二维斑点追踪成像技术在冠状动脉狭窄诊断中的应用

Application of 2D Speckle Tracking Imaging in the Diagnosis of Coronary Artery Stenosis

目的:探讨二维斑点追踪技术(Two-dimensional speckle tracking imaging,2D-STI)在冠状动脉狭窄诊断中的应用。方法:选择本院2016年6月-2017年1月收治入院的冠心病(CHD)患者80例进行心脏超声2D-STI检查,根据CADi评分标准对纳入患者的冠状动脉造影结果进行评分,分别计算心肌纵向应变(longitudial strain,LS)、径向应变(radial strain,RS)及圆周应变(circumferential strain,CS),判断CHD患者冠状动脉狭窄程度。结果:80例患者共检测506段心肌,2D-STI追踪成功416段,成功率为82.21%。冠脉造影结果显示,正常73段,轻度狭窄93段,中度狭窄114段,重度狭窄136段,其中单支病变29例,两支病变20例,三支病变31例。正常心肌与轻度狭窄的各参数比较,差异均无统计学意义(P>0.05);中度狭窄的LS明显低于正常心肌和轻度狭窄,差异均有统计学意义(P<0.05);而中度狭窄的CS和RS与正常心肌和轻度狭窄比较,差异均无统计学意义(P>0.05);重度狭窄的RS、CS、LS均明显低于正常心肌、轻度狭窄和中度狭窄,差异均有统计学意义(P<0.05)。GLS判断重度狭窄的敏感度、特异度及AUC分别为82.35%、80.43%、0.831;GCS判断重度狭窄的敏感度、特异度及AUC分别为76.47%、76.09%、0.797;GRS判断重度狭窄的敏感度、特异度及AUC分别为97.06%、78.26%、0.880。结论:2D-STI技术可为冠心病左室同步性的评价提供客观的参考依据。冠状动脉狭窄程度>50%时,其支配心肌收缩功能已减低,纵向应变可准确评价不同程度冠状动脉狭窄患者心肌功能改变。

Objective： To study the two-dimensional speckle tracking imaging （ 2D-STI ） in the diagnosis of coronary artery stenosis.Method： 80 cases of coronary heart disease （ CHD ）were checked by cardiac ultrasound 2D-STI from June 2016 to January 2017, according to the CADi score standard of coronary angiography in patients with into the rating results, the myocardial longitudinal strain （ LS ）, radial strain （ RS ） and circumferential strain （CS） were calculated, the degree of coronary stenosis in CHD patients were determined.Result： A total of 506 segments of myocardium were detected in 80 patients, 2D-STI successfully tracked 416 segments, with a success rate of 82.21%.The results of the coronary angiography showed, normal 73 segments, mild stenosis 93 segments, moderate stenosis 114 segments, severe stenosis 136 segments, including 29 cases of single-branch lesions, 20 cases of two lesions, 31 cases of 3 lesions.There were no significant differences between the parameters of normal myocardium and mild stenosis （ P〉0.05 ） .LS of moderately narrow was significantly lower than that in normal myocardium and mild stenosis, the differences were statistically significant （ P〈0.05 ） .CS and RS of moderately narrow compared with normal myocardium and mild stenosis, the differences were no statistically significant （ P〉0.05 ） .RS, CS and LS of severe stenosis were significantly lower than those of normal myocardium, mild stenosis and moderate stenosis, the differences were statistically significant （ P〈0.05 ） .GLS estimates that the sensitivity, specificity and AUC of severe stenosis were 82.35%, 80.43% and 0.831.GCS judged the sensitivity, specificity and AUC of severe stenosis were 76.47%, 76.09% and 0.797.GRS estimates that the sensitivity, specificity and AUC of severe stenosis were 97.06%, 78.26% and 0.880.Conclusion： 2D-STI technique can provide objective reference for the evaluation of left ventricular synchronicity of coronary heart disease.When the degree of coronary stenosis 〉50%, the myocardial contractile function is reduced, and the longitudinal strain can be used to evaluate the myocardial function changes in patients with different degree of coronary stenosis.