心肌声学造影结合斑点追踪技术评价冠心病患者心肌灌注及收缩功能

Evaluation of the myocardial perfusion and systolic function in patients with coronary heart disease by myocardial contrast echocardiography and speckle tracking imaging

目的应用心肌声学造影结合二维斑点追踪技术评价冠心病患者心肌灌注及收缩功能。方法选取35例健康志愿者为正常对照组,40例冠心病患者为病例组,将病例组供血冠状动脉有狭窄的心肌节段根据狭窄程度划分为三组:轻度狭窄组、中度狭窄组、重度狭窄组(<50%、50%~75%、> 75%)。对所有研究对象进行心肌声学造影和二维斑点追踪检查,获得平台峰值强度A、曲线上升斜率β,两者乘积A×β及收缩期纵向峰值应变(LS)。结果与正常对照组相比,轻度狭窄组A、A×β、LS无明显改变,β减低(P <0. 05);中度及重度狭窄组的β、A×β、LS均明显减低(P <0. 01);中度狭窄组A值虽有减低,但差异无统计学意义(P> 0. 05),重度狭窄组A值减低(P <0. 05)。结论冠状动脉轻度狭窄时,通过心肌声学造影可以早期发现冠状动脉微循环灌注异常。冠状动脉中、重度狭窄时,通过心肌声学造影结合斑点追踪技术可以更充分地评价心肌灌注及收缩功能的改变。

Objective To investigate the myocardial perfusion and systolic function in patients with coronary heart disease by myocardial contrast echocardiography（MCE） and two-dimensional speckle tracking imaging（STI）. Methods 35 healthy volunteers were selected as normal control group and 40 patients with coronary heart disease were selected as case group. According to the coronary artery stenosis,the myocardial segments of patients were divided into three groups： mild,middle,and serious（50%,50% - 75%, 〉75%）. All subjects underwent MCE and two-dimensional STI in order to achieve peak strength of platform（A）,curve rise slope（β）,A × β and systolic long-axis strain（LS）. Results By compared with the normal control group,the value of A,A × β and LS in the mild group had no significant changes except the value of β（P〉0. 05）. The value of β,A ×β and LS in the middle and serious group were obviously decreased（P〈0. 01）,but the value of A in the middle group had no distinctly reduction（P〈0. 05）. The value of A had reduction in the serious group（P〈0. 05）. Conclusion During the mild stenosis of the coronary arteries,the microcirculation perfusion of coronary artery can be detected early through the MCE. During the middle or serious stenosis of the coronary artery,MCE combined with the STI can evaluate the changes of myocardial perfusion and systolic function sufficiently.