超声斑点追踪二维应变对冠心病患者左心室同步性的研究

Evaluation of intraventricular dyssynchrony in patients with coronary artery disease by two dimensional strain imaging

目的探讨超声斑点追踪二维应变检测冠心病左室心肌同步性的临床价值。方法采用二维应变对33例冠心病患者及30例正常人的冠状动脉（冠脉）供血区域进行检测，测量自QRS波起始至收缩期纵向应变达峰时间间期（Ts）及左室18节段的Ts标准差（Ts—SD）。结果狭窄〈75％冠脉供血节段共168个，狭窄≥75％冠脉供血节段共210个。①狭窄≥75％冠脉供血节段与正常对照组比较，绝大部分节段Ts明显延迟，Ts—SD明显升高；②狭窄≥75％冠脉供血节段与狭窄〈75％冠脉供血节段相比，大部分节段Ts明显延迟，Ts—SD明显升高；③狭窄〈75％冠脉供血节段与正常对照组比较，绝大部分节段Ts及Ts—SD差异无统计学意义；④以Ts-SD≥33．0ms为左室收缩不同步，26例冠脉狭窄≥75％冠心病患者中22例（84．6％）收缩不同步，7例冠脉狭窄〈75％冠心病患者中无收缩不同步。结论当冠脉出现严重狭窄，在二维超声心动图上未能观察到室壁运动异常时，二维应变已能准确检测出其心肌运动不同步现象。

Objective To evaluate the dyssynchrony of left ventricle in patients with coronary artery disease（CAD） by two dimensional strain echocardiography （2-DS）. Methods The myocardium of left ventricle of 33 patients with CAD and 30 nomal controls were detected by 2-DS. The time from onset QRS complexes to peak systolic longitudinal strain（Ts） and the standard deviation of Ts of 18 left ventricular segments （Ts-SD）were measured. Results There were 168 segments whose flow was provided by coronary artery with stenosis 〈75%,210 segments whose flow was provided by coronary artery with stenosis 75 %. ①Ts was delayed significantly and Ts-SD was obviously higher in patients with stenosis≥75 % when compared with the control group. ②Ts was delayed and Ts-SD was higher in patients with stenosis≥75% compared with those whose stenosis was 〈75%. ③There were no statistical differences in Ts and Ts-SD between the patients with stenosis 〈 75% and the control group. ④When left ventricular systolic dyssynchrony was defined as Ts-SD≥33.0 ms, there were 22 patients with systolic dyssynchrony of all 26 patients whose coronary artery stenosis ≥75 %, there were no patient with systolic dyssynchrony of all 7 patients whose stenosis 〈 75%. Conclusions Although there are no evident regional wall motion abnormalities by routine echocardiography,in patients with severe coronary artery stenosis,2-DS can detect exactly the dyssynchrony of left ventricle.