超声二维斑点追踪显像评价冠心病患者心室肌局部收缩功能

Left Ventricular Regional Function Assessed by Two-Dimensional Speckle Tracking Imaging in Patients with Coronary Artery Disease

目的:探讨超声二维斑点追踪显像(STI)技术诊断局部心室肌运动异常的临床价值。方法:根据冠状动脉造影(CAG)结果将入选患者分组。对照组为CAG示冠状动脉正常者25例,缺血组为CAG示冠状动脉左前降支(LAD)狭窄≥75%者28例。分别记录心尖位四腔、长轴及两腔切面高帧频图像,应用STI技术测量重度冠状动脉狭窄患者的LAD供血区域各个节段心肌的收缩期纵向峰值应变及应变率。结果:对照组与缺血组成功获得二维应变及应变率的节段数分别为94.0%和93.3%。纵向峰值应变后间隔中间段,前间隔及前壁中间段、心尖段缺血组较对照组均明显减低,差异有统计学意义(P<0.05);纵向峰值应变率前间隔及前壁中间段、心尖段缺血组较对照组均明显减低,差异有统计学意义(P<0.05)。结论:当冠状动脉出现严重狭窄时,STI技术能较好定位冠状动脉粥样硬化性心脏病患者的异常心肌节段,并显示无明显室壁运动异常的冠心病患者局部心肌收缩功能降低。

Objective：To assess the myocardial strain and strain rate by two-dimensional speckle tracking imaging（STI） in patients with coronary artery disease （CAD）. Methods：All of the subjects were underwent coronary angiography （CAG）. There were 25 patients with normal coronary artery in control group; 28 subjects with left anterior descending（LAD） stenosis ≥ 75% in ischemic group. All of the subjects were prospectively imaged within 48 hours of CAG. High frame rate two-dimensional images were recorded from the apical four-chamber view,long-axis view and two-chamber view of the left ventricle respectively. The peak systolic longitudinal strain （SL） and strain rate （SRL） of LAD segments were measured using Q-Lab 6.0 software. Results：Two-dimensional strain and strain rate were obtained in 209 of 224 segments with LAD regional walls in ischemic group; 188 of 200 segments were obtained in control group. SL of mid inferoseptal,mid and apical anteroseptal,mid and apical anterior segments were decreased in ischemic group compared with those of control group（P〈0.05）. SRL of mid and apical anteroseptal,mid and apical anterior segments were decreased in ischemic group compared with that of control group （P〈0.05 ）. Conclusion：STI can detect abnormal myocardial segments more accurately,and evaluate the regional wall motion of the left ventricle in CAD patients.