实时三维斑点追踪成像技术对冠心病并二尖瓣反流临床应用价值

APPLICATION VALUE OF REAL-TIME THREE-DIMENSIONAL SPECKLE TRACKING IMAGING IN PATIENTS WITH CORONARY HEART DISEASE AND MITRAL REGURGITATION

目的评价实时三维斑点追踪成像技术用于冠心病合并二尖瓣反流的临床价值。方法选择我院2017年2月—2019年3月收治的110例冠心病病人作为冠心病组,根据相关影像学征象及相关诊断标准将该组病人再分为单纯冠心病组与合并二尖瓣反流组,抽取同期在我院体检的100例健康者作为对照组。比较3组受检者超声心动图、实时三维斑点追踪成像左心房相关参数水平,以及实时三维斑点追踪成像心肌应变相关参数水平,采用双变量Pearson相关性分析检验冠心病合并二尖瓣反流病人左心房射血分数(LAEF)与主要心肌应变参数相关性。结果与对照组比较,合并二尖瓣反流组舒张早期二尖瓣血流峰速度(E)/舒张早期二尖瓣环运动峰速度(Em)、左心房内径(LAD)升高,Em/舒张晚期二尖瓣环运动峰速度(Am)、LAEF、左心室射血分数(LVEF)、左心房被动射血分数(LApEF)降低,差异有统计学意义(F=37.686~293.320,t=12.203~34.152,P<0.01)。与单纯冠心病组比较,合并二尖瓣反流组左心房主动收缩前容积(LAVp)、LAD、左心房最小容积(LAVmin)升高,LVEF、Em/Am、LApEF降低,差异有统计学意义(F=30.159~293.320,t=3.994~12.948,P<0.05)。单纯冠心病组、合并二尖瓣反流组左心房纵向及圆周应变(GLS、GCS)较对照组降低,且单纯冠心病组低于合并二尖瓣反流组,差异均有统计学意义(F=123.095、450.012,t=12.405~42.356,P<0.01)。与对照组比较,单纯冠心病组和合并二尖瓣反流组纵向、径向、圆周达峰时间标准差(TLS-SD、TRS-SD、TCS-SD)升高,差异有统计学意义(F=68.975~183.182,t=7.997~22.801,P<0.01)。冠心病合并二尖瓣反流病人的GLS、GCS与LAEF呈负相关(r=-0.612、-0.589,P<0.05),左心房径向应变(GRS)与LAEF呈正相关(r=0.835,P<0.05)。结论实时三维斑点追踪成像技术能够通过检测冠心病合并二尖瓣反流病人左心房容积变化情况、计算其LVEF、追踪其心肌运动,对病人左心房心肌运动改变情况进行准确评价,并可评估病人左心房功能,有重要的临床应用价值。

Objective To investigate the clinical value of real-time three-dimensional speckle tracking imaging in coronary heart disease with mitral regurgitation.Methods A total of 110 patients with coronary heart disease who were treated in our hospital from February 2017 to March 2019 were enrolled,and according to related imaging findings and diagnostic criteria,these patients were divided into coronary heart disease group and coronary heart disease+mitral regurgitation group.A total of 100 healthy individuals who underwent physical examination in our hospital during the same period of time were enrolled as control group.The three groups were compared in terms of echocardiogram,parameters of the left atrium on real-time three-dimensional speckle tracking imaging,and myocardial strain parameters on real-time three-dimensional speckle tracking imaging.A bivariate Pearson correlation analysis was used to investigate the correlation between left atrial ejection fraction(LAEF)and main myocar-dial strain parameters in patients with coronary heart disease and mitral regurgitation.Results Compared with the control group,the coronary heart disease+mitral regurgitation group had significant increases in early diastolic peak mitral flow velocity(E)/early diastolic mitral annular velocity(Em)and left atrium diameter(LAD)and significant reductions in Em/late diastolic mitral annular velocity(Am),LAEF,left ventricular ejection fraction(LVEF),and left atrial passive ejection fraction(LApEF)(F=37.686-293.320,t=12.203-34.152,P<0.01).Compared with the coronary heart disease group,the coronary heart disease+mitral regurgitation group had significant increases in left atrial volume before atrial contraction(LAVp),LAD,and minimum left atrial volume(LAVmin)and significant reductions in LVEF,Em/Am,and LApEF(F=30.159-293.320,t=3.994-12.948,P<0.05).Compared with the control group,the coronary heart di-sease group and the coronary heart disease+mitral regurgitation group had significant reductions in global longitudinal strain(GLS)and global circumferential strain(GCS)of the left atrium,and the coronary heart disease group had significantly lower strains than the coronary heart disease+mitral regurgitation group(F=123.095,450.012;t=12.405-42.356;P<0.01).Compared with the control group,the coronary heart disease group and the coronary heart disease+mitral regurgitation group had significant increases in the standard deviations of longitudinal,radial,and circumferential peak time(TLS-SD,TRS-SD,and TCS-SD,respectively)(F=68.975-183.182,t=7.997-22.801,P<0.01).In the patients with coronary artery disease and mitral regurgitation,GLS and GCS were negatively correlated with LAEF(r=-0.612,-0.589;P<0.05),and global radial strain of the left atrium was positively correlated with LAEF(r=0.835,P<0.05).Conclusion For patients with coronary artery disease and mitral regurgitation,real-time three-dimensional speckle tracking imaging can detect the change in left atrial volume,calculate LVEF,track myocardial motion,accurately evaluate the change in myocardial motion of the left atrium,and assess left atrial function.Therefore,it has an important clinical application value.