实时三维斑点追踪成像评估左心室整体收缩功能与冠状动脉狭窄的关系

The association of global left ventricular systolic function evaluated by real-time three dimensional speckle tracking imaging with coronary artery stenosis

目的探究实时三维斑点追踪成像(RT3D-STI)评估左心室整体收缩功能与冠状动脉狭窄的关系。方法冠状动脉造影(CAG)异常但常规超声心动图检查无节段性室壁运动异常的冠心病患者66例,根据CAG结果,分为A组:冠状动脉轻中度狭窄(冠状动脉狭窄均<70%)33例;B组:冠状动脉重度狭窄(至少有一支冠状动脉狭窄≥70%)33例,无冠状动脉病变者30例为对照组,均行RT3D-STI检查。测定左心室收缩末容积(LVESV)、舒张末容积(LVEDV)、左心室射血分数(LVEF)及左心室整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS)、整体面积应变(GAS),作组间比较,计算诊断冠状动脉严重狭窄的ROC曲线下面积。结果 B组GLS、GCS、GRS、GAS较对照组及A组降低(均P<0.05),A组GLS、GAS较对照组降低(均P<0.05);ROC曲线显示GAS诊断冠状动脉重度狭窄的敏感度及特异度较其他参数高;GAS与LVEF相关性较高(r=-0.691,P<0.05)。结论 RT3D-STI能发现二维超声动图上难以发现的左心室收缩活动异常,GAS与冠状动脉狭窄程度相关。

Objective To assess the association of global left ventricular systolic function evaluated by real- time three dimensional speckle tracking imaging （RT3D- STI） with coronary artery stenosis. Methods Sixty- six patients with coronary artery stenosis determined by coronary arteriography （CAG） and no regional ventricular wal motion abnormalities on 2D echocardiography were enrol ed. Of them, 33 cases had coronary artery stenosis〈70%（group A） and 33 cases had at least one coronary artery stenosis≥70%（group B）. RT3D- STI was performed in al patients as wel as in 30 healthy people without coronary artery stenosis. Left ventricular end- systolic volume, end- diastolic volume, ejection fraction, global longitudinal strain （GLS）, global circumferential strain （GCS）, global area strain （GAS） and global radial strain （GRS） were measured and compared between different groups. The area under the receiver operating characteristic curve （ROC） of critical coronary stenosis was calculated. Results GLS、GCS、GRS and GAS were significantly lower in group B than in group A and controal group（al P〈0.05）. GLS and GAS were significantly lower in group A than in control group（ al P〈0.05）. ROC curve showed that GAS had higher sensitivity and specificity than other parameters in detecting critical coronary artery stenosis. GAS was highly correlated with left ventricular ejection fraction. Conclusion RT3D- STI can detect abnormal left ventricular contraction which are difficult to been found by 2D echocardiography. GAS is correlation with coronary artery stenosis.