超声二维斑点追踪技术评价不同程度冠状动脉狭窄患者左心室心内膜及心外膜扭转与解旋运动的研究

Evaluation of the LV Twisting and Untwisting in Patients With Different Levels of Coronary Artery Stenosis by Two-dimensional Ultrasonic Spot Tracking Technology

目的探讨超声二维斑点追踪技术(2D-STI)评价不同程度冠状动脉狭窄患者左心室心内膜、心外膜扭转与解旋运动的特点。方法选取2014年12月—2015年8月在石河子大学医学院第一附属医院心内科住院,并经选择性冠状动脉造影确诊为冠心病的患者55例,依据冠状动脉狭窄程度积分(Gensini积分)分为轻中度狭窄组(Gensini积分≤42.9分,28例)和重度狭窄组(Gensini积分≥43.0分,27例),采用超声2D-STI全方位分析左心室心内膜、心外膜扭转与解旋运动指标,并分析其与Gensini积分的相关性。结果轻中度狭窄组与重度狭窄组患者性别、体质指数(BMI)、心率、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、舒张期左房室瓣前向血流频谱E峰/A峰(E/A)、等容舒张时间(IVRT)比较,差异无统计学意义(P>0.05);重度狭窄组患者年龄、每搏输出量较轻中度狭窄组降低(P<0.05)。重度狭窄组患者左心室扭转角度峰值(Ptw)、主动脉瓣关闭时间点扭转角度(AVCtw)、左房室瓣开放时间点扭转角度(MVOtw)、解旋率(UntwR)、解旋速度峰值(PUV)、扭转速度峰值(PTV)、心底水平心内膜下心肌旋转角度峰值(rot baendo)、心底水平心外膜下心肌旋转角度峰值(rot baepi),心尖水平心内膜下心肌旋转角度峰值(rot apendo)、心尖水平心外膜下心肌旋转角度峰值(rot apepi)较轻中度狭窄组降低,解旋速度达峰时间(TPUV)、扭转达峰时间(TPTV)较轻中度狭窄组升高(P<0.05)。冠心病患者Ptw、AVCtw、UntwR、TPUV、rot apendo、rot apepi与Gensini积分呈高度负相关(r=-0.725,P<0.01;r=-0.794,P<0.01;r=-0.848,P<0.01;r=-0.794,P<0.01;r=-0.989,P<0.01;r=-0.964,P<0.01);TPTV与Gensini评分呈高度正相关(r=0.965,P<0.01)。结论超声2D-STI可以很好地评价左心室舒张功能,左心室心内膜、心外膜旋转角度的下降程度可以从某种程度上反映冠状动脉的狭窄程度。

Objective To investigate the characteristics of the LV twisting and untwisting of patients with different levels of coronary artery stenosis by two - dimensional ultrasonic spot tracking technology（2D - STI） . Methods From December 2014 to August 2015,we enrolled 55 patients who were admitted into the Department of Cardiology of the First Affiliated Hospital of the Medicine College,Shihezi University and were definitely diagnosed as coronary disease by selective coronary angiography. According to the integral of coronary artery stenosis（Gensini integral）,the patients were divided into two groups：mild and moderate group（ n = 28）and severe group（ n = 27）. The indexes of LV twisting and untwisting were analyzed using 2D - STI all - around analysis,and their correlation with Gensini integral was analyzed. Results Mild and moderate group and severe group were not significantly different in gender,BMI,heart rate,LVEDV,LVESV,LVEF,E/ A and IVRT（P 〉 0. 05）;severe group was lower than mild and moderate group in age and LVSV（P 〈 0. 05）. Severe group was lower than mild and moderate group in Ptw,AVCtw,MVOtw,UntwR,PUV,PTV,rot baendo,rot baepi,rot apendo and rot apepi,and was higher than mild and moderate group in TPUV and TPTV（ P 〈 0. 05）. Ptw,AVCtw,UntwR,TPUV,rot apendo,rot apepi of patients with coronary heart disease had negative correlation with Gensini integral（r = - 0. 725,P 〈 0. 01;r = - 0. 794,P 〈 0. 01;r = - 0. 848,P 〈 0. 01;r = - 0. 794,P 〈 0. 01;r = - 0. 989,P 〈 0. 01;r = - 0. 964,P 〈0. 01）;TPTV had positive correlation with Gensini integral（r = 0. 965,P 〈 0. 01）. Conclusion 2D - STI can evaluate the left ventricular diastolic function well,and the descending degree of the rotation angle of the inner and outer membrane of ventriculus sinister can reflect the degree of coronary artery stenosis to some extent.