心肌速度向量成像技术评价心肌梗死患者心肌各节段旋转速度和旋转角度

Assessment of Myocardial Segmental Rotation Velocity and Angle in Patients with Myocardial Infarction Using Velocity Vector Imaging

目的应用速度向量成像（VVI）技术测定心肌梗死患者心肌各节段心内膜和心外膜的旋转角度和旋转速度,评价其在定位左前降支病变中的价值。资料与方法选取25例ST段抬高型心肌梗死、冠状动脉造影示罪犯血管为左前降支闭塞的患者和24例冠状动脉造影正常的患者。超声检查均在冠状动脉介入术后1周内进行,记录心脏心底水平和心尖水平左心室短轴切面,并脱机分析左心室心肌各节段心内膜和心外膜收缩期旋转角度和旋转速度。结果心肌梗死组心底水平前间隔、后间隔心内膜收缩期旋转速度和后间隔心外膜旋转角度与对照组比较,差异有统计学意义（P〈0.05、P〈0.01）。心肌梗死组心尖水平前间隔、前壁、前侧壁和后间隔心内膜收缩期旋转速度及前壁收缩期旋转角度均低于对照组（P〈0.05、P〈0.01）。心肌梗死组前间隔和前壁心外膜收缩期旋转速度、下壁和后间隔心外膜收缩期旋转角度与对照组比较,差异有统计学意义（P〈0.05、P〈0.01）。左心室心尖水平心内膜前间隔、前壁、前侧壁、下侧壁、下壁和后间隔的收缩期旋转速度均能定位左前降支病变（AUC=0.70~0.88）。前壁心内膜收缩期旋转速度≤45.86o/s定位左前降支病变的敏感度和特异度分别为88%和79%。左心室心尖水平心外膜前间壁和前壁收缩期旋转速度能定位左前降支病变（AUC=0.69、0.74）。左心室前壁心外膜收缩期旋转速度≤43.8o/s定位左前降支病变的敏感度和特异度分别为92%和54%。结论心尖收缩期旋转速度与靶血管病变有直接关系,并且有望成为一项新的指标准确定位左前降支病变。

Purpose To determine velocity vector imaging （VVI） in myocardial segmental rotation velocity and angle of the endocardial and epicardial, and to locate the lesion in the left anterior descending （LAD） artery. Materials and Methods Twenty-five myocardial infarction （MI） patients with ST-elevation were recruited in the study. Percutaneous coronary intervention （PCI） showed responsible vessel was LAD. Twenty-four patients with normal coronary angiography were recruited as control group. Echocardiographic exam was performed within one week after PCI. Endocardial and epicardial systolic rotation velocity and angle for each segment at basal level and apical level were analyzed off-line. Results There were significant differences between MI group and the control group for the systolic endocardial rotation velocity of anteroseptum and posterior septum, and for epicardial rotation angle of posterior septum （P〈0.05, P〈0.01）. The systolic endocardial rotation velocity of the anteroseptum, the anterior wall, the anterolateral wall and the posterior septum at the apical level and epicardial rotation angle of the anterior wall in MI group were lower than those of the normal group （P〈0.05, P〈0.0 1）. There were significant differences between MI group and the control group on the systolic epicardial rotation velocity of anteroseptum and the anterior wall, and epicardial rotation angle of the inferior wall and the posterior septum （P〈0.05, P〈0.01）. The systolic endocardial rotation velocity at the apical level had ability to locate LAD disease, and the area under ROC curves （AUC） was 0.70-0.88. The sensitivity and specificity of the systolic endocardial rotation velocity to locate LAD disease were 88% and 79% for 〈 45.86 °/s at anterior wall. The systolic epicardial rotation velocity of the anteroseptum and the anterior wall at apical level locate LAD disease with AUC=0.69 and 0.74. The sensitivity and specificity of systolic epicardial rotation velocity at anterior wall of 〈 43.8 °/s to locate LAD disease were 92% and 54%, respectively. Conclusion The systolic rotation velocities at the apical level is related to the target coronary artery disease, which could be used as a new quota to locate LAD disease.