三维斑点追踪成像定量评价冠状动脉疾病患者左心室局部收缩功能

Value of 3-dimensional speckle tracking imaging to quantify regional left ventricular function in patients with coronary artery disease

目的 探讨三维斑点追踪成像（3-dimensional speckle tracking imaging,3D-STI）技术评价冠状动脉疾病患者左心室局部收缩功能的价值.方法 疑似冠心病而行冠状动脉造影的患者52例,根据冠状动脉造影结果,将左心室壁17节段对应的供血冠状动脉分为正常组、轻度狭窄组、中度狭窄组和重度狭窄组.对52例患者进行常规经胸二维超声心动图和实时三维超声心动图检查,应用3D-STI技术自动测量左心室壁17节段长轴应变、径向应变、圆周应变以及面积应变.结果 46例（88.5％）受检者获得满意的3D-STI图像,其中冠心病35例（76.1％）,非冠心病11例（23.9％）.共138支主要冠状动脉分支,正常组25支（18.1％）,轻度狭窄组31支（22.5％）,中度狭窄组43支（31.2％）,重度狭窄组39支（28.2％）.长轴应变检测结果：中度狭窄组各节段长轴应变均显著低于正常组（P均＜0.05）,且部分节段（中部近前壁间隔壁、心尖部前壁、心尖部、基底部近前壁侧壁、中部近前壁侧壁、心尖部侧壁、基底部近下壁间隔壁、中部近下壁间隔壁、心尖部下壁）显著低于轻度狭窄组（P均＜0.05）,重度狭窄组各节段长轴应变均显著低于正常组、轻度狭窄组和中度狭窄组（P均＜0.05）.径向应变检测结果：中度狭窄组部分节段（基底部近前壁间隔壁、中部前壁、基底部下壁）及重度狭窄组各节段径向应变均较正常组低（P均＜0.05）,重度狭窄组除个别节段（心尖部间隔壁、心尖部侧壁、中部近下壁间隔壁、中部下壁、心尖部下壁）外,径向应变均显著低于轻度狭窄组（P均＜0.05）.圆周应变检测结果：中度狭窄组部分节段（基底部近前壁间隔壁、心尖部间隔壁、基底部近下壁侧壁、基底部下壁）圆周应变均较正常组低（P均＜0.05）,重度狭窄组各节段圆周应变均显著低于正常组、轻度狭窄组和中度狭窄组（P均＜0.05）.面积应变检测结果：除个别节段（基底部近下壁侧壁、中部近前壁侧壁、基底部近下壁间隔壁）外,轻度狭窄组面积应变均较正常组低（P均＜0.05）,中度狭窄组各节段面积应变均显著低于正常组和轻度狭窄组（P均＜0.05）,重度狭窄组各节段面积应变均显著低于正常组、轻度狭窄组和中度狭窄组（P均＜0.05）.面积应变与冠状动脉Gensini积分之间呈显著负相关（r=-0.71,P ＜0.01）.结论 3D-STI可定量评价左心室壁局部收缩功能,其中面积应变是较为敏感的指标.3D-STI可作为早期发现冠状动脉疾病的一种较为简便的无创检测手段.

Objective To assess left ventricular （LV）strain by 3-dimensional speckle tracking imaging（3D-STI） in patients with coronary heart disease （CHD）.Methods All subjects underwent invasive coronary angiography.2-dimensional and 3-dimensional echocardiography were performed in 52 subjects with suspected CHD.Longitudinal strain（LS）,circumferential strain（CS）,radial strain（RS） and area strain（AS）in 17 LV segments were acquired by 3D-STI respectively.Results According to coronary angiography results,35 （76.1%）subjects were diagnosed as CHD,and 138 coronary branches were divided into the control group （25 branches,18.1%）,the mild stenosis group （31 branches,22.5 %）,the moderate stenosis group （43 branches,31.2%） and the severe stenosis group （39 branches,28.2%）.3D-STI was performed with reliable tracking quality in 46（88.5%） out of the 52 subjects initially enrolled in this study.3D-STI showed：（1）LS was similar between mild stenosis group and the control group （P 〉 0.05） and significantly reduced in the moderate stenosis group compared with the control group（P 〈0.05）,and LS in some segments （MAS,AA,A,BAL,MAL,AL,BIS,MIS and AI） of moderate stenosis group were significantly decreased compared with the mild stenosis group （P 〈 0.05）.LS of all segments in the severe stenosis group decreased significantly compared with the control group,the mild stenosis group and the moderate stenosis （P 〈0.05）.（2）RS was similar between mild stenosis group and the control group（P 〉0.05）.RS in some segments （BAS,MA and BI）was significantly decreased in the moderate stenosis group compared with the control group（P 〈 0.05）.RS was significantly decreased in the severe stenosis group compared with the control group and the mild stenosis group （except for AS,AL,MIS,MI and AI） （P 〈 0.05）.（3） CS was similar between mild stenosis group and the control group（P 〉0.05） and was significantly reduced in some segments （BAS,AS,BIL and BI） of the moderate stenosis group compared with the control group （P 〈0.05）.CS was significantly decreased in the severe stenosis group compared with the control group,the mild stenosis group and the moderate stenosis（P 〈 0.05）.（4）AS was significantly decreased in the mild stenosis group compared with the control group （P 〈 0.05,except for BIL,MAL and BIS）and in all segments of the moderate stenosis group compared with the control group and the mild stenosis group（P 〈 0.05）.AS was significantly decreased in the severe stenosis group compared with the control group,the mild stenosis group and the moderate stenosis（P 〈 0.05）.The progressive decrease in AS was observed from the control group to the mild stenosis group,the moderate stenosis group and the severe stenosis group （P 〈 0.05）.In addition,AS was negatively correlated with coronary artery Gensini score （r =-0.71,P 〈 0.01）.Conclusion LV strain can be reliably quantified by 3D-STI.AS is a more sensitive parameter to detect coronary artery disease at early phase.