多普勒组织成像技术在冠心病的冷加压负荷超声心动图中的应用研究

Study of Doppler Tissue Imaging on Coronary Heart Disease during Cold Pressor Test

本文对１３例经冠脉造影确诊的冠心病患者和１５例正常人运用多普勒组织成像技术（ＤＴＩ）和传统的二维超声心动图（２ＤＥ）观察冷加压试验（ＣＰＴ）前后的室壁运动情况。结果显示冠心病患者的室壁活动速度低于正常人，冷加压试验后正常人室壁活动速度明显高于静息时，冠心病患者则相反，尤以冠脉多支病变及冠脉中重度狭窄者为著。ＣＰＴ时与静息时Ｓ及ＤＥ的差值ΔＳ及ΔＤＥ是更有意义的指标。在正常组ΔＳ＞２．０ｃｍ／ｓ，ΔＤＥ＞３．０ｃｍ／ｓ，在冠脉轻度狭窄组ΔＳ＜１．５ｃｍ／ｓ，ΔＤＥ＜１．６ｃｍ／ｓ，在冠脉单支病变组中ΔＳ及ΔＤＥ＜１．０ｃｍ／ｓ，双支病变组中则＜０．８ｃｍ／ｓ，而在冠脉中、重度狭窄组及多支病变组中两者均呈负值。ＤＴＩ对冠心病的诊断优于２ＤＥ（敏感性ＤＴＩ为８５．５％，２ＤＥ为５３．１％；特异性ＤＴＩ为９４．１％，２ＤＥ为９９％；准确性ＤＴＩ为９０．９％，２ＤＥ为８０．４％），是一种新的较敏感的检测冠心病的方法。ＣＰＴ安全简便，对诊断冠心病具有一定的临床价值。

Doppler tissue imaging (DTI) and two dimensional echocardiography (2DE) were performed in 13 patients with known coronary heart disease and 15 normal subjects during Cold Pressor Test (CPT),to assesse the ventricular wall motion (VWM).The results showed the velocity of VWM in patients was lower than that in normal subjects,While in normal subjects the velocity of VWM during CPT was higher than that at rest,but the phenomenon be inverse in patients,especially the moderate and severe coronary stenosis and multivessel lesion.The difference of S and D E between CPT and rest (ΔS、ΔD E) are more valuable indices to detect coronary disease.In normal patients ΔS>2.0cm/s,ΔD E>3.0cm/s.In slight coronary stenosis ΔS<1.5cm/s,ΔD E<1.6cm/s.In single and two vessel lesion they are lower than 1.0cm/s and 0.8cm/s respectively.While in moderate and severe coronary stenosis and multivessel lesion ΔS and ΔD E are negative numbers.The sensitivity and specificity and accuracy by DTI CPT was 854%、941%、909%,while 531%、99%、804% by 2DE CPT respectively.The study demonstrates that DTI could provide a more sensitive method to detect coronary heart disease,and CPT is also a useful method to detect coronary heart disease.