实时三维斑点追踪显像技术评价心肌缺血患者左心室局部功能

Real-time three-dimension speckle tracking in assessment of left ventricular regional function in patients with myocardial ischemia

目的应用实时三维斑点追踪显像（3D-STI）技术评价冠状动脉左前降支（LAD）不同狭窄程度缺血患者左心室心肌局部应变变化。方法根据冠状动脉造影（CAG）结果将138例临床疑诊冠心病患者分为对照组（34例）和狭窄组（104例），另将狭窄组分为轻度狭窄亚组（A亚组，n=34）、中度狭窄亚组（B亚组，n=36）和重度狭窄亚组（C亚组，n=34）。测量LAD供血区域心肌的应变指标：峰值径向应变（PLS）、峰值面积应变（PAS）、应变显像舒张指数（SI—DI），分析2D-STI及3D-STI测值的相关性。结果对照组3D-STI的PLS较2D-STI值偏低（P〈0．05），相关性良好（r值：0．58～0．76）。A亚组PAS与对照组相比差异无统计学意义（P〉0．05）。与对照组比较，C亚组全部节段及B亚组前壁中间段及心尖段、前间隔中间段及前间隔心尖段的PAS值减低（P〈0．05），C亚组全部节段及B亚组前壁基底段及心尖段、前间隔中间段及前间隔心尖段的sI—D1值减低（P〈0．05）；与B亚组比较，C亚组的前壁中间段及心尖段的PAS值减低（P〈0．05），前壁中间段及心尖段和前间隔心尖段的SI-DI值减低（P〈0．05）。结论3D-STI可有效评估心肌缺血患者左心室局部心肌纤维早期形变特征。

Objective To assess the alterations of regional strain in left ventricular （LV） ischemic myocardial segments in patients with different extent of left anterior descending artery （LAD） stenosis with real-time three-dimensional speckle tracking imaging （3D-STI）. Methods One hundred and thirty-eight patients with clinically suspected coronary heart dis- ease （CHD） were divided into control group （n = 34） or stenosis group （n = 108） according to coronary angiography （CAG）, and those in stenosis group were divided into mild stenosis （A, n=34） subgroup, moderate stenosis （B, n= 36） subgroup and severe stenosis （C, n=34） subgroup. STI was performed before CAG, and stain parameters of LV, inclu- ding segmental systolic peak longitudinal strain （PLS）, segmental systolic peak area of strain （PAS） and strain imaging di astolic index （SI-DI） were measured. The relation between 2D-STI and 3D-STI results was analyzed. Results Compared with 2D-STI, PLS of 3D-STI decreased （P〈0.05）, while good correlation was found between 2D-STI and 3D-STI in the control group （r= 0. 58-0. 76）. Compared with control group, PAS of A subgroup were not statistically different （P〈 0.05 ）, while of all segments in C subgroup, of mid anterior and mid anterosepta, as well as of apical anterior and apical an- teroseptal in B subgroup were lower （P〈0.05）, SI-DI of all segments in C subgroup and basal anterior, mid anteroseptal, apical anterior and apical anteroseptal in B subgroup were lower （P〈0.05）. Compared with B subgroup, PAS of mid ante- rior and apical anterior in C subgroup were lower （P〈0.05）, SI-DI of mid anterior, apical anterior and apical anteroseptal in C subgroup were lower （P〈0.05）. Conclusion 3D-STI can effectively evaluate early changes of deformation characteristics of LV regional myocardial ischemia.