自动功能成像预测冠状动脉左前降支严重狭窄
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摘要
目的探讨应用基于二维斑点追踪显像(2D-STI)技术的自动功能成像(AFI)纵向应变预测可疑冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉左前降支(LAD)严重狭窄的价值。方法将92例可疑冠心病患者根据冠状动脉造影(CAG)结果分为2组,A组(LAD狭窄<70%)49例,B组(LAD狭窄≥70%)43例。采集心尖左心室长轴、心尖四腔和心尖两腔心切面二维灰阶动态图像。采用AFI软件自动测量左心室18节段收缩期纵向应变(LS)、左心室收缩期整体纵向应变(GLS)及左前降支支配区域纵向应变(TLS)。比较2组间各常规超声参数和二维纵向应变参数差异,绘制各参数预测LAD严重狭窄的ROC曲线。结果 2组常规超声参数差异均无统计学意义(P均>0.05),B组GLS及TLS均明显低于A组(P均<0.001),TLS和GLS预测LAD严重狭窄的曲线下面积(AUC)最大,分别为0.715和0.705,TLS和GLS预测LAD严重狭窄的截断值、敏感度、特异度分别为:-19.58%、63.3%、67.4%和-20.85%、74.4%、61.2%。结论基于2D-STI技术的AFI测量心肌纵向应变参数可用于预测可疑冠心病患者LAD严重狭窄,GLS较TLS敏感度高。
Objective To explore the value of automated function imaging(AFI)based on two-dimensional speckle tracking imaging(2 D-STI)technique longitudinal strain for predicting severe stenosis of left anterior descending(LAD)coronary artery in patients with suspected coronary heart disease(CHD).Methods Ninety-two patients with suspected CHD were divided into two groups according to the coronary angiography(CAG)results.There were 49 cases in group A(LAD stenosis rate<70%)and 43 cases in group B(LAD stenosis rate≥70%).The two-dimensional gray scale dynamic images were obtained in apical four-chamber view,apical two-chamber view and long axis of left ventricle(LV)view.Eighteen segments of LV longitudinal peak systolic strain,global longitudinal strain(GLS)and territorial longitudinal strain(TLS)supplied with LAD were measured with AFI software.The conventional ultrasonic parameters and the two-dimensional longitudinal strain parameters were compared between the two groups and ROC curve analysis of these parameters was used to predict LAD severe stenosis.Results There was no significant difference in the conventional ultrasonic parameters between the two groups(all P>0.05).The group B had lower GLS,TLS than group A(both P<0.001).GLS and TLS showed the highest area under ROC curve(0.715 and 0.705)for predicting LAD severe stenosis.The cut-off value,sensitivity and specificity for predicting LAD severe stenosis were-19.58%,63.3%,67.4%in TLS,and-20.85%,74.4%,61.2%in GLS respectively.Conclusion The longitudinal strain parameters measured with AFI based on 2 D-STI technique can be used to predict LAD severe stenosis in patients with CHD,and GLS is more sensitive than TLS.
Objective To explore the value of automated function imaging(AFI)based on two-dimensional speckle tracking imaging(2 D-STI)technique longitudinal strain for predicting severe stenosis of left anterior descending(LAD)coronary artery in patients with suspected coronary heart disease(CHD).Methods Ninety-two patients with suspected CHD were divided into two groups according to the coronary angiography(CAG)results.There were 49 cases in group A(LAD stenosis rate<70%)and 43 cases in group B(LAD stenosis rate≥70%).The two-dimensional gray scale dynamic images were obtained in apical four-chamber view,apical two-chamber view and long axis of left ventricle(LV)view.Eighteen segments of LV longitudinal peak systolic strain,global longitudinal strain(GLS)and territorial longitudinal strain(TLS)supplied with LAD were measured with AFI software.The conventional ultrasonic parameters and the two-dimensional longitudinal strain parameters were compared between the two groups and ROC curve analysis of these parameters was used to predict LAD severe stenosis.Results There was no significant difference in the conventional ultrasonic parameters between the two groups(all P>0.05).The group B had lower GLS,TLS than group A(both P<0.001).GLS and TLS showed the highest area under ROC curve(0.715 and 0.705)for predicting LAD severe stenosis.The cut-off value,sensitivity and specificity for predicting LAD severe stenosis were-19.58%,63.3%,67.4%in TLS,and-20.85%,74.4%,61.2%in GLS respectively.Conclusion The longitudinal strain parameters measured with AFI based on 2 D-STI technique can be used to predict LAD severe stenosis in patients with CHD,and GLS is more sensitive than TLS.
引文
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[2]张鹏,张文华,夏稻子,等.超声二维斑点追踪技术对单纯冠状动脉左前降支狭窄患者左心室收缩功能的评价.中国心血管杂志,2013,18(2):107-110.
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[7]Chan J,Hanekom L,Wong C,et al.Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function.JAm Coll Cardiol,2006,48(10):2026-2033.
[8]Xie MY,Yin JB,Lv Q,et al.Assessment of the left ventricular systolic function in multi-vessel coronary artery disease with normal wall motion by two-dimensional speckle tracking echocardiography.Eur Rev Med Pharmacol Sci,2015,19(20):3928-3934.
[9]Montgomery DE,Puthumana JJ,Fox JM,et al.Global longitudinal strain aids the detection of non-obstructive coronary artery disease in the resting echocardiogram.Eur Heart J Cardiovasc Imaging,2012,13(7):579-587.
[10]Dahlslett T,Karlsen S,Grenne B,et al.Early assessment of strain echocardiography can accurately exclude significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary syndrome.J Am Soc Echocardiogr,2014,27(5):512-519.
[11]宋宏宁,陈金玲,秦真英,等.超声心动图多参数联合临床诊断冠状动脉粥样硬化性心脏病.中国医学影像技术,2014,30(6):863-866.
[12]Kalam K,Otahal P,Marwick TH.Prognostic implications of global LV dysfunction:A systematic review and meta-analysis of global longitudinal strain and ejection fraction.Heart,2014,100(21):1673-1680.
[13]Cerqueira MD,Weissman NJ,Dilsizian V,et al.Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart.A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.Circulation,2002,105(4):539-542.
[14]邓倾,周青,黄佳,等.二维斑点追踪技术评价心肌缺血患者左室心肌纵向应变.中华超声影像学杂志,2011,20(8):648-651.
[2]张鹏,张文华,夏稻子,等.超声二维斑点追踪技术对单纯冠状动脉左前降支狭窄患者左心室收缩功能的评价.中国心血管杂志,2013,18(2):107-110.
[3]Biering-Srensen T,Hoffmann S,Mogelvang R,et al.Myocardial strain analysis by 2-dimensional speckle tracking echocardiography improves diagnostics of coronary artery stenosis in stable angina pectoris.Circ Cardiovasc Imaging,2014,7(1):58-65.
[4]Zuo H,Yan J,Zeng H,et al.Diagnostic power of longitudinal strain at rest for the detection of obstructive coronary artery disease in patients with type 2diabetes mellitus.Ultrasound Med Biol,2015,41(1):89-98.
[5]Lang RM,Badano LP,Mor-Avi V,et al.Recommendations for cardiac chamber quantification by echocardiography in adults:An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr,2015,28(1):1-39.
[6]Stankovic I,Putnikovic B,Cvjetan R,et al.Visual assessment vs.strain imaging for the detection of critical stenosis of the left anterior descending coronary artery in patients without a history of myocardial infarction.Eur Heart J Cardiovasc Imaging,2015,16(4):402-409.
[7]Chan J,Hanekom L,Wong C,et al.Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function.JAm Coll Cardiol,2006,48(10):2026-2033.
[8]Xie MY,Yin JB,Lv Q,et al.Assessment of the left ventricular systolic function in multi-vessel coronary artery disease with normal wall motion by two-dimensional speckle tracking echocardiography.Eur Rev Med Pharmacol Sci,2015,19(20):3928-3934.
[9]Montgomery DE,Puthumana JJ,Fox JM,et al.Global longitudinal strain aids the detection of non-obstructive coronary artery disease in the resting echocardiogram.Eur Heart J Cardiovasc Imaging,2012,13(7):579-587.
[10]Dahlslett T,Karlsen S,Grenne B,et al.Early assessment of strain echocardiography can accurately exclude significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary syndrome.J Am Soc Echocardiogr,2014,27(5):512-519.
[11]宋宏宁,陈金玲,秦真英,等.超声心动图多参数联合临床诊断冠状动脉粥样硬化性心脏病.中国医学影像技术,2014,30(6):863-866.
[12]Kalam K,Otahal P,Marwick TH.Prognostic implications of global LV dysfunction:A systematic review and meta-analysis of global longitudinal strain and ejection fraction.Heart,2014,100(21):1673-1680.
[13]Cerqueira MD,Weissman NJ,Dilsizian V,et al.Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart.A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.Circulation,2002,105(4):539-542.
[14]邓倾,周青,黄佳,等.二维斑点追踪技术评价心肌缺血患者左室心肌纵向应变.中华超声影像学杂志,2011,20(8):648-651.