三维斑点追踪技术评价冠状动脉狭窄患者左心室局部和整体收缩功能

目的 探讨三维斑点追踪成像(3D-STI)技术早期检测冠状动脉狭窄患者左心室局部和整体收缩功能的价值.方法 收集46例冠状动脉狭窄(冠状动脉狭窄组)和33例可疑冠状动脉狭窄患者(对照组),经胸采集左心室全容积三维动态图像,测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、心输出量(CO)、每搏量(SV)、左心室舒张末期质量(LVEDMass)、左心室收缩末期质量(LVESMass)、左心室射血分数(LVEF)及整体长轴应变(GPSL),获得左心室17个心肌节段的节段性面积应变值(AS)及整体面积应变均值(GAS);比较两组间及缺血和非缺血心肌节段上述指标差异,对GAS和LVEF进行相关性分析.结果 剔除图像不清晰病例,最终冠状动脉狭窄组41例,对照组30例.冠状动脉狭窄组GPSL和GAS均低于对照组 (P均<0.05).冠状动脉狭窄组缺血心肌节段AS较非缺血心肌节段和对照组心肌节段均明显减低(P均<0.01),冠状动脉狭窄组非缺血心肌节段和对照组心肌节段AS差异无统计学意义(P>0.05).GAS与LVEF呈负相关(r=-0.720,P<0.01).结论 3D-STI可通过测量不同心肌节段面积应变早期评价冠状动脉狭窄患者心肌收缩功能的变化.

Three-dimensional speckle tracking in evaluation on global and regional left ventricular systolic function in patients with coronary stenosis

Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI) on early assessment of global and regional left ventricular systolic function in patients with coronary stenosis. Methods Totally 46 patients with coronary stenosis confirmed by CTCA (coronary stenosis group) and 33 suspected patients (control group) underwent 3D-STI. Real-time three dimensional full volume of the left ventricle was obtained, while left ventricular end-diastolic volume, left ventricular end-systolic volume, cardiac output, stroke volume, left ventricular end-diastolic mass, left ventricular end-systolic mass, left ventricular ejection fraction (LVEF) and global longitudinal peak systolic strain (GPSL) were measured. Regional area strain (AS) of 17 myocardial segments and global area strain (GAS) were also measured. The correlation between LVEF and GAS was studied. Results The cases with unclear images were rejected, and there were 41 cases enrolled in coronary stenosis group and 30 enrolled in control group at last. GPSL and GAS in coronary stenosis group were lower than those in control group (both P<0.05). AS of ischemic myocardial segments in coronary stenosis group was significantly lower than that of non-ischemic myocardium segments in coronary stenosis group and myocardial segments in control group (both P<0.01). There was no significant difference of AS between non-ischemic myocardium segments in coronary stenosis group and myocardial segments in control group (P>0.05). There was significant negative correlation between GAS and LVEF (r=-0.720, P<0.01). Conclusion 3D-STI can evaluate the changes of early myocardial systolic function in patients with coronary stenosis by assessing AS of different myocardial segments.