应用二维斑点追踪成像技术评价早期心肌功能受损的临床价值-东南大学学报医学版

应用二维斑点追踪成像技术评价早期心肌功能受损的临床价值

单位：东南大学医学院附属南京市胸科医院超声诊断科, 江苏南京 210029

分类号：R543.3;R445.1

出版年·卷·期（页码）：2016·35·第一期（46-50）

摘要：

目的:探讨应用二维斑点追踪成像(2D-speckle tracking imaging,2D-STI)技术评价冠心病合并心血管危险因素患者早期心肌功能受损的临床价值。方法:根据冠状动脉造影结果将冠心病合并心血管危险因素的患者分为冠状动脉狭窄 ≥ 75%的冠心病组(A组)31例,冠状动脉轻度狭窄(<50%)组(B组)38例,另选35例正常人作为对照组(C组)。均行常规二维超声检查,采集心尖左室长轴、四腔和二腔观的二维灰阶动态图像,应用STI软件分析长轴方向左室18节段收缩期纵向应变和心尖左室长轴总应变(GLPS-LAX)、四腔总应变(GLPS-A4C)、二腔总应变(GLPS-A2C)及左室长轴平均总应变(GLPS-AVG)。利用受试者工作特征(ROC)曲线获取提示早期心肌功能受损应变值的截点。结果:(1)常规超声参数比较:3组间二维超声测值比较差异无统计学意义(P>0.05)。(2) 2D-STI参数比较:A组在前间隔、前壁、后间隔、侧壁的所有节段,后壁的基底段、中间段,下壁的中间段、心尖段收缩期纵向应变均减低,与C组比较差异有统计学意义(P<0.05)。B组在前间隔与前壁的基底段、中间段,后间隔的所有节段,侧壁的心尖段收缩期纵向应变减低,与C组比较差异有统计学意义(P<0.05)。与B组比较,A组在前间隔的所有节段,前壁的中间段、心尖段,下壁、后壁的心尖段收缩期纵向应变减低,差异有统计学意义(P<0.05)。A组、B组的GLPS-LAX、GLPS-A4C、GLPS-A2C、GLPS-AVG均低于C组,差异有统计学意义(P<0.05)。ROC曲线分析整体室壁基底段、中间段、心尖段,提示早期心肌功能受损的应变值截点分别为-17.5%、-19.5%、-23.5%;敏感性分别为51.3%、65.6%、83.8%,特异性分别为84.3%、66.4%、53.8%。结论:应用2D-STl技术能够早期、定量评价冠心病合并心血管危险因素患者左室心肌功能。

Objective:To evaluate the change of early myocardial function in patients with coronary heart disease associated with risks factors by two-dimensional speckle tracking imaging(2D-STI). Methods:The patients with coronary heart disease associated with risks factors were divided into two groups according to the coronary artery angiography. 31 patients with coronary heart disease (stenosis ≥ 75%) were in group A, 38 patients with coronary mild stenosis(stenosis<50%) were in group B, 35 normal controls were in group C.Dynamic images were recorded from the left ventricular long axis view,the four-chamber view,the two-chamber view. The peak systolic longitudinal strains of 18 segments were obtained by 2D-STI. Results:The peak systolic longitudinal strain of all segments in anterior septum,anterior wall,posterior septum,lateral wall;the basal and middle segments in posterior wall;the middle and apical segments in inferior wall were significantly decreased in group A than the group C(P<0.05).The peak systolic longitudinal strain of the basal and middle segments in anterior septum and anterior wall;all segments in posterior septum;the apical segment in the lateral wall were significantly decreased in group B than the group C(P<0.05).The peak systolic longitudinal strain of all segments in anterior septum;the middle and apical segments in anterior wall; the apical segments in inferior wall and posterior wall were significantly decreased in group A than the group B(P<0.05).The GLPS-LAX,GLPS-A4C,GLPS-A2C and GLPS-AVG were significantly decreased in group A and group B than the group C(P<0.05). The ROC curve analysis showed the cutoff point of the strain were -17.5%,-19.5%,-23.5% in basal segment, middle segment and apical segment, with sensitivity of 51.3%,65.6%,83.8% and specificity of 84.3%,66.4%,53.8%. Conclusions:2D-STI can realize quantitative assessment of left ventricular myocardium function and can be used to identify the early change in patients with coronary heart disease associated with risks factors.

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