三维斑点追踪成像技术评价急性前壁心肌梗死患者左心室收缩功能

Evaluation of Left Ventricular Systolic Function in Acute Anterior Myocardial Infarction with Three-dimensional Speckle Tracking Imaging

目的探讨三维斑点追踪成像(3D-STI)技术定量评价急性前壁心肌梗死(AAMI)患者左心室收缩功能的可行性。资料与方法应用3D-STI技术测量30例AAMI患者左心室纵向应变(LS)、径向应变(RS)、圆周应变(CS)、面积应变(AS)、整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)、整体面积应变(GAS),并与30例对照组患者非梗死节段应变值相比较,分析各项应变参数诊断心肌梗死的阈值、敏感度及特异度。结果病例组左心室12/17节段的LS减低,10/17节段的RS减低,9/17节段的CS减低,11/17节段的AS减低(P<0.05),主要集中在前壁基底段、中间段、心尖段,前间隔基底段、中间段,后间隔心尖段,侧壁中间段、心尖段,心尖部。病例组GLS、GRS、GCS及GAS值均较对照组减低,差异均有统计学意义(P<0.05)。病例组心肌梗死节段LS、RS、CS、AS值较非梗死节段减低,差异均有统计学意义(P<0.05)。ROC分析LS、RS、CS、AS诊断心肌梗死的敏感度分别为89.2%、79.0%、77.9%、85.3%,特异度分别为65.8%、71.0%、66.9%、92.3%;GLS、GRS、GCS、GAS诊断心肌梗死的敏感度分别为91.2%、74.0%、68.9%、85.3%,特异度分别为71.0%、71.0%、76.9%、93.3%。结论 3D-STI技术能够快速、准确检出左心室各节段心肌应变值,判断梗死心肌与非梗死心肌,可为临床评价心肌梗死患者的病变程度提供新的量化手段。

Purpose To discuss the feasibility of evaluating left ventricular systolic function in patients with acute anterior myocardial infarction（AAMI） with three-dimensional speckle tracking imaging（3D-STI）. Materials and Methods Thirty AAMI patients were examined with 3D-STI technique in terms of left ventricular longitudinal strain（LS）, radial strain（RS）, circumferential strain（CS）, area strain（AS）, global longitudinal strain（GLS）, global riadial strain（GRS）, global circumferential strain（GCS） and global area strain（GAS）. The results were compared with those of 30 healthy persons and the strain values in normal segments of those AAMI patients. The threshold, sensibility and specificity of those parameters in diagnosing myocardial infarction were analyzed. Results Compared with healthy group, LS reduced in 12 out of 17 segments（12/17）, RS reduced in 10/17, CS in 9/17 and AS in 11/17; they mainly focused in the base segment, middle and apex of anterior wall, the base segment and the middle of anterior septal, the apex of aboral septal, and the middle segment, apex of the lateral wall. The GLS, GRS, GCS and GAS were all lower than those in healthy group（differences with statistic significance： P〈0.05）. In AAMI patient, LS, RS, CS and AS in the infarcted segments were lower compared with those in the normal segments（differences with statistic significance： P〈0.05）. ROC curve analysis showed that the sensitivity of LS, RS, CS and AS were 89.2%, 79.0%, 77.9%, 85.3%, respectively in the diagnosis of myocardial infarction, and the specificity were 65.8%, 71.0%, 66.9% and 92.3%, respectively. The sensitivity of the GLS, GRS, GCS and GAS were 91.2%, 74.0%, 68.9%, 85.3%, respectively in the diagnosis of myocardial infarction, and the specificity were 69.8%, 71.0%, 76.9% and 93.3%, respectively. Conclusion 3D-STI can detect the strain values of LV segments efficiently and accurately so as to discriminate normal and infracted segments, which provides a reliable measurement to evaluate the extent of the infarction of the patients with acute anterior wall myocardial infarction.