三维斑点追踪成像技术评价冠心病患者左心室心肌应变的临床价值

Assessment of left ventricular (LV) strain in patients with coronary heart disease by three-dimensional speckle tracking imaging (3D-STI)

目的运用三维斑点追踪成像技术(3D-STI)评价冠心病患者左心室短轴及长轴心肌应变特征,探讨其对于冠心病患者左室局部收缩功能的评判价值。方法选取冠心病患者22例,正常对照组23例,采集胸骨旁左室长轴、心尖四腔、心尖三腔切面左心室全容积图像进行在线分析,自动计算左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心室长轴纵向各水平收缩期峰值及平均应变、左心室短轴径向各水平收缩期峰值及平均应变、左心室短轴环向各水平收缩期峰值及平均应变,并比较两组之间的各应变指标变化情况。结果冠心病与正常对照在LVEDV、LVESV、LVEF方面无统计学差异(P>0.05)。正常对照组左室短轴径向收缩期峰值及平均应变从心尖水平至中间段水平再到基底水平呈逐渐增大趋势。正常对照组左室短轴环向及左室长轴纵向收缩期峰值及平均应变心尖水平至中间段水平再到基底水平呈逐渐减小趋势。冠心病组左心室长轴纵向、左心室短轴径向、左心室短轴环向各水平收缩期峰值及平均应变较正常对照组减低(P<0.05)。结论 3D-STI可无创、客观地评价冠心病患者各节段径向、环向、纵向心肌应变,是评价冠心病患者左心室局部收缩功能的一种新方法。

Objective To explore the value in assessment of LV regional systolic function in patients with coronary heart disease by evaluating LV strain in short axis and long axis using three-dimensional speckle tracking imaging（3D-STI）.Methods A total of 22 cases of coronary heart disease（CHD） and 23 cases of healthy volunteers were enrolled in this study.Left ventricular end-systolic volume （LVESV） and end-diastolic volume（LVEDV）,left ventricular ejection fraction（LVEF）,left ventricular long-axis and short-axis strain were gained by 3D-STI which employed full volume 3D acquisition and subsequent quantitative analysis in all subjects.The values of strain were compared between two groups.Results The values of LVEDV,LVESV,LVEF between CHD patients and normal controls were not significantly different（P 0.05）.The peak and average values of LV radial strain at systolic phase were gradually increased from apex,middle segment to basal segment in normal controls.The peak and average values of LV circumferential and longitudinal strain at systolic phase were gradually decreased from apex,middle segment to basal segment in normal controls.The peak and average values of LV radial,circumferential,longitudinal strains at systolic phase in CHD patients were lower than those in normal controls （P0.05）.Conclusion 3D-STI is a non-invasive and objective method to evaluate LV radial,circumferential and longitudinal strains of all segments in patients with CHD.