实时三维超声斑点追踪成像评价冠心病患者左心室整体收缩功能的临床研究

Real-time three-dimensional left ventricular global systolic function in patients with coronary artery diseases

目的应用实时三维超声斑点追踪成像（real—time—dimension speckle tracking imaging，RT3D-STI）技术评价冠心病患者的左室整体收缩功能，探讨RT3D-STI各项应变指标诊断冠心病的临床应用价值。方法收集经冠脉造影证实的冠心病患者55例，对照组34例。应用RT3D-STI采集心尖全容积图像得出两组左室整体长轴应变（GLS）、左室整体轴向应变（GCS）、左室整体径向应变（GRS）、左室整体面积应变（GAs）及左室射血分数（LVEF）等，分析应变值对冠心病的诊断价值。结果冠心病组GLS、GCS、GRs及GAS均较对照组减低，差异有统计学意义（P〈0．05）。ROC曲线显示GLS诊断冠心病的曲线下面积（AUC）最大，约91．6％，当GLS截断值为-12．5时，GLS的敏感性最高约90．3％，Youden指数0．612；当GAs截断值为-23．0时，GAS特异性最高约95．8％，Youden指数0．539。相关分析表明冠心病组GLS、GAS与LVEF显著相关（r分别为-0．860，-0．926）。结论应用RT3D-STI诊断冠心病的各项指标中，GLS敏感度最高，GAS特异度最高。RT3D-STI可早期发现冠心病患者左室整体收缩功能的变化。

Objective To evaluate left ventricular systolic function by real-time three-dimension speckle tracking imaging （RT3D-STI） in coronary artery diseases （CHD） patients,to determine the clinical value of RT3D-STI in CHD. Methods 34 control subjects and 55 patients with CHD by coronary angiography were involved. Left ventricular global longitudinal strain （GLS）, left ventricular global circumferential strain （GCS）,left ventricular global radial strain （GRS）, left ventricular global area strain （GAS） and left ventrieular ejection fraction （LVEF）, etc, was acquired by RT3D-STI, respectively. The parameters by RT3D-STI to diagnose CHD were analyzed. Results Compared with control group, GLS, GCS,GRS and GAS were significantly decreased in CHD group （P〈0.05）. The area under receiver operating characteristics （AUC） curve of GLS to diagnose CHD was 91.6%. The cutoff value, the sensitivity and Youden index of GLS were -12.5,90.3% and 0. 612, respectiuely. The cutoff value, the sensitivity and Youden index of GAS were - 23.0,95.8% and 0. 539, respectiuely. GLS, GAS correlated well with LVEF in CHD group （ r = - 0. 860, r = - 0. 926）. Conclusions GLS is the most sensitivity and GAS is the most specificity in the all of strain parameters. RT3D-STI can early show the changes of left ventricular global systolic function in patients with CHD.