超声四维应变成像技术预测冠心病患者PCI术后左室心肌功能改善的研究-东南大学学报医学版

超声四维应变成像技术预测冠心病患者PCI术后左室心肌功能改善的研究

单位：新疆医科大学附属中医医院心脏超声科, 新疆乌鲁木齐 830000

分类号：R541.4;R445.1

出版年·卷·期（页码）：2017·36·第五期（710-716）

摘要：

目的：探讨四维应变成像（four-dimensional strain imaging，4D-SI）技术预测经皮冠状动脉介入（percutaneous coronary intervention，PCI）术冠心病患者左心功能改善的临床价值。方法：选取经冠脉造影诊断为冠心病且成功进行PCI术的患者55例，以PCI术后6个月较术前左室射血分数（left ventricular ejection fraction，LVEF）改善（ΔLVEF）≥5%将冠心病患者分为左心功能改善组（A组）和未改善组（B组）。分别于PCI术前及术后6个月对各组患者进行常规超声心动图检查，测量左室舒张末期容积（left ventricular end-diastolic volume，LVEDV）、左室收缩末期容积（left ventricular end-systolic volume，LVESV）、LVEF；应用自动功能成像（automated function imaging，AFI）技术测量二维整体峰值纵向应变（two-dimensional global longitudinal peak strain，2D-GLPS）；并应用4D-SI技术测得四维整体峰值长轴应变（global longitudinal peak strain，4D-GLPS）、环向应变（global circumferential peak strain 4D-GCPS）、面积应变（global area peak strain，4D-GAPS）及径向应变（global radial peak strain，4D-GRPS）参数指标。结果：A组PCI术前及术后6个月2D-GLPS、4D-GLPS、4D-GCPS、4D-GAPS和4D-GRPS均明显高于B组（P<0.05）。单参数受试者工作特征曲线（ROC曲线）分析结果显示4D-GLPS的曲线下面积（AUC）较大，为0.944，灵敏度及特异度较高，分别为91.3%、93.8%，截断值为-16.5%；在多参数联合分析中，四维应变参数联合二维应变参数的AUC较大，为0.969，灵敏度及特异度较高，分别为95.7%、90.6%。结论：4D-SI技术能更准确预测冠心病患者PCI术后左室心肌功能的改善，其中4D-GAPS及4D-GCPS能够作为术后左心整体功能改善的独立预测指标。

Objective:To clarify the role of the newly developed four-dimensional strain imaging(4D-SI) in the prediction of the left ventricular function improvement after percutaneous coronary intervention(PCI). Methods:55 patients diagnosed with coronary heart disease(CHD) by coronary angiography and successfully provided with PCI were recruited. After 6 months of follow up, the CHD patients were grouped into A and B group based on whether having left ventricular function recovery or not. Before and after PCI, left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction(LVEF) by echocardiography, the global longitudinal peak strain(2D-GLPS) by strain imaging using automated function imaging (AFI), global longitudinal peak strain(4D-GLPS), circumferential peak strain(4D-GCPS),radial peak strain(4D-GRPS) and area peak strain (4D-GAPS) by 4D-SI were assessed. Results:Before and after PCI,all left ventricular strain values of A group were higher than those of B group(P<0.001);the single parameter mode of ROC curve analysis showed that the area under the ROC curve (AUC)(0.944), sensitivity(91.3%) and specificity (93.8%) of 4D-GAPS were relatively higher than other strain parameters.The single technology mode of ROC curve analysis showed that AUC(0.969),sensitivity(95.7%) and specificity(90.6%) of 4D-SI were higher than those of the AFI-based longitudinal strain. Conclusion:4D-SI is a more accurate and comprehensive method in the prediction of the left ventricular myocardial function recovery, and 4D-GAPS, a novel automatic index, as well as 4D-GCPS, can act as independent predictors in the left ventricular myocardial function recovery.

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