三维斑点追踪技术评价无症状心肌缺血患者左室旋转及扭转

Evaluation of three-dimensional speckle tracking echocardiography to left ventricular rotation and twist in patients with silent myocardial ischemia

目的:应用三维斑点追踪技术(3D-STE)分析无症状心肌缺血(SMI)患者左室旋转及扭转特征,探讨3D-STE对无症状心肌缺血的诊断价值。方法:选取66例SMI患者作为SMI组,以Gensini评分为依据分为3个亚组:轻度组(n=16)、中度组(n=26)、重度组(n=24);选取30例选择性冠状动脉造影阴性的受检者作为对照组。计算室壁运动积分指数(WMSI),测量左室射血分数(LVEF)、心尖水平旋转角度峰值(Prot-A)、心底水平旋转角度峰值(Prot-B)、左室整体旋转角度峰值(LVrot)、左室整体扭转角度峰值(LVtw),比较各组参数。结果:SMI各组随病变严重程度的增加,WMSI呈递增趋势,而LVEF,Prot-A,Prot-B,LVrot,LVtw呈递减趋势,且均与Gensini评分呈显著相关(P<0.05)。LVEF,WMSI,Prot-A,Prot-B,LVrot,LVtw对SMI均有较高的诊断价值,其中以3D-STE测定的LVtw诊断价值最高。结论:应用3D-STE对SMI患者进行左室旋转与扭转评价,可以评估其心肌缺血的严重程度。

Objective： To analyze the characteristics of left ventricular rotation and twist in patients with silent myocardial ischemia （SMI） by three-dimensional speckle tracking echocardiography （3D-STE）, and to explore the diagnostic value of this method for SMI. Methods： According to Gensini score, 66 patients with SMI were divided into 3 subgroups： a mild lesion group （n=16）, a moderate lesion group （n=26） and a severe lesion group （n=24）. Thirty patients with negative results in selective coronary angiography served as a control group. The parameters of wall motion score index （WMSI）, left ventricular ejection fraction （LVEF）, peak basal rotation （Ptw-B）, peak apical rotation （Prot-A）, left ventricular peak apical rotation （LVrot）, left ventricular peak apical twist （LVtw） were measured.Results： In the SMI group, with an increase in severity of myocardial ischemia, LVEF, Prot-A, Prot-B, LVrot, LVtw showed a decrease trend while WMSI exhibited an opposite phenomenon （P〈0.05）, and all of them displayed a significant corelation with Gensini score （P〈0.05）. In the diagnosis of SMI, all of the above-mentioned parameters were highly sensitive and specific. 3D-STE showed the highest diagnostic value for LVtw. Conclusion： Left ventricular rotation and twisting motion monitered by 3D-STE can evaluate the severity of myocardial ischemia in patients with SMI.