微机辅助多相位左室壁运动定量测定及其对冠心病的诊断价值

Quantitative Cineangiographic Evaluation of Ventricular Wall Motion with Integrated Multi-phased Analysis:Values for Diagnosing Coronary Heart Disease

本研究在 LM-2000心脏医学图象处理系统的辅助下,应用多帧多相位定量测定法分析了17例正常人和24例冠心病患者节段性左室壁运动功能。结果表明,在正常左心室或冠心病组非缺血节段,相关系数 r 值和回归斜率 b 值高且其标准差小,在冠心病组的缺血节段,r 值和 b 值降低且其标准差增大(Pr<0.01,Pb<0.01)。分析180根辐射轴上室壁运动障碍的发生时相发现80%的辐射轴在收缩早期呈现室壁运动障碍,至收缩晚期仅见34%的辐射轴仍呈现室壁运动障碍。比较左心室整体功能参数(EF,1/3EF)及节段性室壁运动障碍指数(RI)与冠状动脉病变程度指数(CAI),发现 RI 与 CAI 关系最为密切。用 r 值和 b 值分析左心室节段性壁运动障碍具有高的敏感性及特异性。作者认为多帧多相位节段性左心室壁运动定量测定法能确切地反映缺血心肌运动异常的时空不一致性;r 值和 b 值是评价左心室壁运动障碍的敏感指标,其特异性也高。本法能用于定量诊断冠心病。

Regional left ventricular wall motion of 17 normal subjects and 24 patients with coronary artery disease was assessed with quantitative integrated multi-phased analyzing method by the aid of LM- 2000 Cardiac Medical Image Processing System(LM-2000 MIPS).All of the patients underwent selec- tive coronary arterography and left ventriculography.The serial contours of right anterior oblique left ventriculograms were extracted frame-by-frame automatically or semi-automatically using digital im- age processing techniques,and the floating reference coordinate system with 45 radii was developed for regional wall motion analysis.High radial r values and b values with small standard deviations were observed in normal left ventricles or nonischeamic left ventricular segment in the patients with CHD, conversely,reduced radial r values and b values with large standard deviations were found in ischeamic left ventricular segments in the same patients with CHD(Pr<0.01,Pb<0.01).Using the proposed method to detect regional left ventricular wall motion abnormalities,the sensitivity and specificity were 89%and 900%,respectively. in order to demonstrate the temporal and spatial variability of wall motion abnormalities,the ini- tial and persisted phases of the wall motion abnormality occurrence along 180 radii were analysed sta- tistically,80% of wall motion abnormalities occurred between early systole and mid-systole,and only 34% of wall motion abnormalities persisted till end-systole. Meanwhile,by comparision of the global left ventricular functional parameters(EF,1/3EF)and regional left ventricular wall motion abnormality index(RI)with coronary artery stenotic index (CAI),the correlation coefficients were-0.27,0.048,and 0.71,respectively. The results indicate that:Ⅰ integrated multi-phased analysing method for evaluation of regional left ventricular wall motion has high sensitivity and specificity;Ⅱ.this porposed method may provid a new mean for quantitative diagnosis of coronary artery disease.and Ⅲ.the temporal and spatial vari- ability of abnormal wall motion is significant and the method has ability to detect this variability.