超声三维斑点追踪技术评价冠心病患者左心室整体收缩功能的研究

目的应用超声三维斑点追踪技术（3D—STI）分析冠心病患者左心室整体应变参数，探讨3D—STI评价其左心室整体收缩功能的临床价值。方法冠心病患者39例（经冠脉造影证实），年龄、性别和高血压发病率匹配的对照组26例。经胸采集心尖全容积三维图像，应用三维斑点追踪分析软件测量两组病例左室整体长轴应变值（G15）、整体圆周应变值（GCS）、整体径向应变值（GRS）及整体面积应变值（GAS）。绘制各参数ROC曲线，确定曲线下面积和最佳截断点。并对各参数与左室射血分数（LVEF）之间的相关性进行分析。结果与对照组比较，冠心病组各整体心肌应变参数均明显减低fGRS：（47．72±8．66）比（40．05±8．66），P〈0．001；GCS：（-17．88±2．37）比（-14．89±2．61），P〈0．001；GLS：（-14．10±2．61）比（-17．04±2．60），P〈0．001；GAS：（-30．20±2．57）比（-25．63±3．73），P〈0．001]。ROC曲线表明GRS、GCS、GLS、GAS诊断冠心病的敏感性分别为68．8％、65．6％、78．1％、84．4％，特异性分别为65．2％、65．4％、70．0％、78-3％。相关性结果表明：GLS、GCS、GAS与LVEF之间呈负相关，r分别为-0．674、-0．655、-0．693（P〈0．001）；GRS与LVEF之间呈正相关，r为0．643（P〈0．001）。结论3D—STI能较敏感地评价冠心病患者早期左室整体收缩功能的变化，其中面积应变较其他指标更加敏感。

Quantitative evaluation of left ventricular global systolic function in patients with coronary heart disease by three-dimensional speckle tracking echocardiography

Objective To explore the clinical value of three-dimensional speckle tracking imaging in evaluation of left ventricular global systolic function in patients with coronary heart disease （CHD） by evaluating left ventricular （LV） global strains. Methods 39 patients with coronary heart disease confirmed by CCTA （CHD group） and 26 sex-age matched subjects （control group） were enrolled in this study. Real-time three dimensional full volume of the LV was obtained. The longitudinal peak systolic strain （GLS）, circumferential peak systolic strain （GCS）, radial peak systolic strain （GRS） and area peak systolic strain （GAS） were analyzed by 3DT analysis software. The ROC curves of the parameters were generated for the sensitivity and specificity in the detection of myocardial ischemia, and the correlation between the LVEF and the parameters were also studied. Results There was significant difference of each index about global strain between control group and CHD group GRS： （47.72±8.66） vs （40.05±8.66）; GCS： （-17.88±2.37） vs （-14.89±2.61）; GLS： （-14.10±2.61） vs （-17.04±2.60）; GAS： （-30.20±2.57） vs （-25.63±3.73）, all P 〈 0.001]. ROC curves showed the sensitivity of GRS, GCS, GLS and GAS in the diagnosis of coronary heart disease was 68.8%, 65.6%, 78.1% and 84.4%, respectively, while the specificity of them was 65.2%, 65.4%, 70.0% and 78.3%. The correlations among LVEF and GLS, GCS; GAS, GRS were found （r = -0.674, -0.655, -0.693, 0.643, all P 〈 0.001）. Conclusion Three-dimensional speckle tracking can be used to evaluate the early myocardial systolic function changes in patients with coronary heart disease, and GAS is more sensitive than other parameters.