实时三维斑点追踪成像技术评价无节段性室壁运动异常的不同程度冠状动脉病变患者的心肌应变

Real-time three-dimentional speckle tracking imaging on assessment of myocardial strain in different degrees of coronary artery disease patients without regional wall motion abnormality

目的探讨实时三维斑点追踪成像(RT3D-STI)技术评价不同程度冠状动脉病变患者左心室心肌应变的价值。方法收集超声结果提示无节段性室壁运动异常(RWMA)的冠心病患者109例,并根据冠状动脉造影(CAG)结果分为:对照组(n=30)、单支病变组(n=34)、多支病变组(n=45)。应用RT3D-STI技术获得左心室整体纵向应变(GLS)、整体周向应变(GCS)、整体面积应变(GAS)、整体径向应变(GRS)及左心事射血分数(LVEF)等,比较各参数的组间差异,并分析不同应变参数问及其与LVEF的相关性。结果随着冠状动脉病变程度的加重,GLS、GCS、GAS、GRS逐渐减低,单支病变组低于对照组(P均<0.05),多支病变组低于单支病变组(P均<0.05),GAS组间差异较显著。GLS、GCS、GAS与C-RS相关系数分别为-0.874、-0.848、-0.906,GAS与GRS相关关系更为密切;GLS、GCS、GAS、GRS与LVEF的相关系数分别为-0.684、-0.657、-0.717、0.672,GAS与LVEF相关性最好。结论 RT3D-STI技术参数能够定量评价无节段性室壁运动异常的不同程度冠状动脉病变患者心肌应变,测量准确性及可重复性高.新参数GAS更具优势。

Objective To explore the value of real-time three-dimentional speckle tracking imaging （RT3D-STI） on assessment of myocardial strain in patients with different degrees of coronary artery disease （CAD）. Methods Totally 109 CAD patients without regional wall motion abnormality （RWMA） were divided into control group （n=30）, single vessel disease group （n=34） and multi-vessel disease group （n=45） based on coronary angiography （CAG）. All the patients Underwent three-dimentiondal echoeardiography, left ventrieular globle longitudinal strain （GLS）, globle circumferential strain （GCS）, globle area strain （GAS）, globle radial strain （GRS） and left ventrieular ejection fraction （LVEF）,ere,were aquired by RT3D-STI respectively. Difference of each parameter among three groups were compared, the correlation among different strain parameters and LVEF were analyzed. Results GLS, GCS, GAS, GRS decreased with the degree of the coronary artery disease, and GLS, GCS, GAS, GRS in single vessel disease group were lower than those in control group （all P〈0.05）, and GLS, GCS, GAS, GRS in multi-vessel disease group were lower than in single vessel disease group（all P〈0.05）. GAS showed significant difference among the three group. Correlation coefficents of GLS, GCS, GAS with GRS were —0.874, —0.848, —0.906, GAS was closely related to GRS;the correlation coefficents between different strain parameters and LVEF were —0.684, —0.657,—0.717, 0.672, GAS had the best correlation with GRS. Conclusion RT3D-STI strain parameters can quantitatively assess the myocardial strain in different degrees of CAD patients without RWMA, showing high measurement accuracy and reproducibility. The novel GAS plays an more important role.