侧支循环对局部缺血心肌节段功能的影响

The effects of the coronary collateral circulation on ischemic myocardial regional function

目的应用超声斑点追踪二维应变显像技术探讨支循环供血对相应缺血心肌节段功能的影响。方法121例行冠状动脉（冠脉）造影检查者分为3组：1组，冠状动脉正常者30例；2组，冠状动脉狭窄≥75％且伴有侧支循环者45例；3组，冠状动脉狭窄≥75％且不伴有侧支循环者46例。经胸采集左室心尖四腔观、两腔观和长轴观及二尖瓣、乳头肌、心尖短轴观的二维图像。分析各组相应血管供血心肌节段在纵向（L）、径向（R）、周向（C）上的收缩期峰值应变（Sps）、收缩末期应变（Ses）、收缩期峰值应变率（SRs）、舒张早期应变率（SRe）、舒张晚期应变率（SRa）和扭转（Rot）的角度及扭转率。结果与1组相比，2组纵向的Sps、Ses、SRs、SRa，径向的SRe、SRa，周向的SRe，舒张早期扭转率、舒张晚期扭转率，3组纵向的Sps、Ses、SRs、SRa、SRe，径向的Ses、SRs、SRe、Sra，周向的Sps、Ses、SRs、SRe、SRs，收缩期扭转的峰角度、收缩期峰值扭转率、舒张早期扭转率的绝对值均减少（P〈0．05）；与2组相比，3组纵向的Sps、Ses、SRs，径向的Ses、SRs，周向的Sps、Ses、SRs、Sra，收缩期扭转的峰角度、收缩期峰值扭转率、舒张早期扭转率的绝对值均减少（P〈0．05）。结论侧支循环供血可以改善相应缺血心肌节段在各运动方向上的心功能；二维应变显像技术可以有效地评价缺血心肌节段功能。

Objective To study the protective effects of the coronary collateral circulation to ischemic myocardial regional function with coronary artery stenosis ≥75% using 2D strain technique. Methods Two dimensional images of apical four-, two chambers, long-axis views and LV short-axis views were obtained in 121 patients. According to the results of coronary angiogram, all the 121 patients were divided into 3 groups：group 1,with normal coronary artery; group 2,with stenosis ≥75% in ≥ 1 main coronary artery involved right coronary artery,left anterior descending branch and left circumflex branch and with the presence of coronary collateral circulation（CCC） ; group 3, with stenosis ≥75 % in ≥ 1 main coronary artery but with no presence of CCC. The segments＂ systolic peak strain（Sps）, strain rate （SRs）, end systolic strain （Ses）, early diastolic strain rate （SRe） and late diastolic strain rate （SRa） in longitudinal （L）, radial （R）, circumficial （C） directions and the rotation （Rot）, rotation rate were analyzed with EchoPAC offline software. Results Compared with 1 group,I.Sps,LSes,LSRs,LSRa,RSRe,RSRa,CSRe,Rotsre,Rotsra of 2 group, LSps, LSes, LSRs, LSRa, LSRe, RSes, RSRs, RSRe, RSRa, CSps, CSes, CSRs, CSRe, CSRs, Rotps, Rotsrs,Rotsre,Rotsra of 3 group decreased significantly （ P 〈0.05） ; compared with 2 group, LSps, LSes, LSRs,RSes,RSRs, CSps, CSes, CSRs, CSRa, Rotps, Rotsrs, Rotsre of 3 group decreased markedly（ P〈0.05）. Conclusions Coronary collateral circulation provides a protection effection to ischemic myocardial regional function. 2D-strain technique may serve as an efficient method to assess ischemic myocardial regional function.