三维斑点追踪超声心动图评估冠心病患者左心室舒张功能的临床应用价值

Clinical Value of Three-dimensional Speckle-tracking Echocardiography for Evaluating Left Ventricular Diastolic Function in Patients With Coronary Artery Disease

目的:探讨三维斑点追踪超声心动图(3D-STE)评估冠心病患者的左心室整体舒张功能的临床应用价值。方法:前瞻性纳入68例左心室射血分数正常的冠心病患者。据左心室舒张末期压(LVEDP),将68例冠心病患者分为两组:舒张功能正常组[LVEDP≤15 mm Hg,(1 mm Hg=0.133 k Pa)]31例,舒张功能不全组(LVEDP>15 mm Hg)37例。采集心尖四腔全容积图像,运用4D Auto LVQ软件进行离线分析,得到左心室整体(四项三维应变指标)纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)及径向应变(GRS)。结果:左心室舒张功能不全组GLS、GCS、GAS、GRS较舒张功能正常组均明显减低(P<0.001)。Pearson相关性分析显示四项三维应变指标与LVEDP中度相关:GLS(r=0.585,P<0.001),GCS(r=0.589,P<0.001),GAS(r=0.674,P<0.001)及GRS(r=-0.643,P<0.001)。受试者工作特征(ROC)曲线分析显示GLS在-15.5%时预测左心室舒张功能不全的灵敏度和特异度均为68%;GCS在-17.5%时预测左心室舒张功能不全的灵敏度和特异度分别为76%和81%,GAS在-29.5%时预测左心室舒张功能不全的灵敏度和特异度分别为84%和68%。结论:3D-STE的相关应变参数可用来预测左心室射血分数正常冠心病患者的LVEDP,并能作为新的超声诊断指标来评估患者的左心室舒张功能。

Objective： To investigate the clinical value of three-dimensional speckle-tracking echocardiography （3D-STE） for evaluating left ventricular diastolic function in patients with coronary artery disease （CAD）. Methods： A total of 68 CAD patients were prospectively recruited. According to left ventricular enddiastolic pressure （LVEDP）, the patients were divided into 2 groups： Normal diastolic function group, the patients with LVEDP〈15mmHg, n=31 and Diastolic n=37. The global longitudinal strain （GLS）, global and global radial strain （GRS） were analyzed with a chamber full-volume image. dysfunction group, the patients with LVEDP〉15mmHg, circumferential strain （GCS）, global area strain （GAS） commercial software （4D Auto LVQ） by the apical four Results： Compared with Normal diastolic function group, the patients in Diastolic dysfunction group showed obviously decreased GLS, GCS, GAS and GRS, P〈0.001. Pearson analysis presented that the above indexes were moderately related to LVEDP as for GLS （r=0.585, P〈0.001）, for GCS （r=0.589, P〈 0.001）, for GAS （r=0.674, P〈0.001） and for GRS （r= -0.643, P〈 0.001）. The receiver operating characteristic （ROC） analysis showed that the sensitivity and specificity tbr diagnosing left ventricular diastolic dysfunction when GLS=-15.5 % were at 68% and 68%, when GCS=- 17.5 % were at 76 % and 81%, when GAS=-29.5% were at 84 % and 68 % respectively. Conclusion： 3D-STE may predict LVEDP and it may be used as the alternative index of echocardiography in diagnosing left ventricular dysfunction in CAD patients with normal LVEF.