心肌分层应变对冠状动脉复杂多支病变的预测价值

The value of layer-specific strain in identifying complex coronary artery disease

目的:应用心肌分层应变(LSS)评估可疑冠心病患者左心室功能,以了解LSS是否能预测冠状动脉复杂多支病变。方法:连续选取2014年1月至2015年12月在台州医院住院治疗的可疑冠心病患者116例,所有患者均行冠状动脉造影,根据冠状动脉造影结果分成3组:对照组29例(冠状动脉主干及主要分支狭窄<50%)、1～2支病变组43例(1～2支主要分支狭窄≥50%)和复杂多支病变组44例(左主干和/或3支主要分支狭窄≥50%),利用LSS测量左心室内膜、中层、外膜整体纵向(GLS)及圆周应变(GCS),通过绘制ROC曲线分析GLS和GCS预测复杂多支病变的价值。结果:与对照组比较,复杂多支病变组左心室内膜、中层、外膜GLS和GCS均明显降低,差异有统计学意义(P<0.01);与1～2支病变组比较,复杂多支病变组左心室内膜、中层、外膜GLS和内膜、中层GCS明显降低,差异有统计学意义(P<0.05);ROC曲线显示GLS预测复杂多支病变的准确性较高,内膜GLS的最佳截断值为-21.00%,敏感性和特异性分别为75.0%、75.0%,中层GLS的最佳截断值为-18.65%,敏感性和特异性分别为72.2%、70.5%,外膜GLS的最佳截断值为-15.95%,敏感性和特异性分别为73.6%、70.5%,其中内膜GLS准确性最高,约登指数为0.50。结论:GLS测量尤其是内膜GLS也许能成为一种预测是否存在冠状动脉复杂多支病变的无创方法。

Objective: To apply layer-specific strain (LSS) to assess the left ventricular of patients with suspected coronary artery disease (CAD) to identify whether myocardial strain can predict the presence of complex multi-vessel disease of the coronary artery. Methods: A total of 116 patients with suspicious CAD in Taizhou Hospital from January 2014 to December 2015 were included. All patients were underwent coronary angiography and were divided into 3 groups: control group (no significant coronary stenosis was considered as a <50% reduction of vessel diameter in every coronary artery and its main branch,n=29),1-2 vessel disease group [1-vessel disease (1VD) or 2-vessel disease (2VD) was defined as a ≥50% reduction of lumen diameter in 1 or 2 major coronary artery n=43] and complex CAD group (left main branch and/or 3VD of each coronary lesion with ≥50% stenosis,n=44). Endocardial,mid-myocardial,epicardial global longitudinal (GLS) and circumferential stain (GCS) of left ventricules were measured by LSS. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of GLS and GCS for complex multivessel disease. Results: Compared with controls,endocardial,mid-myocardial,epicardia GLS and GCS in complex CAD were all statistically reduced (P<0.01). Compared with 1-2VD,endocardial,mid-myocardial,epicardial GLS and endocardial,mid-myocardial GCS in complex CAD were all significantly reduced (P<0.05). By ROC analysis,GLS showed better diagnostic accuracy for identifying complex CAD: the cutoff value of endocardial GLS was -21.00%; the sensitivity and specificity were 75.0% and 75.0% respectively; the cutoff value of mid-myocardial GLS was -18.65%; the sensitivity and specificity were 72.2% and 70.5% respectively; the cutoff value of epicardial GLS was -15.95%; the sensitivity and specificity were 73.6% and 70.5% respectively. However,endocardial GLS demonstrated the highest value with 0.50 in Youden index. Conclusion: The measurement of GLS,especially endocardial GLS,might be a noninvasive method to identify complex CAD.