超声二维应变技术在室壁运动正常的冠心病中的应用研究
|
摘要
背景与目的:客观定量分析心肌功能是众多学者一直努力研究的主要领域,应变和应变率分别反映了心肌的形变程度和形变速度,是量化局部心肌收缩和舒张功能的新指标。心肌应变可以通过放射造影、心肌内植入超声微晶体等有创方法及无创的磁共振成像(MRI)技术进行检测。超声技术对于应变及应变率的测量有几种方法。最简单的方法是应用M型超声心动图通过计算收缩期室壁增厚率而估测应变,但仅能估测前间隔及后壁的心肌增厚;近几年出现的直线解剖M型技术可以在360°范围内任意放置取样线,得到任意点、任意角度的M型图像,提高了M型超声心动图的准确性和应用范围;但M型超声心动图仅提供了一维半定量地评价左室短轴方向上的心肌增厚或变薄的估测方法,缺少长轴或圆周方向的心肌功能信息。目前研究最多的是基于组织多普勒原理的应变率成像技术,有角度依赖性,仅能估测沿声束方向的应变,在有方位角及垂直切面上测量的应变结果不可靠(依赖于声束的Cosθ角),局限于评价心肌长轴方向的功能,在分析径向和圆周方向的心肌形变时受到限制。
二维应变超声心动图(2DSE)是超声定量评价心肌功能的新方法,应用斑点追踪成像(STI)技术在超声图像中自动辨认由小于入射波长的组织结构发生背向散射产生的斑点结构,没有角度依赖性,可以从任何方向逐帧追踪每个随心肌同步运动的斑点位移以及斑点间的相对运动,定量分析室壁各节段在长轴、径向、圆周方向以及心室扭转的心肌收缩及舒张运动的情况,使得临床医生对于评价心脏的复杂空间活动成为可能。
本实验应用2DSE定量分析常规方法显示室壁运动正常的冠心病患者左室壁的收缩运动情况,对比评价长轴、圆周、径向方向以及左室扭转的各项应变指标对于局部及整体室壁收缩运动异常方面的意义,探讨2DSE在心肌缺血诊断中的临床应用价值。
方法:(1)选择2007年10月至2008年5月因疑诊冠状动脉粥样硬化性心脏病(CHD)而施行选择性冠状动脉造影术的住院患者69例,根据造影结果分为冠心病组(38例)及对照组(31例),均排除合并其他明确的心脏疾患。(2)应用Vivid 7彩色多普勒超声诊断仪M3S探头,谐波模式频率1.7～3.4MHz,帧频>80帧/秒。采集左室短轴二尖瓣环、乳头肌、心尖水平切面以及心尖四腔、两腔、长轴切面的二维灰阶动态图像。(3)测量常规超声指标,采用心尖双平面Simpson法测量左室射血分数(LVEF)、短轴缩短率(FS)。(4)应用EchoPAC工作站,对左室壁各节段测量长轴应变(SL)、长轴应变率(SrL)、左室整体长轴应变(GLS)、径向应变(SR)、圆周应变(SC)、径向应变率(SrR)、圆周应变率(SrC)、左室整体扭转度(torsion)及左室整体扭转率(torsion rate)、心尖扭转度(apex rot)及心尖扭转率(apex rot rate)、瓣环扭转度(base rot)及瓣环扭转率(base rot rate),并获得其相应的曲线图和应变牛眼图。
结果:(1)冠心病组38例中的27例患者有至少一支冠状动脉狭窄≥75%,而对照组31例中有24例患者的三支冠状动脉狭窄均≤20%,冠心病组38例中有左前降支狭窄患者32例(占84.21%)。(2)常规超声测量指标如左室横径、左房横径、左室射血分数(LVEF)、短轴缩短率(FS)、E/A比值及E峰减速时间(DT)在组间比较中,差异均无统计学意义(P > 0.05)。(3) 2DSE追踪成功率为96.46～97.26%,追踪不成功的节段主要出现在二尖瓣环切面。(4)对照组各室壁的长轴、圆周、径向应变及应变率有一定规律性,室壁间的长轴、径向应变及应变率差异无统计学意义(P >0.05),冠心病组收缩期的应变及应变率波形紊乱,除乳头肌水平及心尖水平的径向应变率增高外,长轴应变及应变率、圆周应变及应变率、径向应变及瓣环水平径向应变率的绝对值均较对照组相应减低,部分室壁差异有统计学意义(P <0.05或P <0.01)。长轴应变对于冠心病组异常节段的检出率最高,径向应变率对于冠心病组异常节段的检出率最低。(5)心尖和瓣环扭转度及扭转率曲线在正负方向上的改变,组间比较有显著统计学差异(P <0.01)。冠心病组的左室整体、心尖、瓣环扭转度及扭转率的绝对值均较对照组减低,整体扭转率差异有统计学差异(P <0.05)。(6)冠心病组左室整体长轴应变(GLS)的绝对值较对照组明显减低(P <0.05),与左室射血分数(LVEF)、短轴缩短率(FS)相关性良好(P <0.05)。(7)在诊断冠心病的指标中,长轴应变率(SrL)与圆周应变(SC)的曲线下面积(AUC)最大,SrL以截断值为﹣0.855s-1诊断冠心病的灵敏度81.6%、特异度为71.4%,Yuedden指数最高,为0.530。而整体长轴应变(GLS)以截断值为﹣22.85%诊断冠心病的敏感性最高,达到84.2%,但Yudden指数最低,仅为0.249。(8)在诊断左前降支狭窄的指标中,长轴应变(SL)的AUC最大,以前壁及前间隔SL的截断值为﹣15.77%诊断左前降支狭窄的灵敏度为74.2%、特异度82.1%,Yuedden指数最高,为0.563。结论:(1) 2DSE可以评价冠心病左室壁收缩运动异常,敏感性高于常规超声心动图,对检出有统计学差异的异常室壁节段数从高到低排列顺序为:长轴方向>圆周方向>径向方向,应变指标>应变率指标,长轴应变对冠心病组异常节段的检出率最高,径向应变率对冠心病组异常节段的检出率最低。(2)心尖和瓣环的扭转方向改变可以评价冠心病。在左室整体、心尖、瓣环的扭转度及扭转率指标中,整体扭转率对于评价冠心病左室壁收缩运动异常的敏感性最高。(3)左室整体长轴应变(GLS)可以检出冠心病组的左室壁收缩运动异常,与LVEF、FS相关性良好。(4)在诊断冠心病的指标中,长轴应变率(SrL)与圆周应变(SC)的诊断价值最高,SrL以截断值为﹣0.855s-1诊断冠心病的Yuedden指数最高(0.530)。(5)在诊断左前降支狭窄的指标中,长轴应变(SL)的诊断价值最高,以前壁及前间隔SL的截断值为﹣15.77%诊断左前降支狭窄的Yuedden指数最高(0.563)。
Backgrounds and Objectives: There is a main research field for the cardiologist to quantify objectively myocardial function. Strain measures the extent of myocardial deformation whilst strain rate measures the rate of the deformation. Both strin and strain rate have been shown to provide new quantitative indexes about the clinical assessment of regional myocardial systolic and diastolic function. Myocardial strain and strain rate can be detected through those methods such as radiation contrast, the implantation of cardiac ultrasonic minicrystal, and magnetic resonance imaging (MRI). Strain and strain rate also can be estimated by several echocardiographic methods. The simplest way is using parasternal short-axis M-Mode view, calculatting wall thickening rate during systole. This however only gives estimates of anteroseptal and posterior wall thickening. Straight anatomy M-mode has been developed years ago. It can place the sample line in 360°radius so as to obtain M-mode image in arbitrary point or angle, which can improve the accurateness and so improve the application of M-mode echocardiogram. However, this method only provides uni-dimensional semi-quantitative assessment of myocardial thickening or thinning, without any information concerning about longitudinal and circumferential function. The most widely used and validated technique is tissue Doppler-derived strain so far. But it is only able to estimate strain along the ultrasound beam due to the angle dependency and thus cannot reliably measure strain in the azimuth or perpendicular plane (dependent on Cosθof the angle of insonation), which limits the usage of this technique primarily to longitudinal fibers, not able to quantify deformation in the radial and circumferential plane.
Two-dimensional strain echocardiography (2DSE) is a novel method of the quantitative assessment of myocardial function. This technique is not encumbered by angle dependency and based on tracking of natural acoustic markers formed by speckle patterns arising from interference of ultrasound backscattered from tissue structures in B mode images. Since the speckle can be tracked in any direction, it is possible to measure its movement in both axial and perpendicular planes, allowing estimation of radial and circumferential strains. This removes the previous limitation of only being able to measure strain along the beam of ultrasound. In addition to the circumferential deformation parameters, ventricular rotation and twist can also be calculated using this technique. It is possible for clinician to estimate special movement of heart.
In the present study, 2DSE was used in quantifying the systolic motion of patients with coronary heart disease (CHD), whose left ventricular (LV) wall motion was estimated normal by conventional echocardiography, trying to estimate its application and difference in evaluating LV wall abnormal motion in longitudinal, radial and circumferential dimensions and ventricular rotation, and to investigate its feasibility and clinical value in identifying ischemic myocardium.
Methods: (1) Sixty-nine doubtful CHD patients sufferring from coronary arteriography in General Navy Hospital from Oct 2007 to May 2008 were involved in this study, which were divided into two groups, one was CHD group (n=38) and the other control group (n=31). And there was no other heart disease in all the objects. (2) Vivid 7 color Doppler Ultrasound Diagnostic Instrument was used and an M3S transducer in harmonic 1.7~3.4 MHz mode was adopted, frame frequency of which was above 80 frames/s. The two-dimensional images from LV short-axis views at the levels of mitral annulus, papillary muscle and apex, and LV apical four-chamber view, two-chamber view and long-axis view in 3 continuous cardiac cycles were recorded. (3) LV ejection fraction (LVEF) and fraction shortening of short axis (FS) was calculated by bi-plane Simpson’s method by conventional echocardiography. (4) Using EchoPAC personal computer, longitudinal strain and strain rate (SL, SrL), circumferential strain and strain rate (SC, SrC), radial strain and strain rate (SC, SrC) of LV segments, global systolic strain (GLS), and torsion and torsional rate were obtained in each plane, and the corresponding curve was accessed.
Results: (1) Twenty-seven of all the 38 patients in CHD group (27/38) had at least one coronary artery stenosis≥75%, while 24 patients in the control group (24/31) with stenosis≤20% in each of the three coronary arteries. Thirty-two patients in CHD group (32/38, 84.21%) had left anterior descending coronary (LAD) narrow. (2) Conventional echocardiographic parameters such as LV diameter, left atria diameter, LVEF, FS, E/A ratio and E-wave deceleration time had no statistical difference between the two groups (P>0.05). (3) Tracking success rate of 2DSE is 96.46% to 97.26%, and unsuccessful tracking happened more often at mitral annulus level than others. (4) In control group, strain (S) and strain rate (SR) of the longitudinal, circumferential and radial dimensions in LV have certain regularity, and there has no statistical differences of longitudinal and radial S and SR among LV walls (P>0.05). In CHD group, except that radial SR in papillary muscle and apex level increased, the absolute value of longitudinal, circumferential and radial S and radial SR in mitral annulus level were lower than that in control group, and the homogeneity disappeared, and there has significant difference at several segments (P<0.05 or P<0.01). The longitudinal S had highest rate to detect the abnormal segments in CHD group and radial SR lowest. (5) The absolute value of torsion and torsional rate in each plane in CHD group were lower than that of control subjects, and there was significant difference between the two groups at global torsion rate (P<0.05). (6) Global systolic strain (GLS) in CHD group was significantly increased (P<0.05), and has good correlations with LVEF and FS (P<0.05). (7) The area under curve (AUC) of each receiver operating characteristic (ROC) curve of S and SR were compared to evaluate their diagnostic efficacy of CHD. The results showed that the AUC of SrL and SC were maximum. The cut value of SrL﹣0.855 s-1 has the highest Yuedden index (0.530) to diagnose CHD, with sensitivity 81.6% and specificity 71.4%. While the cut value of GLS﹣22.85% has the lowest Yuedden index (0.249) to diagnose CHD, with the highest sensitivity of 84.2%. (8) The AUC of SL to the diagnosis of LAD stenosis was maximum. The cut value of SL was﹣15.77% at anterior wall and anteroseptal, which had the highest Yuedden index (0.563), with sensitivity of 74.2% and specificity of 82.1%.
Conclusion: (1) 2DSE has the higher sensitivity than conventional echocardiography in the diagnosis of CHD. The detection rate of indexes to abnormal segments from highest to lowest in the three dimensions is: longitudinal dimension>circumferential>radial, and detection rate of strain was higher than that of strain rate. The detection rate of longitudinal strain was the highest and radial strain rate the lowest. (2) Of all those parameters such as torsional angle and torsional rate in both globe and in each plane, the global torsional rate has the highest sensitivity in the diagnosis of CHD. (3) Global longitudinal strain (GLS) is a sensitive index to evaluate wall motion abnormality in CHD group, and has good correlations with LVEF and FS. (4) The efficacy of longitudinal strain rate (SrL) and circumferential strain (SC) were the maximum to the diagnosis of CHD. The cut value of SrL was﹣0.855s-1 with the highest Yuedden index (0.530). (5) The efficacy of longitudinal strain (SL) was the maximum to diagnose the stenosis of left anterior descending. At anterior wall and anteroseptal, the cut value of SL was﹣15.77% with the highest Yuedden index (0.563).
二维应变超声心动图(2DSE)是超声定量评价心肌功能的新方法,应用斑点追踪成像(STI)技术在超声图像中自动辨认由小于入射波长的组织结构发生背向散射产生的斑点结构,没有角度依赖性,可以从任何方向逐帧追踪每个随心肌同步运动的斑点位移以及斑点间的相对运动,定量分析室壁各节段在长轴、径向、圆周方向以及心室扭转的心肌收缩及舒张运动的情况,使得临床医生对于评价心脏的复杂空间活动成为可能。
本实验应用2DSE定量分析常规方法显示室壁运动正常的冠心病患者左室壁的收缩运动情况,对比评价长轴、圆周、径向方向以及左室扭转的各项应变指标对于局部及整体室壁收缩运动异常方面的意义,探讨2DSE在心肌缺血诊断中的临床应用价值。
方法:(1)选择2007年10月至2008年5月因疑诊冠状动脉粥样硬化性心脏病(CHD)而施行选择性冠状动脉造影术的住院患者69例,根据造影结果分为冠心病组(38例)及对照组(31例),均排除合并其他明确的心脏疾患。(2)应用Vivid 7彩色多普勒超声诊断仪M3S探头,谐波模式频率1.7～3.4MHz,帧频>80帧/秒。采集左室短轴二尖瓣环、乳头肌、心尖水平切面以及心尖四腔、两腔、长轴切面的二维灰阶动态图像。(3)测量常规超声指标,采用心尖双平面Simpson法测量左室射血分数(LVEF)、短轴缩短率(FS)。(4)应用EchoPAC工作站,对左室壁各节段测量长轴应变(SL)、长轴应变率(SrL)、左室整体长轴应变(GLS)、径向应变(SR)、圆周应变(SC)、径向应变率(SrR)、圆周应变率(SrC)、左室整体扭转度(torsion)及左室整体扭转率(torsion rate)、心尖扭转度(apex rot)及心尖扭转率(apex rot rate)、瓣环扭转度(base rot)及瓣环扭转率(base rot rate),并获得其相应的曲线图和应变牛眼图。
结果:(1)冠心病组38例中的27例患者有至少一支冠状动脉狭窄≥75%,而对照组31例中有24例患者的三支冠状动脉狭窄均≤20%,冠心病组38例中有左前降支狭窄患者32例(占84.21%)。(2)常规超声测量指标如左室横径、左房横径、左室射血分数(LVEF)、短轴缩短率(FS)、E/A比值及E峰减速时间(DT)在组间比较中,差异均无统计学意义(P > 0.05)。(3) 2DSE追踪成功率为96.46～97.26%,追踪不成功的节段主要出现在二尖瓣环切面。(4)对照组各室壁的长轴、圆周、径向应变及应变率有一定规律性,室壁间的长轴、径向应变及应变率差异无统计学意义(P >0.05),冠心病组收缩期的应变及应变率波形紊乱,除乳头肌水平及心尖水平的径向应变率增高外,长轴应变及应变率、圆周应变及应变率、径向应变及瓣环水平径向应变率的绝对值均较对照组相应减低,部分室壁差异有统计学意义(P <0.05或P <0.01)。长轴应变对于冠心病组异常节段的检出率最高,径向应变率对于冠心病组异常节段的检出率最低。(5)心尖和瓣环扭转度及扭转率曲线在正负方向上的改变,组间比较有显著统计学差异(P <0.01)。冠心病组的左室整体、心尖、瓣环扭转度及扭转率的绝对值均较对照组减低,整体扭转率差异有统计学差异(P <0.05)。(6)冠心病组左室整体长轴应变(GLS)的绝对值较对照组明显减低(P <0.05),与左室射血分数(LVEF)、短轴缩短率(FS)相关性良好(P <0.05)。(7)在诊断冠心病的指标中,长轴应变率(SrL)与圆周应变(SC)的曲线下面积(AUC)最大,SrL以截断值为﹣0.855s-1诊断冠心病的灵敏度81.6%、特异度为71.4%,Yuedden指数最高,为0.530。而整体长轴应变(GLS)以截断值为﹣22.85%诊断冠心病的敏感性最高,达到84.2%,但Yudden指数最低,仅为0.249。(8)在诊断左前降支狭窄的指标中,长轴应变(SL)的AUC最大,以前壁及前间隔SL的截断值为﹣15.77%诊断左前降支狭窄的灵敏度为74.2%、特异度82.1%,Yuedden指数最高,为0.563。结论:(1) 2DSE可以评价冠心病左室壁收缩运动异常,敏感性高于常规超声心动图,对检出有统计学差异的异常室壁节段数从高到低排列顺序为:长轴方向>圆周方向>径向方向,应变指标>应变率指标,长轴应变对冠心病组异常节段的检出率最高,径向应变率对冠心病组异常节段的检出率最低。(2)心尖和瓣环的扭转方向改变可以评价冠心病。在左室整体、心尖、瓣环的扭转度及扭转率指标中,整体扭转率对于评价冠心病左室壁收缩运动异常的敏感性最高。(3)左室整体长轴应变(GLS)可以检出冠心病组的左室壁收缩运动异常,与LVEF、FS相关性良好。(4)在诊断冠心病的指标中,长轴应变率(SrL)与圆周应变(SC)的诊断价值最高,SrL以截断值为﹣0.855s-1诊断冠心病的Yuedden指数最高(0.530)。(5)在诊断左前降支狭窄的指标中,长轴应变(SL)的诊断价值最高,以前壁及前间隔SL的截断值为﹣15.77%诊断左前降支狭窄的Yuedden指数最高(0.563)。
Backgrounds and Objectives: There is a main research field for the cardiologist to quantify objectively myocardial function. Strain measures the extent of myocardial deformation whilst strain rate measures the rate of the deformation. Both strin and strain rate have been shown to provide new quantitative indexes about the clinical assessment of regional myocardial systolic and diastolic function. Myocardial strain and strain rate can be detected through those methods such as radiation contrast, the implantation of cardiac ultrasonic minicrystal, and magnetic resonance imaging (MRI). Strain and strain rate also can be estimated by several echocardiographic methods. The simplest way is using parasternal short-axis M-Mode view, calculatting wall thickening rate during systole. This however only gives estimates of anteroseptal and posterior wall thickening. Straight anatomy M-mode has been developed years ago. It can place the sample line in 360°radius so as to obtain M-mode image in arbitrary point or angle, which can improve the accurateness and so improve the application of M-mode echocardiogram. However, this method only provides uni-dimensional semi-quantitative assessment of myocardial thickening or thinning, without any information concerning about longitudinal and circumferential function. The most widely used and validated technique is tissue Doppler-derived strain so far. But it is only able to estimate strain along the ultrasound beam due to the angle dependency and thus cannot reliably measure strain in the azimuth or perpendicular plane (dependent on Cosθof the angle of insonation), which limits the usage of this technique primarily to longitudinal fibers, not able to quantify deformation in the radial and circumferential plane.
Two-dimensional strain echocardiography (2DSE) is a novel method of the quantitative assessment of myocardial function. This technique is not encumbered by angle dependency and based on tracking of natural acoustic markers formed by speckle patterns arising from interference of ultrasound backscattered from tissue structures in B mode images. Since the speckle can be tracked in any direction, it is possible to measure its movement in both axial and perpendicular planes, allowing estimation of radial and circumferential strains. This removes the previous limitation of only being able to measure strain along the beam of ultrasound. In addition to the circumferential deformation parameters, ventricular rotation and twist can also be calculated using this technique. It is possible for clinician to estimate special movement of heart.
In the present study, 2DSE was used in quantifying the systolic motion of patients with coronary heart disease (CHD), whose left ventricular (LV) wall motion was estimated normal by conventional echocardiography, trying to estimate its application and difference in evaluating LV wall abnormal motion in longitudinal, radial and circumferential dimensions and ventricular rotation, and to investigate its feasibility and clinical value in identifying ischemic myocardium.
Methods: (1) Sixty-nine doubtful CHD patients sufferring from coronary arteriography in General Navy Hospital from Oct 2007 to May 2008 were involved in this study, which were divided into two groups, one was CHD group (n=38) and the other control group (n=31). And there was no other heart disease in all the objects. (2) Vivid 7 color Doppler Ultrasound Diagnostic Instrument was used and an M3S transducer in harmonic 1.7~3.4 MHz mode was adopted, frame frequency of which was above 80 frames/s. The two-dimensional images from LV short-axis views at the levels of mitral annulus, papillary muscle and apex, and LV apical four-chamber view, two-chamber view and long-axis view in 3 continuous cardiac cycles were recorded. (3) LV ejection fraction (LVEF) and fraction shortening of short axis (FS) was calculated by bi-plane Simpson’s method by conventional echocardiography. (4) Using EchoPAC personal computer, longitudinal strain and strain rate (SL, SrL), circumferential strain and strain rate (SC, SrC), radial strain and strain rate (SC, SrC) of LV segments, global systolic strain (GLS), and torsion and torsional rate were obtained in each plane, and the corresponding curve was accessed.
Results: (1) Twenty-seven of all the 38 patients in CHD group (27/38) had at least one coronary artery stenosis≥75%, while 24 patients in the control group (24/31) with stenosis≤20% in each of the three coronary arteries. Thirty-two patients in CHD group (32/38, 84.21%) had left anterior descending coronary (LAD) narrow. (2) Conventional echocardiographic parameters such as LV diameter, left atria diameter, LVEF, FS, E/A ratio and E-wave deceleration time had no statistical difference between the two groups (P>0.05). (3) Tracking success rate of 2DSE is 96.46% to 97.26%, and unsuccessful tracking happened more often at mitral annulus level than others. (4) In control group, strain (S) and strain rate (SR) of the longitudinal, circumferential and radial dimensions in LV have certain regularity, and there has no statistical differences of longitudinal and radial S and SR among LV walls (P>0.05). In CHD group, except that radial SR in papillary muscle and apex level increased, the absolute value of longitudinal, circumferential and radial S and radial SR in mitral annulus level were lower than that in control group, and the homogeneity disappeared, and there has significant difference at several segments (P<0.05 or P<0.01). The longitudinal S had highest rate to detect the abnormal segments in CHD group and radial SR lowest. (5) The absolute value of torsion and torsional rate in each plane in CHD group were lower than that of control subjects, and there was significant difference between the two groups at global torsion rate (P<0.05). (6) Global systolic strain (GLS) in CHD group was significantly increased (P<0.05), and has good correlations with LVEF and FS (P<0.05). (7) The area under curve (AUC) of each receiver operating characteristic (ROC) curve of S and SR were compared to evaluate their diagnostic efficacy of CHD. The results showed that the AUC of SrL and SC were maximum. The cut value of SrL﹣0.855 s-1 has the highest Yuedden index (0.530) to diagnose CHD, with sensitivity 81.6% and specificity 71.4%. While the cut value of GLS﹣22.85% has the lowest Yuedden index (0.249) to diagnose CHD, with the highest sensitivity of 84.2%. (8) The AUC of SL to the diagnosis of LAD stenosis was maximum. The cut value of SL was﹣15.77% at anterior wall and anteroseptal, which had the highest Yuedden index (0.563), with sensitivity of 74.2% and specificity of 82.1%.
Conclusion: (1) 2DSE has the higher sensitivity than conventional echocardiography in the diagnosis of CHD. The detection rate of indexes to abnormal segments from highest to lowest in the three dimensions is: longitudinal dimension>circumferential>radial, and detection rate of strain was higher than that of strain rate. The detection rate of longitudinal strain was the highest and radial strain rate the lowest. (2) Of all those parameters such as torsional angle and torsional rate in both globe and in each plane, the global torsional rate has the highest sensitivity in the diagnosis of CHD. (3) Global longitudinal strain (GLS) is a sensitive index to evaluate wall motion abnormality in CHD group, and has good correlations with LVEF and FS. (4) The efficacy of longitudinal strain rate (SrL) and circumferential strain (SC) were the maximum to the diagnosis of CHD. The cut value of SrL was﹣0.855s-1 with the highest Yuedden index (0.530). (5) The efficacy of longitudinal strain (SL) was the maximum to diagnose the stenosis of left anterior descending. At anterior wall and anteroseptal, the cut value of SL was﹣15.77% with the highest Yuedden index (0.563).
引文
[1]. Mirsky I, Parmley WW. Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res, 1973, 33: 233- 243.
[2]. Becker M, Bilke E, Kuhl H, et al. Analysis of myocardial deformation based on pixel tracking in two-dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart, 2006, 92:1102–1108.
[3]. Segar DS , Brown SE , Sawasa SG, et al . Dobutamine stress echocardiography: correlation wit h coronary lesion severity as determined by quantitative angiography. J Am Coll Cardiol, 1992, 19: 1197-1202.
[4]. Gould KL, Lipscomb K. Effects of coronary stenosis on coronary flow reserve and resistance. Am J Cardiol, 1974, 34: 48-55.
[5]. Myers J H , Stirling MC , Choy M , et al . Direct measurement of inner and outer wall thincking dynamics with epicardial echocardiography. Circulation ,1986 ,74 : 164-172.
[6]. Jonathan C, Lizelle H, Chiew W, et al. Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function. J Am Coll cardiol, 2006, 48:2026-2033.
[7]. Clark NR, Reichek N, Bergey P, et al. Circumferential myocardial shortening in the normal human left ventricle:Assessment by magnetic resonance imaging using spatial modulation of magnetization. Circulation, 1991, 84:67–74.
[8]. Derumeaux G, Loufoua J, Pontier G, et al. Tissue doppler imaging differentiates transmural from nontransmural acute myocardial infarction after reperfusion therapy. Circulation, 2001, 103:589–596.
[9]. Nakai H, Takeuchi M, Nishikage T, et al. Effect of aging on twist-displacement loop by 2-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19: 880-885.
[10]. Gallagher KP, Osakada G, Matsuzaki M, et al. Nonuniformity of inner and outer systolic wall thickening inconscious dogs. Am J Physiol, 1985, 249:241–248.
[11]. Nelson C, McCrohon J, Khafagi F, et al. Impact of scar thickness on the assessmentof viability using dobutamine echocardiography and thallium single-photon emission computed tomography: a comparison with contrast-enhanced magnetic resonance imaging. J Am Coll Cardiol, 2004, 43:1248–1256.
[12]. MacGowan GA, Shapiro EP, Azhari H, et al. Noninvasive measurement of shortening in the fiber and cross-fiber directions in the normal human left ventricle and in idiopathic dilated cardiomyopathy. Circulation, 1997, 96:535–541.
[13]. Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol, 2006, 47:789-793.
[14]. Taber LA, Yang M, Podszus WW. Mechanics of ventricular torsion. J Biombch, 1996, 29: 745-752.
[15]. Takeuchi M, Nakai H, Kokumai M, et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19: 1077-1084.
[16]. Tibayan FA, Lai DT, Timek TA, et al. Alteration in left ventricular torsion in tachycardia-induced dilated cardiomyopathy. J Thorac Cardiovasc Surg, 2002, 124: 43-49.
[17]. Kim HK, Sohn DW, Lee SE, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogra, 2007, 20:45-53.
[18]. Chung J, Abraszewski P, Yu X, et al. Paradoxical increase inventricular torsion and systolic torsion rate in type 1 diabetic patients under tight glycemic control. J Am Coll Cardiol, 2006, 47: 384-390.
[19]. Sallin EA. Fiber orientation and ejection fraction in the human left ventricle. Biophys J, 1969, 9: 954-964.
[20]. Taeuchi M, Nishikage T, Nakai H, et al. The assessment of left ventricular twist in anterior wall myocardial infarction using two-dinmensional speckle tracking imaging. J Am Soc Echocardiogra, 2007, 20: 36 - 44.
[21]. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography– from technical considerations to clinical applications. J Am SocEchocardiogra, 2007, 20:234–243.
[22]. Dogan S, Aydin M, Gursurer, M, et al. Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogra,2006 ,19 :243-248.
[23]. Cohen GI, Pietrolungo JF, Thomas JD, et al. A practical guide to assessment of ventricular diastolic function using Doppler echocardiography. J Am Coll Cardiol , 1996 , 27 : 1753-1760.
[24]. Swets JA. M easuring the accuracy of diagno stic system s. Science, 1988, 240: 1285.
[25]. Souza KD, MacIsaac A, Best J, et al. Echocardiographic imaging in the dual focus mode affects two-dimensional speckle tracking strain rate imaging. Heart, Lung and Circulation, 2007, 16:S1–S201.
[1]. Becker M, Bilke E, Kuhl H, et al. Analysis of myocardial deformation based onixel tracking in two-dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart, 2006, 92:1102–1108.
[2]. Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol, 2006, 47:789-793.
[3]. Korinek J, Kjaergaard J, Sengupta PP, et al. High spatial resolution speckle tracking improves accuracy of 2-dimensional strain measurements: an update on a new method in functional echocardiography. J Am Soc Echocardiogra, 2007, 20:165–170.
[4]. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography: from technical considerations to clinical applications. J Am Soc Echocardiogra, 2007, 20:234–243.
[5]. Torrent-Guasp F, Buckberg GD, Clemente C, et al. The structure and function of the helical heart and its buttress wrapping: The normal macroscopic structure of the heart. Semin Thorac Cardiovasc Surg, 2001, 13: 301-319.
[6]. Chung J, Abraszewski P, Yu X, et al. Paradoxical increase in ventricular torsion and systolic torsion rate in type I diabetic patients under tight glycemic control. J Am Coll Cardiol, 2006, 47:384-390.
[7]. Sallin EA. Fiber orientation and ejection fraction in the human left ventricle. Biophys J, 1969, 9: 954-964.
[8]. Takeuchi M, Nakai H, Kokumai M, et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19: 1077-1084.
[9]. Notomi Y, Srinath G, Shiota T, et al. Maturational and adaptive modulation of left ventricular torsional biomechanics: Dopple tissue imaging observation from infancy to adulthood. Circulation, 2006, 113: 2534-2541.
[10]. Nakai H, Takeuchi M, Nishikage T, et al. Effect of aging on twist-displacement loop by 2-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19:880-885.
[11]. Artis NJ, Oxborough DL, Williams G, et al. Two-dimensional strain imaging: a new echocardiographic advance with research and clinical applications. J Am Coll Cardiol, 2008, 123:240-248.
[12]. Hui L, Pemberton J, Hickey E, et al. The contribution of left ventricular muscle bands to left ventricular rotation: assessment by a 2-dimensional speckle tracking method. J Am Soc Echocardiogra, 2007, 20:486-491.
[13]. Kim HK, Sohn DW, Lee SE, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogra, 2007, 20:45-53.
[14]. Liang HY, Cauduro S, Pellikka P, et al. Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease. J Am Coll Cardiol, 2006, 98:1581-1586.
[15]. Winter R, Jussila R, Nowak J, et al. Speckle tracking echocardiography is a sensitive tool for the detection of myocardial ischemia: a pilot study from the catheterization laboratory during percutaneous coronary intervention. J Am Soc Echocardiogra, 2007, 20:974-981.
[16]. Migrino RQ, Aggarwal D, Konorev E, et al. Early detection of Doxorubicin cardiomyopathy using two-dimensional strain echocardiography. Ultrasound Med Biol, 2008, 34:208-214.
[17]. Popovic ZB, Benejam C, Bian J, et al. Speckle tracking echocardiography correctly identifies segmental left ventricular dysfunction induced by scarring in a rat model of myocardial infarction. Am J Physiol Heart Circ Physiol, 2007, 292: 2809-2816.
[18]. Teske AJ,De Boeck BW,Melman PG,et al.Echocardiographic quantification of myocardial function using tissue deformation imaging: a guide to image acquisition and analysis using tissue Doppler and speckle tracking.Cardiovasc Ultrasound, 2007,5:27.
[19]. Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med, 2000, 343: 1445–1453.
[20]. Helle-Valle TM, Vartdal T, Smith H, et al. Differentiation between transmural andnon-transmural infarction by assessment of circumferential strain by speckle tracking echocardiography. Circulation, 2006,114:S1–S2243.
[21]. 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. J Am Coll Cardiol, 2006, 48:2026-2033.
[22]. Gjesdal O, Hopp E, Vartdal T, et al. Global longitudinal strain measured by two-dimensional speckle tracking echocardiography is closely related to myocardial infarct size in chronic ischaemic heart disease. Clin Sci, 2007, 113:287-296.
[23]. Edvardsen T , Helle-Valle T , Smiseth OA. Systolic dysfunction in heart failure with normal ejection fraction: speckle tracking echocardiography. Prog Cardiovasc Dis, 2006, 49:207-214.
[24]. Dogan S, Aydin M, Gursurer, M, et al. Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogra,2006 ,19 :243-248.
[25]. Helle-Valle T, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation, 2005, 112:3149-3156.
[26]. Taeuchi M, Nishikage T, Nakai H, et al. The assessment of left ventricular twist in anterior wall myocardial infarction using two-dinmensional speckle tracking imaging. J Am Soc Echocardiogra, 2007, 20: 36 - 44.
[27]. Wang J, Khoury DS, Yue Y, et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation, 2007, 116:2580-2586.
[28]. Takeuchi M, Borden WB, Nakai H, et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging. Eur Heart J, 2007, 28:2756-2762.
[29]. Notomi Y, Martin-Miklovic MG, Oryszak SJ, et al. Enhanced ventricular untwisting during exercise a mechanistic manifestation of elastic recoil descibed by Doppler tissue imaging. Circulation, 2006, 113: 2524-2533.
[30]. Serri K, Reant P, Lafitte M, et al. Global and regional myocardial function quantification by two-dimentional strain: application in hypertrophic cardiomyopathy. J Am Coll Cardiol, 2006, 47: 1175 - 1181.
[31]. Richand V, Lafitte S, Reant P, et al. An ultrasound speckle tracking (two-dimensional strain) analysis of myocardial deformation in professional soccer players compared with healthy subjects and hypertrophic cardiomyopathy. J Am Coll Cardiol, 2007, 100:128-132.
[32]. Masaaki Takeuchi, Hiromi Nakai, Michiko Kokumai, et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle-tracking imaging. J Am Soc Echocardiogra, 2006, 19: 1077- 1084.
[33].张芸,邓又斌,张清阳,等.超声二维应变成像技术在评价扩张型心肌病患者左心收缩功能中的应用.中国超声医学杂志,2007,23:747-750.
[34]. Modesto KM, Cauduro S, Dispenzieri A, et al. Two-dimensional acoustic pattern derived strain parameters closely correlate with one-dimensional tissue Doppler derived strain measurements. Eur J Echocardiogra , 2006,7:315–321.
[35]. Tops LF, Schalij MJ, Holman ER, et al. Speckle-tracking radial strain reveals left ventricular dyssynchrony in patients with permanent right ventricular pacing. Circulation, 2006, 114:S1–S2137.
[36]. Matsuoka K, Masami N, Hashimoto A, et al. Right ventricular apical pacing impairs left ventricular torsion as well as synchrony. Circulation, 2006, 114:S1–S2136.
[37]. Murata K, Ueyama T, Tanaka T, et al. Longitudinal myocardial strain in right ventricular wall reduced by pilsicainide challenge in patients with Brugada type electrocardiography : evaluation by two-dimensional strain imaging technique. Circulation, 2006, 114:S1–S2910.
[38]. Pirat B, McCulloch ML, Zoghbi WA. Evaluation of Global and Regional Right Ventricular Systolic Function in Patients With Pulmonary Hypertension Using a Novel Speckle Tracking Method. J Am Coll Cardiol, 2006, 98:699–704.
[39]. Borges AC, Knebel F, Eddicks S, et al. Right ventricular function assessed by two-dimentional strain and tissue Doppler echocardiography in patients with pulmonary arterial hypertension and effect of vasodilator therapy. J Am Coll Cardiol, 2006, 98: 530 - 534.
[40]. Jackson KP, Sievers B, Pappas P, et al. Echocardiographic two-dimensional strain analysis identifies regional myocardial scar: a comparison with contrast-enhanced MRI. Circulation, 2006,114:S1–S3141.
[41]. Becker M, Franke A, Breithardt OA.Impact of left ventricular lead position on the efficacy of cardiac resynchronisation therapy: a two-dimensional strain echocardiography study. Heart, 2007, 93:1197-1203.
[42]. Ahmad A, Popovic Z, Benejam C, et al. Longitudinal rotation: an unrecognized motion pattern in patients with left bundle branch block and dilated cardiomyopathy. Circulation, 2006,114:S1–S2906.
[43]. Knebel F, Schattke S, Bondke H, et al. Evaluation of longitudinal and radial two-dimensional strain imaging versus Doppler tissue echocardiography in predicting long-term response to cardiac resynchronization therapy. J Am Soc Echocardiogra, 2007, 20:335-341.
[44]. Matthew SS, Kaoru DH, Maxime C, et al. Novel speckle-tracking radial strain from roution black-and-white schocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization theraphy. Circulation, 2006, 113: 960- 968.
[45]. Suffoletto MS, Tanabe M, Saba S, et al. Improvement in speckle-tracking radial strain dyssynchrony after cardiac resynchronization therapy. Circulation, 2006, 114:S1–S2138.
[46]. Suffoletto MS, Dohi K, Cannesson M, et al. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation, 2006,113:960–968.
[47]. Bart WL, Maarten-Jan M, Peter L, et al. Two-Dimensional strain imaging to assess the origin and extent of ventricular preexcitation associated with an accessory bypass. Circulation, 2006, 113:835-839.
[48]. Han W, Xie M, Wang X, et al. Assessment of left ventricular global twist in essential hypertensive heart by speckle tracking imaging. J Huazhong Univ Sci Technolog Med Sci, 2008,28:114-117.
[49]. Jens H, Fabian K, Stephan E, et al. Noninvasive monitoring of myocardial function after surgical and cytostatic therapy in a peritoneal metastasis rat model: assessment with tissue Doppler and non-Doppler 2D strain echocardiography. Cardiovasc Ultrasound, 2007; 5: 23.
[50]. Chan W, DeBoer R, Rosenthal MA, et al . Applying strain and strain rate analysis byspeckle tracking echocardiography to detect subclinical left ventricular dysfunction in breast cancer patients undergoing chemotherapy. Heart, Lung and Circulation, 2007,16:S1–S201.
[51]. Soo J, Seung WP, Sung WC, et al. Detection of acute graft rejection after heart transplantation by two-dimensional ultrasound speckle tracking imaging. Heart, Lung and Circulation, 2008,17:S4–S53.
[52]. Serri K, Labrousse L, Reant P, et al. Significant improvement of myocardial function following cardiac support device implantation: illustration by two-dimensional strain. Eur J Echocardiogr, 2006, 7:473-475.
[53]. Souza K, MacIsaac A, Best J, et al. Echocardiographic imaging in the dual focus mode affects two-dimensional speckle tracking strain rate imaging. Heart, Lung and Circulation, 2007, 16:S1–S201.
[54]. Migrino RQ, Zhu X, Pajewski N, et al. Assessment of segmental myocardial viability using regional 2-dimensional strain echocardiography. J Am Soc Echocardiogra, 2007, 20:342–351.
[55]. Saijo Y, Tanska A, Iwamoto T, et al. Intravascular two-dimentional tissue strain imaging. Ultrasonics, 2006, 44:147-151.
[56]. Langeland S, Wouters PF, Claus P, et al. Experimental assessment of a new research tool for the estimation of two-dimensional myocardial strain. Ultrasound Med Biol, 2006,32: 1509–1513.
[2]. Becker M, Bilke E, Kuhl H, et al. Analysis of myocardial deformation based on pixel tracking in two-dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart, 2006, 92:1102–1108.
[3]. Segar DS , Brown SE , Sawasa SG, et al . Dobutamine stress echocardiography: correlation wit h coronary lesion severity as determined by quantitative angiography. J Am Coll Cardiol, 1992, 19: 1197-1202.
[4]. Gould KL, Lipscomb K. Effects of coronary stenosis on coronary flow reserve and resistance. Am J Cardiol, 1974, 34: 48-55.
[5]. Myers J H , Stirling MC , Choy M , et al . Direct measurement of inner and outer wall thincking dynamics with epicardial echocardiography. Circulation ,1986 ,74 : 164-172.
[6]. Jonathan C, Lizelle H, Chiew W, et al. Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function. J Am Coll cardiol, 2006, 48:2026-2033.
[7]. Clark NR, Reichek N, Bergey P, et al. Circumferential myocardial shortening in the normal human left ventricle:Assessment by magnetic resonance imaging using spatial modulation of magnetization. Circulation, 1991, 84:67–74.
[8]. Derumeaux G, Loufoua J, Pontier G, et al. Tissue doppler imaging differentiates transmural from nontransmural acute myocardial infarction after reperfusion therapy. Circulation, 2001, 103:589–596.
[9]. Nakai H, Takeuchi M, Nishikage T, et al. Effect of aging on twist-displacement loop by 2-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19: 880-885.
[10]. Gallagher KP, Osakada G, Matsuzaki M, et al. Nonuniformity of inner and outer systolic wall thickening inconscious dogs. Am J Physiol, 1985, 249:241–248.
[11]. Nelson C, McCrohon J, Khafagi F, et al. Impact of scar thickness on the assessmentof viability using dobutamine echocardiography and thallium single-photon emission computed tomography: a comparison with contrast-enhanced magnetic resonance imaging. J Am Coll Cardiol, 2004, 43:1248–1256.
[12]. MacGowan GA, Shapiro EP, Azhari H, et al. Noninvasive measurement of shortening in the fiber and cross-fiber directions in the normal human left ventricle and in idiopathic dilated cardiomyopathy. Circulation, 1997, 96:535–541.
[13]. Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol, 2006, 47:789-793.
[14]. Taber LA, Yang M, Podszus WW. Mechanics of ventricular torsion. J Biombch, 1996, 29: 745-752.
[15]. Takeuchi M, Nakai H, Kokumai M, et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19: 1077-1084.
[16]. Tibayan FA, Lai DT, Timek TA, et al. Alteration in left ventricular torsion in tachycardia-induced dilated cardiomyopathy. J Thorac Cardiovasc Surg, 2002, 124: 43-49.
[17]. Kim HK, Sohn DW, Lee SE, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogra, 2007, 20:45-53.
[18]. Chung J, Abraszewski P, Yu X, et al. Paradoxical increase inventricular torsion and systolic torsion rate in type 1 diabetic patients under tight glycemic control. J Am Coll Cardiol, 2006, 47: 384-390.
[19]. Sallin EA. Fiber orientation and ejection fraction in the human left ventricle. Biophys J, 1969, 9: 954-964.
[20]. Taeuchi M, Nishikage T, Nakai H, et al. The assessment of left ventricular twist in anterior wall myocardial infarction using two-dinmensional speckle tracking imaging. J Am Soc Echocardiogra, 2007, 20: 36 - 44.
[21]. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography– from technical considerations to clinical applications. J Am SocEchocardiogra, 2007, 20:234–243.
[22]. Dogan S, Aydin M, Gursurer, M, et al. Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogra,2006 ,19 :243-248.
[23]. Cohen GI, Pietrolungo JF, Thomas JD, et al. A practical guide to assessment of ventricular diastolic function using Doppler echocardiography. J Am Coll Cardiol , 1996 , 27 : 1753-1760.
[24]. Swets JA. M easuring the accuracy of diagno stic system s. Science, 1988, 240: 1285.
[25]. Souza KD, MacIsaac A, Best J, et al. Echocardiographic imaging in the dual focus mode affects two-dimensional speckle tracking strain rate imaging. Heart, Lung and Circulation, 2007, 16:S1–S201.
[1]. Becker M, Bilke E, Kuhl H, et al. Analysis of myocardial deformation based onixel tracking in two-dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart, 2006, 92:1102–1108.
[2]. Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol, 2006, 47:789-793.
[3]. Korinek J, Kjaergaard J, Sengupta PP, et al. High spatial resolution speckle tracking improves accuracy of 2-dimensional strain measurements: an update on a new method in functional echocardiography. J Am Soc Echocardiogra, 2007, 20:165–170.
[4]. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography: from technical considerations to clinical applications. J Am Soc Echocardiogra, 2007, 20:234–243.
[5]. Torrent-Guasp F, Buckberg GD, Clemente C, et al. The structure and function of the helical heart and its buttress wrapping: The normal macroscopic structure of the heart. Semin Thorac Cardiovasc Surg, 2001, 13: 301-319.
[6]. Chung J, Abraszewski P, Yu X, et al. Paradoxical increase in ventricular torsion and systolic torsion rate in type I diabetic patients under tight glycemic control. J Am Coll Cardiol, 2006, 47:384-390.
[7]. Sallin EA. Fiber orientation and ejection fraction in the human left ventricle. Biophys J, 1969, 9: 954-964.
[8]. Takeuchi M, Nakai H, Kokumai M, et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19: 1077-1084.
[9]. Notomi Y, Srinath G, Shiota T, et al. Maturational and adaptive modulation of left ventricular torsional biomechanics: Dopple tissue imaging observation from infancy to adulthood. Circulation, 2006, 113: 2534-2541.
[10]. Nakai H, Takeuchi M, Nishikage T, et al. Effect of aging on twist-displacement loop by 2-dimensional speckle tracking imaging. J Am Soc Echocardiogra, 2006, 19:880-885.
[11]. Artis NJ, Oxborough DL, Williams G, et al. Two-dimensional strain imaging: a new echocardiographic advance with research and clinical applications. J Am Coll Cardiol, 2008, 123:240-248.
[12]. Hui L, Pemberton J, Hickey E, et al. The contribution of left ventricular muscle bands to left ventricular rotation: assessment by a 2-dimensional speckle tracking method. J Am Soc Echocardiogra, 2007, 20:486-491.
[13]. Kim HK, Sohn DW, Lee SE, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogra, 2007, 20:45-53.
[14]. Liang HY, Cauduro S, Pellikka P, et al. Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease. J Am Coll Cardiol, 2006, 98:1581-1586.
[15]. Winter R, Jussila R, Nowak J, et al. Speckle tracking echocardiography is a sensitive tool for the detection of myocardial ischemia: a pilot study from the catheterization laboratory during percutaneous coronary intervention. J Am Soc Echocardiogra, 2007, 20:974-981.
[16]. Migrino RQ, Aggarwal D, Konorev E, et al. Early detection of Doxorubicin cardiomyopathy using two-dimensional strain echocardiography. Ultrasound Med Biol, 2008, 34:208-214.
[17]. Popovic ZB, Benejam C, Bian J, et al. Speckle tracking echocardiography correctly identifies segmental left ventricular dysfunction induced by scarring in a rat model of myocardial infarction. Am J Physiol Heart Circ Physiol, 2007, 292: 2809-2816.
[18]. Teske AJ,De Boeck BW,Melman PG,et al.Echocardiographic quantification of myocardial function using tissue deformation imaging: a guide to image acquisition and analysis using tissue Doppler and speckle tracking.Cardiovasc Ultrasound, 2007,5:27.
[19]. Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med, 2000, 343: 1445–1453.
[20]. Helle-Valle TM, Vartdal T, Smith H, et al. Differentiation between transmural andnon-transmural infarction by assessment of circumferential strain by speckle tracking echocardiography. Circulation, 2006,114:S1–S2243.
[21]. 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. J Am Coll Cardiol, 2006, 48:2026-2033.
[22]. Gjesdal O, Hopp E, Vartdal T, et al. Global longitudinal strain measured by two-dimensional speckle tracking echocardiography is closely related to myocardial infarct size in chronic ischaemic heart disease. Clin Sci, 2007, 113:287-296.
[23]. Edvardsen T , Helle-Valle T , Smiseth OA. Systolic dysfunction in heart failure with normal ejection fraction: speckle tracking echocardiography. Prog Cardiovasc Dis, 2006, 49:207-214.
[24]. Dogan S, Aydin M, Gursurer, M, et al. Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogra,2006 ,19 :243-248.
[25]. Helle-Valle T, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation, 2005, 112:3149-3156.
[26]. Taeuchi M, Nishikage T, Nakai H, et al. The assessment of left ventricular twist in anterior wall myocardial infarction using two-dinmensional speckle tracking imaging. J Am Soc Echocardiogra, 2007, 20: 36 - 44.
[27]. Wang J, Khoury DS, Yue Y, et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation, 2007, 116:2580-2586.
[28]. Takeuchi M, Borden WB, Nakai H, et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging. Eur Heart J, 2007, 28:2756-2762.
[29]. Notomi Y, Martin-Miklovic MG, Oryszak SJ, et al. Enhanced ventricular untwisting during exercise a mechanistic manifestation of elastic recoil descibed by Doppler tissue imaging. Circulation, 2006, 113: 2524-2533.
[30]. Serri K, Reant P, Lafitte M, et al. Global and regional myocardial function quantification by two-dimentional strain: application in hypertrophic cardiomyopathy. J Am Coll Cardiol, 2006, 47: 1175 - 1181.
[31]. Richand V, Lafitte S, Reant P, et al. An ultrasound speckle tracking (two-dimensional strain) analysis of myocardial deformation in professional soccer players compared with healthy subjects and hypertrophic cardiomyopathy. J Am Coll Cardiol, 2007, 100:128-132.
[32]. Masaaki Takeuchi, Hiromi Nakai, Michiko Kokumai, et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle-tracking imaging. J Am Soc Echocardiogra, 2006, 19: 1077- 1084.
[33].张芸,邓又斌,张清阳,等.超声二维应变成像技术在评价扩张型心肌病患者左心收缩功能中的应用.中国超声医学杂志,2007,23:747-750.
[34]. Modesto KM, Cauduro S, Dispenzieri A, et al. Two-dimensional acoustic pattern derived strain parameters closely correlate with one-dimensional tissue Doppler derived strain measurements. Eur J Echocardiogra , 2006,7:315–321.
[35]. Tops LF, Schalij MJ, Holman ER, et al. Speckle-tracking radial strain reveals left ventricular dyssynchrony in patients with permanent right ventricular pacing. Circulation, 2006, 114:S1–S2137.
[36]. Matsuoka K, Masami N, Hashimoto A, et al. Right ventricular apical pacing impairs left ventricular torsion as well as synchrony. Circulation, 2006, 114:S1–S2136.
[37]. Murata K, Ueyama T, Tanaka T, et al. Longitudinal myocardial strain in right ventricular wall reduced by pilsicainide challenge in patients with Brugada type electrocardiography : evaluation by two-dimensional strain imaging technique. Circulation, 2006, 114:S1–S2910.
[38]. Pirat B, McCulloch ML, Zoghbi WA. Evaluation of Global and Regional Right Ventricular Systolic Function in Patients With Pulmonary Hypertension Using a Novel Speckle Tracking Method. J Am Coll Cardiol, 2006, 98:699–704.
[39]. Borges AC, Knebel F, Eddicks S, et al. Right ventricular function assessed by two-dimentional strain and tissue Doppler echocardiography in patients with pulmonary arterial hypertension and effect of vasodilator therapy. J Am Coll Cardiol, 2006, 98: 530 - 534.
[40]. Jackson KP, Sievers B, Pappas P, et al. Echocardiographic two-dimensional strain analysis identifies regional myocardial scar: a comparison with contrast-enhanced MRI. Circulation, 2006,114:S1–S3141.
[41]. Becker M, Franke A, Breithardt OA.Impact of left ventricular lead position on the efficacy of cardiac resynchronisation therapy: a two-dimensional strain echocardiography study. Heart, 2007, 93:1197-1203.
[42]. Ahmad A, Popovic Z, Benejam C, et al. Longitudinal rotation: an unrecognized motion pattern in patients with left bundle branch block and dilated cardiomyopathy. Circulation, 2006,114:S1–S2906.
[43]. Knebel F, Schattke S, Bondke H, et al. Evaluation of longitudinal and radial two-dimensional strain imaging versus Doppler tissue echocardiography in predicting long-term response to cardiac resynchronization therapy. J Am Soc Echocardiogra, 2007, 20:335-341.
[44]. Matthew SS, Kaoru DH, Maxime C, et al. Novel speckle-tracking radial strain from roution black-and-white schocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization theraphy. Circulation, 2006, 113: 960- 968.
[45]. Suffoletto MS, Tanabe M, Saba S, et al. Improvement in speckle-tracking radial strain dyssynchrony after cardiac resynchronization therapy. Circulation, 2006, 114:S1–S2138.
[46]. Suffoletto MS, Dohi K, Cannesson M, et al. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation, 2006,113:960–968.
[47]. Bart WL, Maarten-Jan M, Peter L, et al. Two-Dimensional strain imaging to assess the origin and extent of ventricular preexcitation associated with an accessory bypass. Circulation, 2006, 113:835-839.
[48]. Han W, Xie M, Wang X, et al. Assessment of left ventricular global twist in essential hypertensive heart by speckle tracking imaging. J Huazhong Univ Sci Technolog Med Sci, 2008,28:114-117.
[49]. Jens H, Fabian K, Stephan E, et al. Noninvasive monitoring of myocardial function after surgical and cytostatic therapy in a peritoneal metastasis rat model: assessment with tissue Doppler and non-Doppler 2D strain echocardiography. Cardiovasc Ultrasound, 2007; 5: 23.
[50]. Chan W, DeBoer R, Rosenthal MA, et al . Applying strain and strain rate analysis byspeckle tracking echocardiography to detect subclinical left ventricular dysfunction in breast cancer patients undergoing chemotherapy. Heart, Lung and Circulation, 2007,16:S1–S201.
[51]. Soo J, Seung WP, Sung WC, et al. Detection of acute graft rejection after heart transplantation by two-dimensional ultrasound speckle tracking imaging. Heart, Lung and Circulation, 2008,17:S4–S53.
[52]. Serri K, Labrousse L, Reant P, et al. Significant improvement of myocardial function following cardiac support device implantation: illustration by two-dimensional strain. Eur J Echocardiogr, 2006, 7:473-475.
[53]. Souza K, MacIsaac A, Best J, et al. Echocardiographic imaging in the dual focus mode affects two-dimensional speckle tracking strain rate imaging. Heart, Lung and Circulation, 2007, 16:S1–S201.
[54]. Migrino RQ, Zhu X, Pajewski N, et al. Assessment of segmental myocardial viability using regional 2-dimensional strain echocardiography. J Am Soc Echocardiogra, 2007, 20:342–351.
[55]. Saijo Y, Tanska A, Iwamoto T, et al. Intravascular two-dimentional tissue strain imaging. Ultrasonics, 2006, 44:147-151.
[56]. Langeland S, Wouters PF, Claus P, et al. Experimental assessment of a new research tool for the estimation of two-dimensional myocardial strain. Ultrasound Med Biol, 2006,32: 1509–1513.