左室径向应变和圆周应变对冠状动脉粥样硬化性心脏病患者心肌缺血的诊断价值

Value of left ventricular radial and circumferential strain for evaluation of myocardial ischemia in patients with coronary heart disease

目的应用斑点追踪技术评价室壁运动正常的心肌缺血患者左室径向应变及圆周应变,探讨其检测心肌缺血的临床价值。方法 30例经冠状动脉造影证实的冠状动脉粥样硬化性心脏病(CHD)患者,28例健康者为对照组,应用二维应变软件分析左室短轴二尖瓣水平、乳头肌水平及心尖水平图像,获取左室短轴各节段心肌径向应变和圆周应变均值。结果 CHD组径向应变和圆周应变均较对照组减低(P<0.001);ROC曲线表明径向应变诊断心肌缺血的敏感性为89.3%,特异性为80.0%;圆周应变诊断心肌缺血的敏感性为75.0%,特异性为63.3%;径向应变诊断心肌缺血的敏感性和特异性均较圆周应变增高。结论二维短轴应变能较敏感地发现心肌缺血,径向应变较圆周应变能更准确地评价心肌缺血。

Objective To assess left ventricular radial strain and circumferential strain in coronary artery disease patients without regional wall motion abnormality by speckle tracking imaging（STI） ,and to explore its clinical value in detecting myocardial ischemia. Methods Thirty patients with coronary artery disease （ CAD group ） and 28 cases of normal subjects （control group）were enrolled in this study. The speckle data were obtained in left ventricular short-axis views at the levels of mitral annulus, papillary muscle and apex. The average of peak systolic circumferential strain and radial strain were analyzed. Results The circumferential strain and radial strain in CAD group were decreased than those in control group（ P 〈 0. 001 ）, ROC curve showed the sensitivity and specificity of radial strain in diagnosis of myocardial ischemia were 89.3% and 80.0% , while the sensitivity and specificity of radial strain in diagnosis of myocardial ischemia were 75.0% and 63.3%. The sensitivity and specificity of radial strain were higher than those of circumferential strain. Conclusion Two - dimensional regional strain is sensitive to detect myocardial ischemia, radial strain is better than circumferential strain in detecting myocardial ischemia.