多模态超声评估冠心病患者冠状动脉狭窄程度及预后的价值

Value of Multimodal Ultrasound in Evaluating Coronary Artery Stenosis Degree and Prognosis of Patients with Coronary Heart Disease

目的研究多模态超声评估冠心病患者冠状动脉狭窄程度及预后的价值。方法选择2021年12月至2022年12月泸州市人民医院收治的500例冠心病患者为研究对象,患者均进行多模态超声检查,以数字减影血管造影(DSA)为金标准,分析多模态超声检查冠状动脉狭窄程度的结果及其对冠状动脉狭窄程度≥70%的诊断效能;对比不同冠状动脉狭窄程度的多模态超声指标[整体面积应变(GAS)、整体圆周应变(GCS)、整体径向应变(GRS)、整体纵向应变(GLS)、代谢当量(METs)],采用Pearson相关性分析冠状动脉狭窄程度与多模态超声指标的关系;对比预后不良组与预后良好组多模态超声指标,采用受试者工作特征曲线(ROC曲线)评估多模态超声指标对冠心病患者预后的预测价值。结果经DSA检查冠状动脉狭窄程度显示,病变支数共896支,其中轻度394支、中度331支、重度171支。多模态超声检查冠状动脉狭窄程度显示,轻度389支、中度334支、重度173支。以DSA为金标准,多模态超声检查冠状动脉狭窄程度≥70%的Kappa值为0.892,灵敏度、特异度、准确度分别为91.81%、97.79%、96.65%。不同冠状动脉狭窄程度组GAS、GCS、GRS、GLS、METs水平比较差异有统计学意义(P<0.01),其中冠状动脉中度狭窄组和重度狭窄组GAS、GCS、GRS、GLS水平均高于轻度组,且重度狭窄组均高于中度狭窄组;冠状动脉中度狭窄组和重度狭窄组METs水平低于轻度组,且重度狭窄组低于中度狭窄组(P<0.01)。Pearson相关性分析结果显示,冠状动脉狭窄程度与GAS、GCS、GRS、GLS均呈正相关(r=0.526,P<0.001;r=0.512,P<0.001;r=0.459,P=0.011;r=0.487,P=0.006),与METs呈负相关(r=-0.473,P=0.009)。预后不良组GAS、GCS、GRS、GLS水平均高于预后良好组,METs水平低于预后良好组(P<0.01)。ROC曲线结果显示,GAS、GCS、GRS、GLS、METs的曲线下面积分别为0.859、0.827、0.801、0.812、0.769,联合检测的曲线下面积为0.910。结论多模态超声检查的各指标与冠状动脉狭窄程度具有明显相关性,对冠心病患者的诊断及预后评估具有较高的预测价值。

Objective To study the value of multimodal ultrasound in evaluating the coronary artery stenosis degree and prognosis of patients with coronary heart disease.Methods A total of 500 patients with coronary heart disease admitted to Luzhou People′s Hospital from Dec.2021 to Dec.2022 were included.All the patients had multimodal ultrasound examination to analyze the results of coronary artery stenosis and its diagnostic efficacy for≥70%of coronary artery stenosis using digital subtraction angiography(DSA)as the gold standard.The multi-modal ultrasound indexes[global area strain(GAS),global circumferential strain(GCS),global radial strain(GRS),global longitudinal strain(GLS)and metabolite equivalents(METs)]of different degrees of coronary artery stenosis were compared,and the relationship between the degree of coronary artery stenosis and the multi-modal ultrasound indexes was analyzed by Pearson correlation.The multimodal ultrasound indicators of the poor prognosis group and the good prognosis group were compared.The predictive value of multimodal ultrasound indicators for the prognosis of patients with coronary heart disease was evaluated by receiver operating characteristic curve(ROC curve).Results The degree of coronary artery stenosis examined by DSA showed that the number of diseased branches was 896,including 394 mild,331 moderate and 171 severe.Multimodal ultrasound examination of the degree of coronary artery stenosis showed mild 389 branches,moderate 334 branches,and severe 173 branches.Using DSA as the gold standard,the Kappa value of≥70%of coronary artery stenosis was 0.892,and the sensitivity,specificity and accuracy were 91.81%,97.79%and 96.65%,respectively.The levels of GAS,GCS,GRS,GLS,and METs of groups of different degrees of coronary artery stenosis were statistically significantly different(P<0.01),the levels of GAS,GCS,GRS,and GLS in the moderate and severe coronary artery stenosis groups were higher than those in the mild group,and the severe stenosis group was higher than that in the moderate stenosis group;the levels of METs in the moderate and severe coronary artery stenosis groups were lower than those in the mild group,and the severe stenosis group was lower than the moderate stenosis group(P<0.01).Pearson correlation analysis showed that the degree of coronary artery stenosis in patients with coronary heart disease was positively correlated with GAS,GCS,GRS,and GLS(r=0.526,P<0.001;r=0.512,P<0.001;r=0.459,P=0.011;r=0.487,P=0.006),and negatively correlated with METs(r=-0.473,P=0.009).The levels of GAS,GCS,GRS,and GLS in the poor prognosis group were higher than those in the good prognosis group,while the levels of METs were lower than those in the good prognosis group(P<0.01).The ROC curve results showed that the areas under the curve for GAS,GCS,GRS,GLS,and METs were 0.859,0.827,0.801,0.812,and 0.769,respectively,and the area under the curve of the combined test was 0.910.Conclusion The indicators of multimodal ultrasound examination are significantly correlated with the degree of coronary artery stenosis,which has high clinical value for the diagnosis and prognosis evaluation of patients with coronary heart disease.