三维斑点追踪成像评价不同病变血管的冠心病患者左心室扭转运动

Three-dimensional speckle tracking imaging in evaluation of patients with different vascular lesions of coronary heart disease twist motion

目的 应用三维斑点追踪成像（3D-STI）技术评价不同病变血管的冠心病患者左心室心肌扭转运动.方法 收集2013年7月至2016年4月在我院行冠状动脉造影的患者,年龄42-78（63.5±13.7）岁,男性126例,女性94例.根据病变血管将患者分为5组：单支病变3组,分别为LAD组47例、LCX病变组46例、RCA组47例,不同病变程度的冠心病患者在三组中分布均衡;三支病变组40例;正常对照40例.220例研究对象应用三维斑点追踪成像技术获得心尖段、基底段、左室整体扭转角度峰值（PAR、PBR、Ptw）及达峰时间（PART、PBRT、PtwT）、左室射血分数（LVEF）等指标,比较各组与正常组之间上述指标的差异.结果 LAD组PART（398.2±120.6）ms、PtwT（395.1±114.0）ms,均较对照组延长,PAR（5.55±3.71）°、Ptw（10.24±5.50）°较对照组减低,差异有统计学意义（P＜0.05）.LCX组、RCA组的PBRT较对照组延长,而扭转参数与对照组比较未见统计学差异（P＞0.05）.与对照组比较,多支病变组PART、PBRT、PtwT延长,PAR、PBR、Ptw减低;扭转角度峰值与LVEF均有一定相关性,PAT与LVEF相关性最佳（r=0.61,P＜0.05）.结论 3D-STI可以检测不同病变血管的冠心病患者左心室扭转运动,不同病变血管的冠心病患者左心室扭转运动有所不同.

Objective Evaluation of twist motion in patients with different left ventrieular coronary lesion by applying three-dimensional speckle tracking imaging （3D-STI）. Methods Patients with coronary angiography were collected from July 2013 to April 2016 in our hospital, aged 42-78 （63.5±13.7）years, 126 cases of male, female 94 cases. The patients were divided into 5 groups according to the lesion vessel： single vessel disease group, 47 cases of LAD group, 46 cases of LCX group, 47 cases of RCA group, 40 cases of three vessel disease group, 40 cases of normal control group. Apical segments, basal segment, left ventricular torsion angle peak （PAR, PBR, Ptw） and time to peak （PART, PBRT, PtwT）, left ventricular ejection fraction （LVEF） were ob- tained by three-dimensional speckle tracking imaging. The differences between these indicators and other indicators in each group were compared. Results PART （398.2±120.6）ms and PtwT（395.1±114.0）ms in LAD group were statistical significantly lower than the control group[PAR（5.55±3.71 ）°, Ptw （10.24±5.50）° ]（P〈0.05 ）; PBRT was prolonged in LCX group and RCA group when compared with normal group, but twist parameters compared with the normal group the difference was not statistically significant （P〉0.05）; PART, PBRT, PtwT in multi-vessel disease patients were prolonged, and PAR, PBR, Ptw were lower compared with the normal group. The values of PAR, PBR, Ptw in CHD groups have some correlation with LVEF, and PAT has best correlation with LVEF （r= 0.61, P〈0.05 ）. Conclusion Twist motion of left ventricle in coronary heart disease can be detected by using 3D-STI, and the twist motion is different in different coronary lesion artery patients.