三维斑点追踪收缩期峰值面积应变评估冠状动脉粥样硬化性心脏病左室收缩功能
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摘要
目的应用三维斑点追踪成像(3D-STI)技术评价冠状动脉粥样硬化性心脏病(以下简称冠心病)患者左室各节段及整体收缩功能。方法选取50例超声心动图检查未见明显节段性室壁运动异常但经冠状动脉造影检查确诊的冠心病患者为试验组,30例临床高度怀疑冠心病但二维超声心动图及冠状动脉造影均未见异常的患者为对照组。应用3D-STI技术、M型Teichholz法及二维双平面Simpson法分别测量并比较试验组患者的左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及左室射血分数(LVEF)。应用3D-STI获得对照组和试验组各亚组(左前降支组、左回旋支组、右冠状动脉组及多支病变组)左室收缩期峰值环向应变(LS)、圆周应变(CS)、径向应变(RS)及面积应变(AS),以及左室17节段的时间-应变曲线及牛眼图,以冠状动脉造影结果为金标准,比较各组上述参数的差异。绘制各应变参数绝对值(GLS、GCS、GRS及GAS)诊断冠心病的受试者工作特征(ROC)曲线,并计算其诊断效能。结果对照组3D-STI、二维超声及M型超声三种方法测得的LVEDV、LVESV及LVEF比较,差异均无统计学意义;试验组三种方法测得的LVEDV、LVESV及LVEF比较,差异均有统计学意义(均P<0.05)。试验组各亚组经冠状动脉造影检出的缺血节段其相应的LS、CS、RS及AS与对照组比较,差异均有统计学意义(均P<0.05)。试验组GLS、GAS与对照组比较,差异均有统计学意义(均P<0.05)。ROC曲线分析表明GLS、GAS为诊断冠心病的最佳敏感指标,当GLS、GAS截断值分别为-15.5%、-26.5%时,其特异性分别为83%、93%,敏感性分别为82%、76%。结论 3D-STI技术能更好地评估冠心病节段病变及整体左室收缩功能,为临床及早诊断冠心病提供依据。
Objective To evaluate the left ventricular segments and the global systolic function in patients with coronary atherosclerotic heart disease(CHD)by three-dimensional speckle tracking imaging(3 D-STI).Methods Fifty patients without abnormal segmental wall movement were detected by echocardiography,and coronary artery angiography(CAG)was used to diagnose CHD(experimental group). 30 patients were highly suspected of CHD,and without abnormality by both two-dimensional echocardiography and CAG(control group).The experimental group were divided into the left anterior descending branch(LAD group),the left circumflex branch(LCX group),the right coronary artery(RCA group),and the multiple branch lesion group.The left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV)and left ventricular ejection fraction(LVEF) were measured and compared by 3 D-STI,M mode Teichholz and two-dimensional biplane Simpson method.3 D-STI was used to detect two groups of related strain parameters,including peak systolic strain(LS),circumferential strain(CS),radial strain(RS) and area strain(AS),the time strain curve of the 17 segment of the left ventricle,and the eye diagram showed the strain of each segment of the left ventricle.Taken the results of CAG as gold standard,all the strain parameters list above were compared with those of the control group.The specificity and sensitivity of 3 D-STI in diagnosing CHD were analyzed.Results The difference of LVEDV,LVESV and LVEF measured by three methods in the control group were not statistically significant,and the difference of LVEDV,LVESV and LVEF measured by three methods in the experimental group were statistically significant(all P<0.05).Compared with control group,there were significant differences of LS,CS,RS and AS in LAD group,LCX group,RCA group and multiple branch lesion group(all P < 0. 05). The differences of GLS and GAS in experimental group were statistically significant compared with those in control group(all P<0.05).The ROC curve showed that GLS and GAS were the best sensitive indicators in diagnosis of CHD when the cutoff values of GLS and GAS were-15.5% and-26.5%,the specificity was 83% and 93%,and the sensitivity was 82% and 76%,respectively.Conclusion 3 D-STI technology can better assess CHD and global left ventricular systolic function,so as to provide reference for clinical diagnosis of CHD in time.
Objective To evaluate the left ventricular segments and the global systolic function in patients with coronary atherosclerotic heart disease(CHD)by three-dimensional speckle tracking imaging(3 D-STI).Methods Fifty patients without abnormal segmental wall movement were detected by echocardiography,and coronary artery angiography(CAG)was used to diagnose CHD(experimental group). 30 patients were highly suspected of CHD,and without abnormality by both two-dimensional echocardiography and CAG(control group).The experimental group were divided into the left anterior descending branch(LAD group),the left circumflex branch(LCX group),the right coronary artery(RCA group),and the multiple branch lesion group.The left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV)and left ventricular ejection fraction(LVEF) were measured and compared by 3 D-STI,M mode Teichholz and two-dimensional biplane Simpson method.3 D-STI was used to detect two groups of related strain parameters,including peak systolic strain(LS),circumferential strain(CS),radial strain(RS) and area strain(AS),the time strain curve of the 17 segment of the left ventricle,and the eye diagram showed the strain of each segment of the left ventricle.Taken the results of CAG as gold standard,all the strain parameters list above were compared with those of the control group.The specificity and sensitivity of 3 D-STI in diagnosing CHD were analyzed.Results The difference of LVEDV,LVESV and LVEF measured by three methods in the control group were not statistically significant,and the difference of LVEDV,LVESV and LVEF measured by three methods in the experimental group were statistically significant(all P<0.05).Compared with control group,there were significant differences of LS,CS,RS and AS in LAD group,LCX group,RCA group and multiple branch lesion group(all P < 0. 05). The differences of GLS and GAS in experimental group were statistically significant compared with those in control group(all P<0.05).The ROC curve showed that GLS and GAS were the best sensitive indicators in diagnosis of CHD when the cutoff values of GLS and GAS were-15.5% and-26.5%,the specificity was 83% and 93%,and the sensitivity was 82% and 76%,respectively.Conclusion 3 D-STI technology can better assess CHD and global left ventricular systolic function,so as to provide reference for clinical diagnosis of CHD in time.
引文
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[10]Seo Y,Ishizu T,Enomoto Y,et al.Endocardial surface area tracking for assessment of regional LV wall deformation with 3D speckle tracking imaging[J].JACC Cardiovasc Imaging,2011,4(4):358-365.
[2]Dandel M,Lehmkuhl H,Knosalla C,et al.Strain and strain rate imaging by echocardiography-basic concepts and clinical applicability[J].Curr Cardiol Rev,2009,5(2):133-148.
[3]Luis SA,Yamada A,Khandheria BK,et al.Use of three-dimensional speckle-tracking echocardiography for quantitative assessment of global left ventricular function:a comparative study to threedimensional echocardiography[J].J Am Soc Echocardiogr,2014,27(3):285-291.
[4]Takeguchi T,Nishiura M,Abe Y,et al.Practical considerations for a method of rapid cardiac function analysis based on three-dimensional speckle tracking in a three-dimensional diagnostic ultrasound system[J].J Med Ultrason,2010,37(2):41-49.
[5]Reant P,Barbot L,Touche C,et al.Evaluation of global left ventricular systolic function using three-dimensional echocardiography speckletracking strain parameters[J].J Am Soc Echocardiogr,2012,25(1):68-79.
[6]李秀娟,陆永萍.三维斑点追踪技术的临床应用及研究进展[J].中国心血管杂志,2017,22(1):65-68.
[7]汤乔颖,邓又斌.超声斑点追踪技术评价左心室局部收缩功能的进展[J].中国超声影像学杂志,2012,21(5):171-174.
[8]Seo Y,Ishizu T,Enomoto Y,et al.Validation of 3-dimensional speckle tracking imaging to quantify regional myocardial deformation[J].Circ Cardiovasc Imaging,2009,2(6):451-459.
[9]姚静,许迪,戴阳,等.面积应变评价正常人左心室收缩模式及功能[J].中华超声影像学杂志,2013,22(1):1-5.
[10]Seo Y,Ishizu T,Enomoto Y,et al.Endocardial surface area tracking for assessment of regional LV wall deformation with 3D speckle tracking imaging[J].JACC Cardiovasc Imaging,2011,4(4):358-365.