二维斑点追踪技术评价冠心病患者左室收缩功能及收缩同步性

Assessment of left ventricular systolic function and synchrony in patients with coronary artery disease by two-dimentional speckle tracking technology

目的应用二维斑点追踪技术（2DSTI）评价不同程度冠脉狭窄患者左室收缩功能以及收缩同步性。方法 109例拟诊冠心病患者接受常规二维超声和斑点追踪检查。根据造影结果分为对照组和冠心病组,同时根据Gensini积分将冠心病组分为3个亚组,轻度组（〈25分）,中度病变组（25-50分）,重度病变组（〉50分）。对所采集的高频帧二维图像脱机应用CMQ软件分析,测量左室整体纵向（GLS）及圆周峰值应变（GCS）,同时测量心电图QRS波起点至左室长轴上的收缩期纵向应变达峰时间（Tssl）及短轴观的收缩期圆周应变达峰时间（Tssc）。计算左室16节段纵向、圆周达峰时间标准差（Tssl-SD、Tssc-SD）以及纵向、圆周达峰时间最大差值（Tssl-Diff、Tssc-Diff）,以时间标准差和最大差值作为不同步性指标。结果 1与对照组比较,冠心病各组年龄、收缩压、舒张压、体重指数（BMI）、心率、二尖瓣舒张早期血流速度/舒张晚期血流速度（E/A）差异均无统计学意义;而冠心病各组左房增大,差异有统计学意义（P〈0.05）;2与对照组比较,冠心病各组GLS、GCS均低于对照组（P〈0.05）;随着Gensini积分的增加,GLS与GCS总体趋势呈进行性降低;3与对照组比较,重度病变组Tssl-SD及Tssl-Diff明显增加（P〈0.01）;中度病变组Tssl-SD及Tssl-Diff增加（P〈0.05）;轻度病变组Tssl-SD及Tssl-Diff差异无统计学意义。Tssc-SD与Tssc-Diff在两组之间差异无统计学意义;4冠心病组左室收缩同步性与射血分数相关分析：在冠心病组中将不同步性指数与射血分数进行相关性分析,得出Tssl-SD、Tssl-Diff与LVEF均呈显著负相关性。结论2DSTI可准确评价冠心病患者左室心肌收缩功能及收缩同步性,为冠心病患者的早期诊断、治疗方案的选择及减少心血管事件的发生提供一种无创检查方法。

Objective To evaluate left ventricular myocardial strain and myocardial systolic synchrony in patients with different degrees of coronary stenosis by two-dimensional speckle tracking technology（ 2DSTI）. Methods The study included 109 cases of coronary heart disease patients with conventional two-dimensional ultrasounding and speckle tracking. Subjects were divided into control group and coronary heart disease group according to the results of angiography,while the experimental group was divided into mild disease group（ 25 points）,moderate disease group（ 25 - 50 points）,and severe disease group（ 50 points） on the basis of the Gensini score. Analyzed the high-frequency two-dimensional images with the CMQ software to measure the left ventricular global longitudinal strain（ GLS） and the left ventricular global circumferential strain（ GCS） offline. The time to minimal systolic longitudinal,circumferential strain（ Tssl,Tssc） was measured from the start point of QRS wave of electrocardiogram. The left ventricular 16 segments longitudinal and circumferential standard deviation（ Tssl-SD,Tssc-SD） and maximal difference（ Tssl-Diff,Tssc-Diff） were calculated,which were in terms of systolic asynchrony indexes. Results 1 Compared with the control group,coronary heart disease group of age,systolic blood pressure,diastolic blood pressure,body mass index（ BMI）,heart rate,E / A had no statistically significant difference while LA increased（ P 〈0. 05）; 2 Each group＇s GLS,GCS of coronary heart disease was lower than the control group（ P 〈0. 05）. GLS and GCS overall trends showed progressive decrease as Gensini increasing; 3 The severe disease group Tssl-SD and Tssl-Diff significantly increased（ P 〈0. 01） when compared with the control group while moderate disease group Tssl-SD and Tssl-Diff increased（ P 〈0. 05）; mild disease group Tssl-SD and Tssl-Diff were not statistically significant. Tssc-SD and Tssc-Diff between the two groups were not statistically significant; 4 The correlation analysis of the coronary heart disease group between the left ventricular systolic synchrony and ejection fraction： Tssl-SD,Tssl-Diff negative correlation with LVEF. Conclusion 2DSTI can evaluate coronary artery disease patients＇ left ventricular systolic function and synchrony accurately,which can be a noninvasive examination method for coronary heart disease＇s early diagnosis,selection of treatment regimen and can also reduce the incidence of cardiovascular events.