三维斑点追踪超声心动图在冠心病合并高血压患者中的应用价值

Application value of three-dimensional speckle tracking echocardiography in patients with coronary artery disease and hypertension

目的探讨三维斑点追踪超声心动图(three-dimensional speckle tracking echocardiography,3D-STE)技术评价老年冠心病(coronary artery disease,CAD)合并高血压患者颈动脉硬化、左心功能的价值。方法回顾性分析82例住院治疗的老年CAD患者一般资料,根据是否合并高血压,将其分为CAD+HT组(CAD合并高血压,35例)、CAD组(47例),另选取45例健康志愿者纳入对照组。采用3D-STE技术对受试者进行检查,比较不同组别患者常规超声心动图参数、超声心动图心室形态构成、3D-STE相关参数及左心室节段应变值水平。结果CAD+HT组左前降支直径、左心房容积(LAV)、室间隔厚度、左心室后壁厚度(LVPWTd)、相对室壁厚度(RWT)、左心室重量指数(LVMI)、LVEDd均显著高于CAD组、对照组,LVEF、E/A低于CAD组、对照组(P均<0.05)。CAD组与对照组左前降支直径、LAV、LVEDd、室间隔厚度、E/A、LVEF间的差异有统计学意义(P均<0.05);CAD+HT组心室形态正常率明显低于CAD组、对照组,且CAD+HT组、CAD组向心性重构占比均明显高于对照组(P均<0.05);CAD+HT组球形指数、左心室重量、左心室整体纵向应变(GLS)、整体圆周应变(GCS)、整体面积应变(GAS)均显著高于CAD组、对照组,整体径向应变(GRS)明显低于CAD组、对照组(P均<0.05),CAD组与对照组GLS、GCS比较,差异有统计学意义(P<0.05);CAD+HT组、CAD组基底段、中间段、心尖段应变值水平均显著高于对照组,CAD+HT组基底段前壁、侧壁、后壁应变值及中间段前壁、侧壁应变值均显著高于CAD组(P均<0.05)。结论3D-STE可提供客观且可靠的数据对老年CAD合并高血压患者节段室壁运动障碍进行评估,还可作为评估患者颈动脉硬化、左心功能损伤的重要手段。

Objective To explore the value of three-dimensional speckle tracking echocardiography(3D-STE)technology in evaluating carotid atherosclerosis and left ventricular function in elderly patients with coronary artery disease(CAD)and hypertension.Methods The general data of 82 inpatients with CAD were retrospectively analyzed.According to the presence or absence of hypertension,these patients were divided into CAD+HT group(CAD complicated with hypertension,35 cases)and CAD group(47 cases).Meanwhile,45 healthy volunteers were selected as the control group.All subjects underwent 3D-STE examination.The conventional echocardiographic parameters,echocardiographic ventricular morphology,3D-STE related parameters,and left ventricular segmental strain values in different groups were comparatively analyzed.Results Diameter of left anterior descending branch,LAV,IVST,LVPWTd,RWT,LVMI and LVEDd of the CAD+HT group were all significantly higher than those of the CAD group and the control group.LVEF and E/A were both lower than those of the other groups(P<0.05).There were significant differences between the CAD group and the control group in terms of the diameter of left anterior descending branch,LVEDd,IVST,E/A,and LVEF(P<0.05).The normal rate of ventricular morphology in the CAD+HT group was significantly lower than that in the CAD group and the control group;the proportions of centripetal remodeling in the CAD+HT group and the CAD group were significantly higher than that in the control group(P<0.05).The spherical index,LVM,GLS,GCS and GAS of the CAD+HT group were all significantly higher than those of the CAD group and the control group while GRS was significantly lower than that of the other groups(P<0.05).There were significant differences in GLS and GCS between the CAD group and the control group(P<0.05).The strain values of the basal,middle,and apical segment in the CAD+HT group and the CAD group were significantly higher than those of the control group;the strain values of the anterior,lateral and posterior wall of the basal segment,and the values of the anterior and lateral wall of the middle segment in the CAD+HT group were significantly higher than those in the CAD group(P<0.05).Conclusion The technology of 3D-STE can provide objective and reliable data for evaluating segmental ventricular dyskinesia in elderly patients with CAD and hypertension.It can also be used as an important method for evaluating carotid atherosclerosis and left ventricular function damage in these patients.