三维超声斑点追踪技术评价不同程度冠状动脉狭窄患者左心室局部径向收缩功能

Assessment of left ventricular regional radial systolic function in patients with different graded coronarY artery stenosis by three-dimensional ultrasound speckle tracking imaging

目的应用三维超声斑点追踪技术（three—dimensional speckle trackingimaging，3D-STI）评价不同冠状动脉狭窄程度对应的心肌节段的径向收缩期峰值应变（thesystolic peakradial strain，RS）和径向应变达峰时间（the time to systolic peak radial strain，TRs）。方法拟诊冠心病患者87例，均接受冠状动脉造影检查。所有心肌节段按冠状动脉狭窄情况分为5组：0级组，冠状动脉无狭窄；1级组，冠状动脉狭窄≤25％；2级组，冠状动脉狭窄〉25％～≤50％；3级组，冠状动脉狭窄〉50％～≤75％；4级组，冠状动脉狭窄〉75％。运用3D-STI自动测量左心室壁16个节段的RS和TRS，采用心率对所有时间值进行校正。结果0级组、1级组和2级组各节段RS差异无统计学意义（P〉0．05）；3级组和4级组较0级组、1级组和2级组病变冠状动脉相对应的部分节段RS减低；4级组较3级组RS减低，差异有统计学意义（P〈0．05）。0级组和1级组各节段TRS差异无统计学意义（P〉0．05）；2级组、3级组和4级组病变冠状动脉相对应的部分节段TRS较0级组和1级组延迟；3级组和4级组较2级组TRS延迟；与3级组比较，4级TRs相对提前，冠状动脉病变相对应部分节段差异有统计学意义（P〈0．05）。结论左心室壁冠状动脉病变相对应节段的RS随冠状动脉狭窄程度的加重而减低，TRS随狭窄程度的加重而延迟。重度冠状动脉狭窄（〉75％）时，病变冠状动脉相对应节段TRS较轻中度冠状动脉狭窄（〉50％～≤75％）组有提前的趋势。3D-STI可以评价不同冠状动脉狭窄程度的局部心肌收缩功能改变。

Objective To assess the alterations of the systolic peak radial strain （RS） and the time to systolic peak radial strain（TRS） in ischemie myocardial segments with different extent of coronary artery stenosis using three-dimensional ultrasound speckle tracking imaging（3D-STI）. Methods RS and TRS of 16 left ventrieular segments were analyzed by 3DSTI in 87 patients, every left ventricular segment of all patients were divided into 5 groups according to coronary stenosis based on the results of selected coronary angiography ： normal, ≤25%, 〉25 %- ≤50 %, 〉50% - ≤75 %, 〉 75%. All times were corrected by heart rate. Results In the coronary normal group, coronary stenosis extent ≤25% group and coronary stenosis extent 〉25% ≤50%group, the variance of RS was non-significant（ P 〉0.05）. Compared with the coronary normal group, coronary stenosis extent ≤25 % group and coronary stenosis extent 〉 25 % - ≤ 50% group, RS was decreased in groups of coronary stenosis 〉50% - ≤75% and 〉75%. Between the coronary normal group and coronary stenosis extent ≤25 % group, the variance of TRS was non-significant（ P 〉0.05）. Compared with coronary normal and coronary stenosis extent ≤25 % group,TRS was increased in groups of coronary stenosis 〉25% - ≤50%, 〉50 % - ≤75 %, 〉75 %. Compared with group of coronary stenosis 〉50% -≤75%, TRS was shorter in group of coronary stenosis 〉75%, some variance was significant（ P 〈0.05）. Conclusions The RS was decreased along with the coronary stenosis increase, but TRS was increased along with the coronary stenosis increase. There is a tendency that TRS was decreased when the coronary stenosis is more than 75 % compared with the coronary stenosis 〉50% - ≤75 % group. 3D-STI can access the regional radial systolic function of the ischemie myocardial segment.