三维斑点追踪技术评价冠状动脉病变严重程度
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摘要
目的探讨三维斑点追踪成像(3D-STI)技术评价冠状动脉粥样硬化性心脏病(简称冠心病)患者冠状动脉病变程度的价值。方法收集103例疑似冠心病患者,参考冠状动脉造影结果,根据冠状动脉Gensini评分,将其分为病变组(n=79)和正常组(Gensini评分0分,n=24),病变组又分为轻度(Gensini评分<25分,n=40)、中度(Gensini评分25～50分,n=26)和重度(Gensini评分>50分,n=13)3个亚组。应用3D-STI技术获得左心室三维整体纵向应变(3D-GLS)、三维整体周向应变(3D-GCS)、三维整体面积应变(3D-GAS)和三维整体径向应变(3D-GRS),比较2组间和3个亚组间的差异。绘制ROC曲线,评价3D-STI参数评价冠状动脉正常或轻度病变(Gensini评分<25分)与中重度病变(Gensini评分≥25分)的效能。结果病变组3D-GLS、3D-GCS、3D-GAS及3D-GRS均低于正常组(P均<0.05)。病变组内轻度、中度与重度亚组间各应变参数总体差异均有统计学意义(P均<0.05)。ROC曲线结果显示,AUC由大到小依次为3D-GLS(0.929)、3D-GCS(0.873)、3D-GRS(0.853)和3D-GAS(0.819)。结论 3D-STI技术用于评价冠心病患者冠状动脉病变严重程度具有一定价值。
Objective To explore the value of 3 D speckle tracking imaging(3 D-STI) in evaluating the degree of coronary artery disease in patients with coronary artery disease. Methods Totally 103 patients with suspected coronary artery disease were enrolled. According to the coronary angiography results and Gensini score, the patients were divided into lesion group(n=79) and normal group(Gensini score=0, n=24). Patients in lesion group were then divided into mild subgroup(Gensini score <25, n=40), moderate subgroup(Gensini score 25—50, n=26) and severe subgroup(Gensini score >50, n=13). 3 D global longitudinal strain(3 D-GLS), 3 D global circumferential strain(3 D-GCS), 3 D global area strain(3 D-GAS) and 3 D radial strain(3 D-GRS) were obtained using 3 D-STI and compared between the two groups and among the three subgroups. ROC curve was drawn, and the efficacy of 3 D-STI parameters were evaluated for the normal or mild coronary lesions(Gensini score <25) and moderate to severe lesions(Gensini score ≥25). Results 3 D-GLS, 3 D-GCS, 3 D-GAS and 3 D-GRS in the lesion group were lower than those in the normal group(all P<0.05). There were significant differences in the overall strain parameters among the mild, moderate and severe subgroups in the lesion group(all P<0.05). ROC curve results showed that AUC decreased from 3 D-GLS(0.929), 3 D-GCS(0.873), 3 D-GRS(0.853) to 3 D-GAS(0.819). Conclusion 3 D-STI has certain value in evaluating the severity of coronary artery disease in patients with coronary artery disease.
Objective To explore the value of 3 D speckle tracking imaging(3 D-STI) in evaluating the degree of coronary artery disease in patients with coronary artery disease. Methods Totally 103 patients with suspected coronary artery disease were enrolled. According to the coronary angiography results and Gensini score, the patients were divided into lesion group(n=79) and normal group(Gensini score=0, n=24). Patients in lesion group were then divided into mild subgroup(Gensini score <25, n=40), moderate subgroup(Gensini score 25—50, n=26) and severe subgroup(Gensini score >50, n=13). 3 D global longitudinal strain(3 D-GLS), 3 D global circumferential strain(3 D-GCS), 3 D global area strain(3 D-GAS) and 3 D radial strain(3 D-GRS) were obtained using 3 D-STI and compared between the two groups and among the three subgroups. ROC curve was drawn, and the efficacy of 3 D-STI parameters were evaluated for the normal or mild coronary lesions(Gensini score <25) and moderate to severe lesions(Gensini score ≥25). Results 3 D-GLS, 3 D-GCS, 3 D-GAS and 3 D-GRS in the lesion group were lower than those in the normal group(all P<0.05). There were significant differences in the overall strain parameters among the mild, moderate and severe subgroups in the lesion group(all P<0.05). ROC curve results showed that AUC decreased from 3 D-GLS(0.929), 3 D-GCS(0.873), 3 D-GRS(0.853) to 3 D-GAS(0.819). Conclusion 3 D-STI has certain value in evaluating the severity of coronary artery disease in patients with coronary artery disease.
引文
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[16] Gao C,Lu K,Ye W,et al.Reconstruction of the architecture of ventricular myocardial fibers in ex vivo human hearts.Heart Surg Forum,2009,12(4):E225-E229.
[2] Gensini GG.A more meaningful scoring system for determining the severity of coronary hearts disease.Am J Cardiol,1983,51(3):606.
[3] Hubbard RT,Arciniegas Calle MC,Barros-Gomes S,et al.2-dimensional speckle tracking echocardiography predicts severe coronary artery disease in women with normal left ventricular function:A case-control study.BMC Cardiovasc Disord,2017,17(1):231-238.
[4] Huang J,Yan ZN,Fan L,et al.Left ventricular longitudinal function assessment in rabbits after acute occlusion of left anterior descending coronary artery by two-dimensional speckle tracking imaging.BMC Cardiovasc Disord,2017,17(1):219-226.
[5] Caspar T,Samet H,Ohana M,et al.Longitudinal 2D strain can help diagnose coronary artery disease in patients with suspected non-ST-elevation acute coronary syndrome but apparent normal global and segmental systolic function.Int J Cardiol,2017,236:91-94.
[6] 刘国文,杨娅.三维超声心动图斑点追踪技术.心血管外科杂志,2016,5(1):26-30.
[7] Sun YJ,Wang F,Zhang RS,et al.Incremental value of resting three-dimensional speckle tracking echocardiography in detecting coronary artery disease.Exp Ther Med,2015,9(6):2043-2046.
[8] Li L,Zhang PY,Ran H,et al.Evaluation of left ventricular myocardial mechanics by three-dimensional speckle tracking echocardiography in the patients with different graded coronary artery stenosis.Int J Cardiovasc Imaging,2017,33(10):1513-1520.
[9] Seo Y,Ishizu T,Aonuma K.Current status of 3-dimensional speckle tracking echocardiography:A review from our experences.J Cardiovasc Ultrasound,2014,22(2):49-57.
[10] Abate E,Hoogslag GE,Antoni ML,et al.Value of three-dimensional speckle-tracking longitudinal strain for predicting improvement of left ventricular function after acute myocardial infarction.Am J Cardiol,2012,110(7):961-967.
[11] Hung CL,Verma A,Uno H,et al.Longitudinal and circumferential strain rate,left ventricular remodeling,and prognosis after myocardial infarction.J Am Coll Cardiol,2010,56(22):1812-1822.
[12] 高亚坤,张玉辉,刘颖,等.三维超声斑点追踪技术在不同冠状动脉狭窄程度患者心肌收缩功能评估中的价值.中国老年学杂志,2017,12(37):3036-3038.
[13] Cai Z,Dai J,Wu D,et al.The value of 3-dimensional longitudinal strain in the evaluation of complex coronary lesions in non-ST-segment elevation acute coronary syndrome patient.Medicine (Baltimore),2016,95(39):e4667.
[14] 伍伟科,张又红.三维斑点追踪技术在冠心病早期左心室收缩功能评价中的应用.中国中西医结合影像学杂志,2017,15(4):599-602.
[15] Sengupta PP,Krishnamoorthy VK,Korinek J,et al.Left ventricular form and function revisited:Applied translational science to cardiovascular ultrasound imaging.J Am Soc Echocardiogr,2007,20(5):539-551.
[16] Gao C,Lu K,Ye W,et al.Reconstruction of the architecture of ventricular myocardial fibers in ex vivo human hearts.Heart Surg Forum,2009,12(4):E225-E229.