斑点追踪成像对冠状动脉心脏病患者左室心肌应变功能的早期评价

Early evaluation of the left ventricular myocardial strain function in patients with coronary heart disease using speckle tracking imaging

目的应用斑点追踪成像(STI)定量分析冠状动脉心脏病(简称冠心病)患者左室长轴及短轴应变,探讨STI早期诊断心肌缺血的临床价值。方法 59例临床确诊为冠心病患者(冠心病组),33例体检健康者为对照组,于左室心尖二腔、长轴、四腔切面和胸骨旁左室短轴二尖瓣水平、乳头肌水平、心尖水平切面,应用STI定量分析左室长轴纵向应变峰值、短轴径向应变峰值和圆周应变峰值。结果与对照组比较,冠心病组各节段纵向、径向、圆周应变值均减低,其中纵向应变基底段的前间隔,中间段的间隔和前间隔,心尖段的前壁和侧壁均减低(P<0.05)。径向应变二尖瓣水平的后壁、下壁、前间隔,乳头肌水平的下壁、间隔、前间隔、侧壁,心尖水平的间隔减低(P<0.05);圆周应变二尖瓣水平的后壁、间隔、前间隔,乳头肌水平的前壁、侧壁、前间隔,心尖水平除侧壁以外节段均减低(P<0.05)。结论冠心病患者在超声心动图检查尚未见节段性室壁运动异常时,应用STI可显示左室心肌收缩功能明显减低。

Objective To quantitatively analyze the longitudinal and radical strain of left ventricular myocardium using speckle tracking imaging（STI） in patients with coronary heart disease（CHD）,and to explore the clinical value of STI in the early diagnosis of myocardial ischemia.Methods Fifty-nine patients with clinical proved CHD and thirty-three healthy subjects were enrolled as the experiment and control group.High frame rate two-dimensional images were recorded from the left ventricular apical two-,three-and four-chamber views,as well as left ventricular short-axis views at the levels of mitral annulus,papillary muscle and apex.Longitudinal strain （LS）,radical strain （RS）,and circumferential strain （CS） were measured by using STI.Results Compared with the control group,LS,RS,CS values in each segment all decreased,and the average strain of each level significantly decreased（P＜0.05）.LS values in anterior septal of basement,septum and anterior septal of middle segment,anterior wall and side wall of apex all significantly decreased（P＜0.05）.RS values in posterior wall,inferior wall,anterior septal of the mitral valve level,inferior wall,septum wall,anterior septal,lateral wall of the papillary muscle level,septum of the apex cordis level all significantly decreased （P＜0.05）.CS values in posterior wall,septum,anterior septal of the mitral valve level,anterior wall,lateral wall,anterior septal of the papillary muscle level,apex cordis level besides lateral wall all significantly decreased（P＜0.05）.Conclusion When no abnormal segmental wall motion was found by echocardiography in patients with coronary artery disease,STI can be used to find the decrease of left ventricular systonic function.