三维斑点追踪技术评价冠脉狭窄患者左心室局部纵向收缩功能的研究

目的：通过对超声心动图中三维斑点追踪显像（3D-STI）技术的研究，探讨该技术对不同程度冠状动脉狭窄患者左心室局部纵向收缩功能评价的可行性。资料与方法：选择2010年6月—2012年8月卫生部北京医院心内科疑诊为冠心病的患者110例，其中男68例，女42例，年龄（63.2±8.9）岁。所有受试者均行冠状动脉造影（CAG）检查，检查前行三维超声心动图检查，利用3D-STI技术得到左心室16节段所对应的收缩期纵向峰值应变率（LS）和纵向应变达峰时间（T-LS）。根据CAG结果按照冠脉狭窄程度将患者分为5组：冠脉正常组、冠脉微狭窄组、冠脉轻度狭窄组、冠脉中度狭窄组和冠脉重度狭窄组。利用SPSS 16.0统计软件对不同冠脉狭窄组所对应室壁的LS和T-LS进行比较分析。结果：随着狭窄程度的加重，病变血管所对应的部分室壁节段的LS下降，T-LS延长，尤其在重度狭窄组中尤为显著。结论：应用3D-STI技术对不同程度冠脉狭窄患者左室局部纵向收缩功能进行评价具有可行性，为无创技术诊断冠心病提供了依据。

Investigation of 3D-STI for the assessment of left ventricular regional longitudinal systolic function in patients with different graded coronary artery stenosis

Objective： To investigate the feasibility of three-dimensional speckle tracking imaging （STI） for the assessment of left ventricular regional longitudinal systolic function of patients with different graded coronary artery stenosis. Materials and Methods： One hundred and ten patients suspected of coronary heart disease （CHD） in Beijing Hospital of the Ministry of Health were selected from June, 2010 to Aug, 2012. Men 68, women 42, average age was （63.2±8.9） years old. All patients received the examination of regular and three dimensional echocardiography before the CAG. The materials of the three dimensional all volume dynamic cardiac graph were collected and stored. The 3D dynamic graph using the 3D-STI offline were analyzed. The systolic peak longitudinal strain （LS） and the time of peak longitudinal strain （T-LS） of the 16 myocardial segments of the left ventricle（consist of 6 segments at the level of mitral orifice, 6 segments at the level of papillary muscles and 4 segments at apex section） were obtained. According to the results of the CAG, the subjects were divided into 5 groups： normal group （stenosis extent=0%）, slightly narrowed group （0%〈stenosis extents〈25%）, mild narrowed group （25%〈stenosis extents〈50%）, moderate narrowed group（50%〈stenosis extents〈75%）, severe narrowed group（stenosis extent〉75%）. Using statistical software of SPSS 16.0 to compare the peak LS strain value and T-LS in different graded coronary artery stenosis. Results： In different grade coronary artery stenosis groups, LS of part of the myocardial segments corresponded to the lesion vessel were descending, while T-LS were ascending along with the increasing of the grade of setenosis, especially on the severe narrowed group. Conclusion： 3D-STI is feasible for the assessment of left ventricular regional longitudinal systolic function in patients with different graded coronary artery stenosis and can provide some supports for the diagnosis of CHD by noninvasive technique.