RT-3DTEE联合2D-STI对冠心病患者左心房结构的评估及对左前降支狭窄的预测价值

Values of RT-3DTEE combined with 2D-STI in evaluating left atrial structure and predicting left anterior descending branch stenosis in patients with coronary heart disease

目的 探讨经食管实时三维超声心动图(RT-3DTEE)联合二维斑点追踪显像(2D-STI)对冠心病患者左心房结构的评估及对左前降支狭窄的预测价值。方法 行冠状动脉造影(CAG)检查的236例疑诊冠心病患者,根据CAG检查结果分为冠心病组(A组,118例)和非冠心病组(B组,118例),采用RT-3DTEE和2D-STI测量左心房结构参数。A组进一步分为左前降支狭窄(C)组和左前降支无狭窄(D)组,采用多因素logistic回归分析左前降支狭窄的影响因素,采用ROC曲线评估其预测价值。结果 A组左心房最小容积指数(LAVImin)、左心房最大容积指数(LAVImax)、左心房收缩前容积指数(LAVIpreA)和左心房管道期峰值应变率(pLASRcd)均高于B组,左心房总射血分数(LATEF)、左心房被动射血分数(LAPEF)、左心房储器期应变(LASr)、左心房管道应变(LAScd)和左心房储器期峰值应变率(pLASRr)均低于B组(P<0.05)。C组LAVImin、LAVImax、LAVIpreA和pLASRcd均高于D组,LATEF、LAPEF、LASr、LAScd和pLASRr均低于D组(P<0.05)。未校正(模型1)和校正(模型2)混杂因素,LAVImin、LAVImax、LAVIpreA和pLASRcd升高均是左前降支狭窄的独立危险因素(P<0.05),LATEF、LAPEF、LASr、LAScd和pLASRr升高是其保护性因素(P<0.05)。模型2预测左前降支狭窄的AUC高于模型1(P<0.01)。结论 RT-3DTEE联合2D-STI可用于评估冠心病患者的左心房结构改变,对左前降支狭窄有较好的预测价值。

Objective To investigate the values of real-time three-dimensional transesophageal echocardiography(RT-3DTEE) combined with two-dimensional speckle tracking imaging(2D-STI) in evaluating the left atrial structure and predicting the left anterior descending branch stenosis in the patients with coronary heart disease(CHD).Methods A total of 236 cases with suspected CHD underwent coronary angiography, who then were divided into two groups of A(with CHD,118 cases) and B(without CHD,118 cases).The left atrial structural parameters were measured by RT-3DTEE and 2D-STI.The CHD patients were divided into two groups of C(with left anterior descending branch stenosis) and D(without left anterior descending branch stenosis).Multivariate logistic regression was used to analyze the influencing factors for the left anterior descending branch stenosis, and ROC curve was used to evaluate the predictive value.Results The minimum left atrial volume index(LAVImin),maximum left atrial volume index(LAVImax),left atrial pre systolic volume index(LAVIpreA),and peak strain rate during the left atrial conduit phase(pLASRcd) were higher, and total ejection fraction of left atrial(LATEF),left atrial passive ejection fraction(LAPEF),left atrial strain during reservoir phase(LASr),left atrial strain during conduit phase(LAScd),and peak strain rate during the left atrial reservoir phase(pLASRr) were lower in group A than those in group B(P<0.05).The LAVImin, LAVImax, LAVIpreA,pLASRcd were higher, and LATEF,LAPEF,LASr, LAScd, pLASRr were lower in group C than those in group D(P<0.05).Whether the confounders unadjusted(model 1) or adjusted(model 2),higher LAVImin, LAVImax, LAVIpreA and pLASRcd were the independent risk factors for left anterior descending branch stenosis(P<0.05),and higher LATEF,LAPEF,LASr, LAScd and pLASRr were the protective factors(P<0.05).The AUC of model 2 in predicting the left anterior descending branch stenosis was higher than that of model 1(P<0.01).Conclusion RT-3DTEE combined with 2D-STI can be used to evaluate the structure changes of the left atrium in the patients with CHD,and has a high predictive value for the left anterior descending branch stenosis.