心肌做功联合负荷超声心动图评估左前降支不同程度狭窄患者左心室功能  

Evaluation of left ventricular function in patients with different degrees of stenosis in the left anterior descending branch by myocardial work combined with stress echocardiography

作　　者：余丹 梁翠兴 于天乐 李佳城 吴雨萌 薛莉[1,2] Yu Dan;Liang Cuiring;Yu Tianle;Li Jiacheng;Wu Yumeng;Xue Li(Department of Cardiovascular Ultrasound,the Fourth Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Heilongjiang Research Center of Molecular Medicine Engineering Technology,Harbin150001,China)

机构地区：[1]哈尔滨医科大学附属第四医院心血管超声科,哈尔滨150001 [2]黑龙江省分子医学工程技术研究中心,哈尔滨150001

出　　处：《中华超声影像学杂志》2025年第2期129-138,共10页Chinese Journal of Ultrasonography

基　　金：黑龙江省卫生健康委科研课题(20230909020093);哈尔滨医科大学附属第四医院特别资助科研项目(HYDSYTB202226);黑龙江省自然科学基金项目(PL2024H156)。

摘　　要：目的应用负荷后区域心肌做功(MW)和冠状动脉血流储备(CFR)评估冠状动脉左前降支(LAD)不同程度狭窄患者左心室功能和心肌缺血程度,及各参数对LAD不同狭窄程度的诊断效能。方法回顾性收集2023年1月至2024年6月就诊于哈尔滨医科大学附属第四医院疑似冠心病并行冠状动脉造影检查的患者76例,根据LAD狭窄程度分为轻度狭窄组(狭窄率<50%)30例、中度狭窄组(50%≤狭窄率<70%)25例、重度狭窄组(70%≤狭窄率≤90%)21例。应用经胸多普勒冠状动脉血流显像技术获取CFRLAD,于静息和负荷状态下应用斑点追踪技术获取LAD区域纵向应变(LSLAD)、应变达峰时间离散度(PSD),应用心肌做功技术获取LAD区域做功指数(WILAD)和LAD区域做功效率(WELAD)。比较各组间LSLAD和LAD区域MW参数,分析CFRLAD与LAD狭窄程度的相关性。绘制ROC曲线,比较LAD区域MW参数和CFRLAD对LAD中、重度狭窄的诊断效能。结果①静息状态下:与轻度狭窄组相比,重度狭窄组LSLAD绝对值、WILAD、WELAD减低,差异有统计学意义(均P<0.05);与中度狭窄组相比,重度狭窄组WELAD减低,差异有统计学意义(P<0.05);余参数静息状态下组间两两比较差异无统计学意义(均P>0.05)。负荷状态下:与轻度狭窄组相比,中、重度狭窄组LSLAD绝对值、WILAD、WELAD减低,重度狭窄组PSD增大,差异有统计学意义(均P<0.05);与中度狭窄组相比,重度狭窄组LSLAD绝对值、WILAD、WELAD减低,差异有统计学意义(均P<0.05);余参数负荷状态下组间两两比较差异无统计学意义(均P>0.05)。②CFRLAD与LAD狭窄程度呈负相关(r=-0.809,P<0.05)。③ROC曲线显示,区域MW参数中负荷状态WELAD预测LAD中、重度狭窄曲线下面积(AUC)最大,分别为0.803、0.897,截断值为92.5%、91.5%。以CFRLAD≤2.5、CFRLAD≤2.0为截断值分别预测LAD中度、重度狭窄的AUC最大,分别为0.743、0.901。负荷状态WELAD联合CFRLAD预测LAD中、重度狭窄的AUC最大,分Objective:To evaluate left ventricular function and myocardial ischemia in patients with different degrees of left anterior descending(LAD)coronary artery stenosis by using post-stress regional myocardial work(MW)and coronary flow reserve(CFR),and to analyze the diagnostic efficacy of each parameter for different degrees of stenosis in the LAD.Methods:A retrospective analysis was conducted on 76 patients with suspected coronary artery disease who underwent coronary angiography and attended the Fourth Affliiated Hospital of Harbin Medical University from January 2023 to June 2024.According to the degree of LAD stenosis,30 cases were categorized into the mild stenosis group(stenosis<50%),25 cases in the moderate stenosis group(50%≤stenosis<70%),and 21 cases in the severe stenosis group(70%≤stenosis≤90%).Transthoracic Doppler echocardiography was applied to obtain CFR LAD.Longitudinal strain in the left anterior descending region(LS LAD),peak strain dispersion(PSD),left anterior descending region work index(WI LAD)and left anterior descending region work efficiency(WE LAD)were obtained at rest and under stress,respectively.The LAD regional MW indexes were compared between the groups in two pairs.The correlation between CFR LAD and the degree of LAD stenosis was analyzed.ROC curves were plotted to compare the diagnostic efficacy of LAD regional MW parameters and CFR LAD for moderate and severe LAD stenosis.Results:①At rest:compared with the mild stenosis group,the absolute value of LS LAD,WI LAD,and WE LAD were reduced in the severe stenosis group,and the differences were statistically significant(all P<0.05).Compared with the moderate stenosis group,WE LAD was reduced in the severe stenosis group,and the difference was statistically significant(P<0.05).Differences in two-by-two comparisons between groups in the resting state for the remaining parameters were not statistically significant(all P>0.05).Under stress:compared with the mild stenosis group,the absolute values of LS LAD,WI LAD,and WE LAD were reduce

关 键 词：超声心动描记术 负荷 心肌做功 冠状动脉狭窄 冠状动脉血流储备 

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