四维应变技术评价冠心病患者PCI前后左室舒张功能的研究

Evaluation of left ventricular diastolic function in patients with coronary heart disease before and after PCI by four-dimensional strain imaging

目的应用四维应变成像（4D-SI）技术评价冠心病患者PCI术前后左室舒张功能。方法根据疑似冠心病患者行冠脉造影术及左心导管检查结果选取4_4例患者，其中冠心病并左室舒张功能不全患者（需行PCI术）26例为病例组，冠心病左室舒张功能正常患者18例为对照组。分别采集对照组及病例组PCI术前、术后3个月的常规超声心动图检测指标，测量左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）；运用4D-SI技术测得收缩末期纵向应变（GLS）、径向应变（GRS）、面积应变（GAS）、圆周应变（GCS）、纵向应变显像舒张指数（LSI-DI）、面积sI-DI（ASI-DI）、径向sI-DI（RSI-DI）、圆周sI-DI（CSI-DI）。结果①病例组GLS、GCS、GAS、GRS、LSI-DI、CSI-DI、ASI-DI、RSI-DI均小于对照组（P〈0．05）；病例组术后3个月各参数均大于术前（P〈0．05）；②ROC曲线分析结果显示，LSI-DI的曲线下面积（auc）0．921，截值为50．107％，灵敏度和特异度分别为89．2％和81．3％；ASI-DI的AUC0．887，截值为49．233％，灵敏度和特异度分别为86．4％和79．1％。结论4D-sI的相关指标在一定程度上可评价冠心病患者左室舒张功能受损及PCI术后左室舒张功能的改善情况。

Objective This study was to evaluate the left ventricular （LV） diastolic function in coronary heart disease（CHD ） patients before and after percutaneous coronary intervention（PCI ） by four-dimensional strain imaging （4D-SI）. Methods Based on the results of coronary angiography and left cardiac catheterization, the pa- tients suspected of having CHD were grouped into two groups, case group： the patients were diagnosed with CHD, LV diastolic dysfunction and were successfully underwent PCI; control group： the patients with normal coronary ar- teries angiograms and normal LV diastolic function. In the control group and the case group before and after PCI, LVESV, LVEDV and LVEF by routine transthoracic echocardiography, GLS, GCS, GRS, GAS, LSI-DI, CSI- DI, RSI-DI, and ASI-DI by 4D-SI were assessed. Results （1）GLS, GCS, GAS, GRS, LSI-DI, CSI-DI, ASI- DI, RSI-DI of the case group were lower than those of the control group （P〈0.05）; all LV strain values of the case group after PCI were higher than those before PCI（P〈0.05）. （2）ROC curve analysis showed that AUC （0.921, 0.887）, sensitivity（89.2%, 86.4%） and specificity（81.3%, 79.1%） of LSI-DI and ASI-DI were relatively higher than other strain parameters. Conclusion 4D-SI strain index can evaluate LV diastolic dysfunction and LV dias- tolic function recovery after PCI in a certain extent.