超声二维应变成像观察冠心病患者缺血心肌收缩功能异常

Investigation of ischemic myocardial systolic dysfunction in coronary artery disease patients with two-dimensional strain imaging

目的应用超声二维应变成像技术检测冠心病患者左心室缺血心肌在不同方向上收缩运动的变化特点。方法收集接受冠状动脉造影检查患者83例,其中52例造影证实为冠心病(冠心病组),31例造影未见异常(对照组)。超声采集左心室短轴及心尖长轴切面的高频二维动态图像,应用二维应变分析软件测量左心室各节段心肌的收缩期纵向应变(LS)、径向应变(RS)、圆周应变(CS)和旋转角度(RA)。结果二维应变技术对冠心病组缺血心肌的测量成功率为95.26%(402/422);缺血心肌的LS、RS显著低于对照组正常心肌(P<0.05);除乳头肌水平前壁及后壁RA外,两组心肌CS、RA的差异无统计学意义(P>0.05)。结论二维应变技术所测LS、RS可敏感反映缺血所致局部心肌收缩功能异常;而CS、RA对于观察缺血心肌收缩功能损害不够敏感。

Objective To observe ischemic myocardial systolic dysfunction with two-dimensional strain imaging in different directions of the left ventricular in patients with coronary artery disease.Methods Fifty-two patients with coronary artery disease proved with coronary angiography and 31 control subjects were enrolled.High frame rate two-dimensional dynamic images were recorded from the left ventricular short-axis views at the level of mitral annulus,papillary muscle and apex,as well as the four-chamber,two-chamber and long-axis views of the left ventricular from the apex.Using two-dimensional strain software,peak systolic longitudinal strain（LS）,radial strain（RS）,circumferential strain（CS） and rotation angle（RA） from different segments of the left ventricular were measured.Results Totally 95.26%（402/422） of ischemic myocardium were successfully measured with two-dimensional strain imaging in patients with coronary artery disease.LS and RS significantly reduced in ischemic myocardium than those in normal myocardium（P0.05）,while CS and RA were not significantly different between the two groups（P0.05） with the exception of RA in anterior and posterior walls at the level of papillary muscle.Conclusion Measured with two-dimensional strain imaging,LS and RS,rather than CS and RA,are sensitive markers of ischemic myocardial systolic dysfunction in patients with coronary artery disease.