照组。运用RT-3DE检查获得右心房容积参数(RAV_(max)、RAV_(min)、RAVp),并计算右心房被动射血分数(RAPEF)、右心房主动射血分数(RAAEF)及右心房最大容积指数(RAVI_(max))。运用2D-STI测量收缩期、舒张早期、舒张晚期右心房应变率(RASRs、RASRe、RASRa)。采用Pearson相关分析2D-STI参数与氨基末端脑钠肽前体(NT-proBNP)及Gensini评分之间的相关性,采用ROC曲线分析2D-STI、RT-3DE以及二者联合使用对无心肌梗死的TVCAD患者右心房功能的诊断价值。[结果]与对照组相比,狭窄率50%~75%组RAPEF、RASRe减低,RAAEF、RASRa升高(均P<0.05);与对照组、狭窄率50%~75%组相比,狭窄率≥75%组RAPEF、RASRs、RASRe及RASRa减低,RAV_(max)、RAV_(min)、RAVp、RAVI_(max)、RAAEF升高(均P<0.05)。狭窄率50%~75%组、狭窄率≥75%组2D-STI参数与NT-proBNP及Gensini评分之间存在显著相关。2D-STI、RT-3DE及二者联合应用对无心肌梗死的TVCAD患者右心房功能的曲线下面积分别为0.9048、0.8917、0.9564,两种方法联合使用的诊断效能明显高于单独使用,且2D-STI优于RT-3DE。[结论]评价无心肌梗死的TVCAD患者右心房功能时,2D-STI联合RT-3DE的诊断效能高于单独使用,并且2D-STI优于RT-3DE。Aim To evaluate the right atrial function by two-dimensional speckle tracking imaging(2D-STI)combined with real-time three-dimensional echocardiography(RT-3DE)in patients with triple vessel coronary artery disease(TVCAD)without myocardial infarction.Methods Fifty-six patients with TVCAD without myocardial infarction were selected and divided into two groups according to the results of coronary angiography:28 cases with a stenosis rate of 50%~75%and 28 cases with a stenosis rate of≥75%.In addition,30 healthy volunteers were screened as control group.RT-3DE was performed to obtain the parameters of right atrial volume(RAV _(max),RAV min and RAVp)and then calculated right atrial passive ejection fraction(RAPEF)and right atrial active ejection fraction(RAAEF),and the _(max)imum of right atrial volume index(RAVI _(max)).2D-STI was applied to measure right atrium strain rates during systole,early diastole and late diastole(RASRs,RASRe and RASRa).Correlation between 2D-STI parameters and N-terminal pro-brain natriuretic peptide(NT-proBNP),Gensini scores were analyzed by Pearson analysis.ROC curve analysis was used to evaluate the diagnostic value of 2D-STI,RT-3DE,and their combined use for right atrial function in TVCAD patients without myocardial infarction.Results Compared with control group,RAPEF and RASRe reduced in stenosis rate of 50%~75%group,while RAAEF and RASRa increased(all P<0.05).Compared with control group and stenosis rate of 50%~75%group,RAPEF,RASRs,RASRe and RASRa decreased,while RAV _(max),RAV min,RAVp,RAVI _(max) and RAAEF increased in stenosis rate of≥75%group(all P<0.05).There was a significant correlation between 2D-STI parameters and NT-proBNP and Gensini scores.The area under the curve of right atrial function in TVCAD patients without myocardial infarction was 0.9048,0.8917 and 0.9564 for 2D-STI,RT-3DE and their combined use,respectively.The diagnostic efficacy of the two methods was significantly higher when used in combination than when used alone,and 2D-STI was superior to RT-3DE.Conclusi

关 键 词：冠心病三支血管病变 二维斑点追踪技术 实时三维超声心动图 右心房功能 

分 类 号：R5[医药卫生—内科学] R445[医药卫生—临床医学]