二维斑点追踪成像技术及血清脑钠肽对冠心病右心功能的评价分析

Evaluation and analysis of 2D-STE and serum BNP on right ventricular functions in patients with coronary heart disease

目的探讨二维斑点追踪成像技术(2D-STE)联合血清脑钠肽(BNP)对冠心病右心室功能的评价作用。方法选择2018年1月至2019年6月在右江民族医学院附属医院心血管内科住院经冠脉造影确诊为冠心病的患者。根据冠脉造影的结果,按照Gensini积分评分的标准,将冠心病患者分为:冠心病轻度组(Gensini积分≤50分)23例,冠心病重度组(Gensini积分>50分)19例。另选取门诊健康体检者25人作为对照组。检测并比较各组受检者的左室射血分数(LVEF)、BNP、右室游离壁各节段纵向收缩期应变(LS)、应变率(LSRs)及右室整体应变(GLS),分析GLS、LVEF、BNP三者的相关性。结果冠心病轻度组、重度组与对照组三组间LVEF、BNP测值比较差异有统计学意义(P<0.01)。冠心病轻度组右室游离壁心尖段应变值(LS-AP)与对照组比较差异有统计学意义(P<0.01)。冠心病轻度组右室游离壁基底段应变值(LS-B)及中间段应变值(LS-M)与对照组比较差异无统计学意义(P>0.05)。冠心病轻度组右室游离壁各节段应变率(LSRs)与对照组比较差异有统计学意义(P<0.01)。冠心病重度组右室游离壁各节段LS、LSRs值与冠心病轻度组、对照组比较差异有统计学意义(P<0.01)。冠心病轻度组、冠心病重度组、对照组三组间右室整体GLS值比较差异有统计学意义(P<0.01)。BNP与LVEF、GLS有较好的相关性(P<0.001)。结论血清BNP和GLS具有明显相关性,二者联合检测有利于评价冠心病右心室收缩功能,2D-STE技术操作简单、安全、方便、可重复性强,具有临床意义。

Objective To explore the evaluation value of 2D-STE combined with serum brain natriuretic peptide(BNP)on right ventricular functions in patients with coronary heart disease.Methods Patients diagnosed as coronary heart disease by coronary angiography in Cardiovascular Department of Affiliated Hospital of Youjiang Medical University of Nationalities from January 2018 to June 2019 were selected.According to the results of coronary angiography and the criteria of Gensini score,patients with coronary heart disease were divided into mild coronary heart disease group(23 cases,Gensini score≤50)and severe coronary heart disease group(19 cases,Gensini score>50).In addition,25 healthy outpatients were selected as control group.And then,left ventricular ejection fraction(LVEF),serum BNP,longitudinal systolic strain(LS)of all segments of right ventricular free wall,strain rate(LSRs)and right ventricular global strain(GLS)were measured and compared,and the correlation of GLS,LVEF and BNP was analyzed.Results There were statistically significant differences in LVEF and BNP values between the mild coronary heart disease group,the severe coronary heart disease group and the control group(P<0.01).The right ventricular free wall apical strain(LS-AP)in the mild coronary heart disease group was significantly different from that in the control group(P<0.01).There was no statistically significant difference in right ventricular free wall basal segment strain(LS-B)and right ventricular free wall mid segment strain(LS-M)between the mild coronary heart disease group and the control group(P>0.05).There was statistically significant difference in LSRs between the mild coronary heart disease group and the control group(P<0.01).The values of LS and LSRs in each segment of right ventricular free wall in the severe coronary heart disease group were significantly different from those in the mild coronary heart disease group and the control group(P<0.01).There was statistically significant difference in the right ventricular GLS between the mild group,the severe group and the control group(P<0.01).There was a good correlation between BNP and LVEF,GLS(P<0.001).Conclusion There is a good correlation between serum BNP and GLS.The combined detection of BNP and GLS is helpful to evaluate the right ventricular systolic function of coronary heart disease.2D-STE is simple,safe,convenient and reproducible,which has clinical significance.