3D-STI联合RT-3DE评价单纯左前降支冠状动脉狭窄患者左心室收缩功能及同步性

Left Ventricular Systolic Function and Synchronization in Patients with Simple Left Anterior Descending Coronary Artery Stenosis by 3D-STI and RT-3DE

目的联合应用三维超声斑点成像(3D-STI)与实时三维超声心动图(RT-3DE)评价单纯左前降支(LAD)冠状动脉狭窄患者左心室心肌应变和心肌收缩同步性,探讨三维超声技术诊断冠心病患者心功能改变的临床价值。资料与方法回顾性分析2015年1月-2017年1月于青岛大学附属医院黄岛院区心血管内科就诊、并行经冠状动脉造影检查的冠心病患者60例。按LAD狭窄程度分为A亚组(狭窄率≤70%)30例和B亚组(70%<狭窄率<100%)30例;同时纳入30例健康志愿者为对照组。采用3D-STI软件获得3组受检者LAD供血区域心肌节段的平均纵向应变(MLS)、平均径向应变(MRS)、平均圆周应变(MCS)。采用RT-3DE软件获得3组受检者LAD供血区域节段和左心室16节段的收缩同步性参数,并将心动周期标准化,包括Tmsv Sel-SD/R-R、Tmsv Sel-Dif/R-R、Tmsv 16-SD/R-R、Tmsv 16-Dif/R-R。比较3组受检者上述参数的差异,并分析应变参数和同步性参数之间的相关性。结果 A亚组MLS、MRS和MCS小于对照组,B亚组MLS、MRS和MCS小于A亚组和对照组,差异均有统计学意义(P<0.01);A亚组Tmsv Sel-SD/R-R、Tmsv Sel-Dif/R-R、Tmsv 16-SD/R-R和Tmsv 16-Dif/R-R大于A亚组和对照组,B亚组Tmsv Sel-SD/R-R、Tmsv Sel-Dif/R-R、Tmsv 16-SD/R-R和Tmsv 16-Dif/R-R大于A亚组和对照组,差异均有统计学意义(P<0.01);且Tmsv Sel-SD/R-R、Tmsv Sel-Dif/R-R、Tmsv 16-SD/R-R和Tmsv 16-Dif/R-R与MLS、MRS、MCS均相关(r=0.321~0.529,P<0.01)。结论 3D-STI可评价单纯LAD冠状动脉狭窄患者左心室心肌应变,RT-3DE可评价患者左心室心肌收缩同步性。两者联合应用能更准确地评价冠状动脉狭窄患者的左心室功能变化。

Purpose Three-dimensional-speckle tracking imaging（3D-STI） and real-time three-dimensional echocardiography（RT-3DE） are adopted to evaluate myocardial strain of the left ventricle and synchronization of myocardial contraction in patients with simple left anterior descending coronary artery stenosis to explore clinical value of three dimensional ultrasound in diagnosing cardiac function change in patients with coronary heart diseases. Materials and Methods Sixty patients with coronary heart diseases receiving coronary atherosclerotic heart diseases and coronary angiography in Department of Cardiology, Huangdao Branch, Affiliated Hospital of Qingdao University during January 2015 to 2017 were retrospectively analyzed. According to stenosis degree of left anterior descending coronary（LAD）, these patients were divided into subgroup A（stenosis rate less than or equal to 70%） and subgroup B（stenosis rate between 70% and 100%）, with 30 patients in each group. Meanwhile, 30 healthy volunteers were recruited as control group. 3D-STI software was taken to acquire mean longitudinal strain（MLS）, mean radial strain（MRS） and mean circumferential strain（MCS） of the myocardial segments in the patients＇ LAD blood supply area in the three groups. Systolic synchronization parameters of the segments of patients＇ LAD blood supply area and 16 segments of the left ventricle in the three groups were obtained through RT-3DE software and cardiac cycle was standardized, including Tmsv Sel-SD/R-R, Tmsv Sel-Dif/R-R, Tmsv 16-SD/R-R and Tmsv 16-Dif/R-R. All parameters of the three groups were compared and correlation of strain and synchronization parameters was analyzed. Results MLS, MRS and MCS in subgroup A were lower than subgroup A and control group, and MLS, MRS and MCS in subgroup B were lower than those in subgroup A and control group. The difference was of statistical significance（P〈0.01）. Tmsv Sel-SD/R-R, Tmsv Sel-Dif/R-R, Tmsv 16-SD/R-R and Tmsv 16-Dif/R-R in subgroup A were higher than those in control group. Tmsv Sel-SD/R-R, Tmsv Sel-Dif/R-R, Tmsv 16-SD/R-R and Tmsv 16-Dif/R-R in subgroup B were higher than those in subgroup A and control group. The difference was of statistical significance（P〈0.01）. Tmsv Sel-SD/R-R, Tmsv Sel-Dif/R-R, Tmsv 16-SD/R-R and Tmsv 16-Dif/R-R were correlated with MLS, MRS and MCS（r=0.321-0.529, P〈0.01）. Conclusion 3D-STI can evaluate left ventricular myocardial strain in patients with simple left anterior descending coronary artery stenosis, and RT-3DE can be used to assess left ventricular systolic synchronization of these patients Combination of the two can evaluate more accurately left ventricular metergasis in patients with coronary artery stenosis.