斑点追踪技术评价慢性冠状动脉综合征微循环病变左心室收缩功能及ATP负荷的影响

Left Ventricular Systolic Function and the Effect of ATP Stress in Chronic Coronary Syndrome with Microvascular Disease Evaluated by Speckle Tracking Echocardiography

目的应用斑点追踪技术(STE)评价慢性冠状动脉综合征(CCS)微循环病变患者早期左心室收缩功能及腺苷三磷酸(ATP)负荷的影响。资料与方法回顾性收集2019年9月—2021年9月浙江大学医学院附属第二医院56例CCS(包括微循环病变33例,无微循环病变23例),并选取24例正常者为对照组,采用STE评估左心室整体和局部心肌纵向应变及ATP负荷的影响。结果微循环病变组左心室整体纵向应变(GLS)及前间隔、前壁、前侧壁和下壁心肌纵向应变绝对值低于对照组(F=4.47、2.75、2.60、6.24、3.70,P均<0.05),无微循环病变组左心室GLS及前间隔、前壁、下侧壁、下壁和后间隔心肌纵向应变结果与对照组比较差异无统计学意义(F=4.47、2.75、2.60、1.02、3.70、1.06,P均>0.05)。ATP负荷后,与各组基础状态比较,微循环病变组左心室GLS和前间隔、前壁、前侧壁、下侧壁、下壁及后间隔心肌的纵向应变绝对值增加(t/Z=4.31、3.52、4.95、3.32、3.22、2.52、4.07,P均<0.05),无微循环病变组左心室GLS和前间隔、前壁、前侧壁、下壁和后间隔心肌的纵向应变绝对值增加(t/Z=6.07、2.28、4.12、5.02、3.22、3.96,P均<0.05)。结论CCS微循环病变患者可能存在早期左心室收缩功能受损,ATP负荷可改善CCS患者的左心室心肌收缩功能。

Purpose To evaluate the early left ventricular systolic function and the effect of ATP stress in chronic coronary syndrome(CCS)with microvascular disease via speckle tracking echocardiography(STE).Materials and Methods Fifty-six patients with CCS(including 33 patients with microvascular disease and 23 patients without microvascular disease)hospitalized in the Second Affiliated Hospital of Zhejiang University from September 2019 to September 2021,and 24 controls were enrolled as the control group.STE was used to analyze the left ventricular global and regional longitudinal strain and the effect of ATP stress.Results The absolute value of left ventricular global longitudinal strain(GLS)as well as anteroseptal,anterior,anterolateral and inferior longitudinal strains in microvascular disease group were significantlylower than those in control group(F=4.47,2.75,2.60,6.24,3.70,all P<0.05),while the left ventricular GLS,anteroseptal,anterior,inferolateral,inferior and inferoseptal longitudinal strains in non-microvascular disease group showed no significant differences compared to control group(F=4.47,2.75,2.60,1.02,3.70,1.06,all P>0.05).After ATP stress,the left ventricular GLS and anteroseptal,anterior,anterolateral,inferolateral,inferior,inferoseptal longitudinal strains in microvascular disease group significantly increased(t/Z=-4.31,3.52,4.95,3.32,-3.22,2.52,4.07,all P<0.05),as well as the left ventricular GLS and anteroseptal,anterior,anterolateral,inferior,inferoseptal longitudinal strains in non-microvascular disease group(t/Z=6.07,2.28,4.12,5.02,3.22,3.96,all P<0.05)compared with the initial situation of each group.Conclusion Left ventricular systolic function may be early impaired in CCS patients with microvascular disease,while ATP stress can effectively improve systolic function.