二维超声斑点追踪成像技术在早期心肌缺血诊断中的应用价值

Application value of two-dimensional speckle tracking ultrasound in the diagnosis of early myocardial ischemia

目的探讨超声斑点追踪成像技术对早期心肌缺血的诊断价值。方法选取2017年1月至2020年3月本院收治的87例心肌缺血患者作为观察组,另选取同期进行健康检查的87名体检者作为对照组。采用二维斑点追踪成像技术对观察组和对照组进行检查,分别采集两组LVEF、E/A、LAVS、LAVD、LAVP、LAAEF及LAPEF数值。测量心率、LVEDD、LVEDV、LVESV、LVEF及舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值(E/A),采集3个心动周期的图像资料和心尖部6节段(SL6A)、中间部6节段(SL6M)、基底部6节段(SL6S)、基底部+中间部+心尖部节段(SL17)、左室整体18节段(SL18)应变均值。分析SL18和SL17的纵向应变值的诊断价值。结果观察组LVEDD、LVEDV、LVESV、LVEF均明显高于对照组,E/A明显低于对照组,差异均有统计学意义(P<0.05)。观察组SL6A、SL6M、SL6S、SL17及SL18均明显高于对照组,差异均有统计学意义(P<0.05)。观察组SL18和SL17诊断心肌缺血的截断值分别为-19.85%、-18.73,灵敏度为分别为85.63%、84.61%,特异性分别为75.23%和85.72%。,SL17与SL18诊断心肌缺血的敏感性比较差异无统计学意义,SL17特异性高于SL18,SL18综合价值高于SL17。结论二维超声斑点追踪技术通过测量左心室纵向应变,能在早期敏感而准确的发现心肌缺血,客观反映心肌缺血时心肌整体及局部功能变化。

Objective To investigate the diagnostic value of ultrasonic spot tracking imaging in early myocardial ischemia.Methods 87 cases of patients with myocardial ischemia admitted to our hospital from January 2017 to March 2020 were selected as the observation group,and 87 cases of physical examination during the same period were selected as the control group.LVEF,E/A,LAVS,LAVD,LAVP,LAAEF and LAPEF values were collected in the two groups and the observation group and the control group were detected by two-dimensional speckle tracking imaging technique.Heart rate,LVEDD,LVEDV,LVESV,LVEF and the ratio of early diastolic mitral flow velocity to late diastolic mitral flow velocity(E/A)were measured.Then the image data of 3 cardiac cycles were collected,and then the mean strain of 6 apex segments(SL6A),6 middle segments(SL6M),6 basal segments(SL6S),basal+middle+apex segments(SL17),and 18 left ventricular whole segments(SL18)were analyzed.The diagnostic value of the longitudinal strain values of SL18 and SL17 was analyzed.Results The LVEDD,LVEDV,LVESV,LVEF in the observation group were significantly higher than those in the control group,E/A was significantly lower than the control group,the difference was statistically significant(P<0.05).SL6A,SL6M,SL6S,SL17 and SL18 in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The truncation values of SL18 and SL17 in the diagnosis of myocardial ischemia in the observation group were-19.85%and-18.73,respectively,the sensitivity were 85.63%and 84.61%,respectively,and the specificity was 75.23%and 85.72%,respectively.SL17 and SL18 showed no statistically significant difference in the sensitivity of myocardial ischemia diagnosis.The specificity of SL17 was higher than that of SL18,and the comprehensive value of SL18 was higher than that of SL17.Conclusion By measuring the longitudinal strain of the left ventricle,the two-dimensional ultrasonic spot tracking technique can detect myocardial ischemia sensitively and accurately in the early stage,and objectively reflect the changes of the overall and local myocardial function during myocardial ischemia..