超声四维应变成像技术预测冠心病患者PCI术后左室心肌功能改善的研究

Application of four-dimensional strain imaging on the prediction of left ventricular function improvement of coronary heart disease after percutaneous coronary intervention

目的:探讨四维应变成像(four-dimensional strain imaging,4D-SI)技术预测经皮冠状动脉介入(percutaneous coronary intervention,PCI)术冠心病患者左心功能改善的临床价值。方法:选取经冠脉造影诊断为冠心病且成功进行PCI术的患者55例,以PCI术后6个月较术前左室射血分数(left ventricular ejection fraction,LVEF)改善(ΔLVEF)≥5%将冠心病患者分为左心功能改善组(A组)和未改善组(B组)。分别于PCI术前及术后6个月对各组患者进行常规超声心动图检查,测量左室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左室收缩末期容积(left ventricular end-systolic volume,LVESV)、LVEF;应用自动功能成像(automated function imaging,AFI)技术测量二维整体峰值纵向应变(two-dimensional global longitudinal peak strain,2D-GLPS);并应用4D-SI技术测得四维整体峰值长轴应变(global longitudinal peak strain,4DGLPS)、环向应变(global circumferential peak strain 4D-GCPS)、面积应变(global area peak strain,4D-GAPS)及径向应变(global radial peak strain,4D-GRPS)参数指标。结果:A组PCI术前及术后6个月2D-GLPS、4DGLPS、4D-GCPS、4D-GAPS和4D-GRPS均明显高于B组(P<0.05)。单参数受试者工作特征曲线(ROC曲线)分析结果显示4D-GLPS的曲线下面积(AUC)较大,为0.944,灵敏度及特异度较高,分别为91.3%、93.8%,截断值为-16.5%;在多参数联合分析中,四维应变参数联合二维应变参数的AUC较大,为0.969,灵敏度及特异度较高,分别为95.7%、90.6%。结论:4D-SI技术能更准确预测冠心病患者PCI术后左室心肌功能的改善,其中4D-GAPS及4D-GCPS能够作为术后左心整体功能改善的独立预测指标。

Objective： To clarify the role of the newly developed four-dimensional strain imaging（4D-SI） in the prediction of the left ventricular function improvement after percutaneous coronary intervention（PCI）.Methods： 55 patients diagnosed with coronary heart disease（CHD） by coronary angiography and successfully provided with PCI were recruited.After 6 months of follow up,the CHD patients were grouped into A and B group based on whether having left ventricular function recovery or not.Before and after PCI,left ventricular end-systolic volume（LVESV）,left ventricular end-diastolic volume（LVEDV） and left ventricular ejection fraction（LVEF） by echocardiography,the global longitudinal peak strain（2D-GLPS） by strain imaging using automated function imaging（AFI）,global longitudinal peak strain（4D-GLPS）,circumferential peak strain（4D-GCPS）,radial peak strain（4D-GRPS） and area peak strain（4D-GAPS） by 4D-SI were assessed.Results： Before and after PCI,all left ventricular strain values of A group were higher than those of B group（P〈0.001）; the single parameter mode of ROC curve analysis showed that the area under the ROC curve（AUC）（0.944）,sensitivity（91.3%） and specificity（93.8%） of 4D-GAPS were relatively higher than other strain parameters.The single technology mode of ROC curve analysis showed that AUC（0.969）,sensitivity（95.7%） and specificity（90.6%） of 4D-SI were higher than those of the AFI-based longitudinal strain.Conclusion： 4D-SI is a more accurate and comprehensive method in the prediction of the left ventricular myocardial function recovery,and 4D-GAPS,a novel automatic index,as well as4D-GCPS,can act as independent predictors in the left ventricular myocardial function recovery.