斑点追踪技术评估升主动脉弹性与冠心病患者冠脉病变的相关性研究

Correlation between the ascending aortic elasticity evaluated by speckle tracking imaging and the coronary artery lesion of patients with coronary heart disease

目的:使用二维斑点追踪技术(two-dimensional speckle tracking imaging,2D-STI)评估冠心病患者升主动脉弹性功能,并探讨其与冠脉病变程度的相关性。方法:纳入三峡大学第一临床医学院宜昌市中心人民医院2020年1月至2021年3月因胸闷、胸痛住院的疑似冠心病患者206例。均行超声心动图检查,计算升主动脉扩张性(aortic distensibility,AoDIS)、升主动脉僵硬指数(aortic stiffness index,AoSI)及升主动脉应变值等常规动脉僵硬度指标。使用2D-STI测量整体周向升主动脉应变峰值(global circumferential acscending aortic peak strain,GCAAS)及周向升主动脉峰值应变率(crcumferential acscending aortic peak strain rate,CAASR)。依据冠脉造影结果及Gensini积分(Gensini score,GS)分为冠心病组(轻度组、中度组及重度组)和对照组。结果:(1)冠心病组AoDIS、升主动脉应变值、GCAAS、CAASR均低于对照组,AoSI高于对照组(均P<0.05)。(2)单因素logistic回归分析显示,男性、糖尿病、高血压、左室射血分数(left ventricular ejection fraction,LVEF)、AoDIS、GCAAS、CAASR均是冠心病的危险因素(均P<0.05)。经多因素分析后,GCAAS仍是冠心病的独立危险因素(P<0.001)。(3)冠心病组中,GCAAS及CAASR随着冠脉病变严重程度增加而减少(P=0.003,P=0.015)。与轻度组相比,重度组GCAAS、CAASR明显更低(P=0.001,P=0.012)。Spearman相关分析表明,GCAAS与GS呈中度相关(r_(s)=-0.411,P<0.001),CAASR与GS呈弱相关(r_(s)=-0.228,P=0.027)。结论:斑点追踪技术升主动脉应变优于常规超声,能够反映冠心病患者升主动脉弹性的早期改变,整体周向升主动脉应变与冠心病的发生及冠脉病变严重程度密切相关。

Objective:To evaluate the elastic function of ascending aortic in patients with coronary heart disease(CHD) by twodimensional speckle tracking imaging(2D-STI),and to explore its correlation with the degree of coronary artery lesion.Methods:A total of 206 patients with suspected CHD who were admitted to our hospital due to chest tiredness or chest pain from January 2020 to March 2021 were enrolled in the study.All subjects underwent echocardiography,and routine arterial stiffness indexes such as the ascending aortic distensibility(AoDIS),ascending aortic stiffness index(AoSI) and ascending aortic strain values were calculated.Then 2D-STI was used to measure the global circumferential ascending aortic peak strain(GCAAS) and circumferential ascending aortic peak strain rate(CAASR).According to the results of coronary angiography and Gensini score(GS),they were divided into CAD group(mild group,moderate group and severe group) and control group.Results:(1)AoDIS,ascending aortic strain value,GCAAS and CAASR in the CHD group were lower than those in the control group,and AoSI in the CHD group was higher than that in the control group(all P<0.05).(2)Univariate logistic regression analysis showed that man,diabetes,hypertension,left ventricular ejection fraction (LVEF),Ao DIS,GCAAS and CAASR were all risk factors for CHD(all P<0.05).After multivariate analysis,GCAAS was still a risk factor for CHD(P<0.001).(3)In the CHD group,GCAAS and CAASR decreased as the severity of coronary artery lesion increased(P=0.003,P=0.015).GCAAS and CAASR in the severe group were significantly lower than those in the mild group(P=0.001,P=0.012).Spearman correlation analysis showed that GCAAS was moderately correlated with GS(r_(s)=-0.411,P<0.001),while CAASR was weakly correlated with GS(r_(s)=-0.228,P=0.027).Conclusion:The ascending aortic strain of 2D-STI is superior to conventional ultra-sound technology in reflecting the early changes in the elasticity of the ascending aortic in patients with CHD.The global circumferen-tial ascending aortic strain is closely related to the occurrence and progression of CHD and the severity of coronary artery lesion.