应用三维斑点追踪成像技术评价冠状动脉左前降支病变患者左心室心肌纵向应变

目的探讨三维斑点追踪成像（3D-STI）技术评价冠状动脉左前降支（LAD）病变患者左心室心肌收缩末期三维纵向应变（3DLSe）的价值。 方法选择2012年6月至2014年12月台州医院收治的经冠状动脉造影确诊的单纯冠状动脉LAD病变患者60例。其中30例患者发生急性前壁心肌梗死（梗死组），余30例患者未发生急性前壁心肌梗死（非梗死组）。选择我院同期心内科住院患者60例作为对照组。应用3D-STI技术测量所有患者冠状动脉LAD供血区域、邻近区域及远隔区域3DLSe。采用单因素方差分析比较3组患者3DLSe差异，进一步组间两两比较采用LSD-t检验。采用Bland-Altman绘图分析法分析观察者内及观察者间测量左心室心肌3DLSe的一致性。 结果梗死组患者冠状动脉LAD供血区域7个节段3DLSe均低于非梗死组及对照组患者，且差异均有统计学意义（梗死组vs对照组：t值分别为6.96、7.41、8.94、8.23、8.94、12.09、15.99，P值均<0.01；梗死组vs非梗死组：t值分别为5.30、5.50、4.66、4.32、4.66、7.66、10.11，P值均<0.01）；非梗死组患者冠状动脉LAD供血区域前壁中间段、前间隔中间段、前壁心尖段、室间隔心尖段、心尖部3DLSe均低于对照组患者，且差异均有统计学意义（t值分别为3.56、3.23、3.02、3.25、4.36，P值均<0.01），而前壁基底段、前间隔基底段3DLSe差异均无统计学意义。3组患者冠状动脉LAD邻近区域下间隔基底段3DLSe差异均无统计学意义。梗死组患者冠状动脉LAD邻近区域侧壁基底段、下间隔中间段、侧壁中间段、下壁心尖段、侧壁心尖段3DLSe均低于非梗死组及对照组患者，且差异均有统计学意义（梗死组vs对照组：t值分别为4.15、4.79、4.58、9.24、12.07，P值均<0.01；梗死组vs非梗死组：t值分别为2.66、3.59、4.29、7.74、10.33，P值均<0.01）；而非梗死组与对照组患者冠状动脉LAD邻近区域侧壁基底段、下间隔中间段、侧壁中间段、下壁心尖段、侧壁心尖段3DLSe差异均无统计学意义。3组患者冠状动脉LAD远隔区域4个节段3DLSe差异均无统计学意义。Bland-Altman绘图分析结果显示，观察者内及观察者间测量左心室心肌3DLSe差值的均值分别为-0.3%、-0.2%，95%置信区间分别为（-5.6%，5.0%）、（-8.2%，7.7%），表明观察者内及观察者间测量左心室心肌3DLSe的一致性均较好。 结论左心室心肌3DLSe显示心肌收缩功能的细微变化较常规超声心动图更为敏感，并且能够对心肌缺血或梗死的部位、范围进行定位及定量分析，相关测值具有很好的一致性。

Evaluation of left ventricular longitudinal strain in patients with lesions of left anterior descending coronary artery using three-dimensional speckle tracking technique

ObjectiveTo explore the value of three-dimensional speckle tracking (3DT-STI) technique for evaluating end-systolic three-dimensional longitudinal strain (3DLSe) of left ventricular myocardium in patients with left anterior descending coronary artery (LAD) lesions. MethodsSixty patients with pure LAD lesions diagnosed by coronary artery angiography (CAG) in Taizhou Hospital from June 2012 to December 2014 were enrolled, including 30 patients with acute anterior wall myocardial infarction (infarction group) and 30 patients without acute anterior wall myocardial infarction (non-infarction group). Sixty patients in the control group were enrolled in Department of cardiology in Taizhou Hospital in the same period. 3DLSe within LAD blood-supplied region, adjacent region and remote region were analyzed in all cases using 3DT-STI. The 3DLSe differences of 3 groups were compared by one-way analysis of variance, and the 3DLSe differences between two groups were compared by the LSD-t test. The inter-observer and intra-observer consistency of 3DLSe of left ventricular myocardium were analyzed by Bland-Altman drawing analysis method. Results3DLSe of all 7 segments within LAD blood-supplied region were lower in infarction group than those of non-infarction group and control group, and the differences were statistically significant (infarction group vs. control group: t values were 6.96, 7.41, 8.94, 8.23, 8.94, 12.09 and 15.99, respectively, P values were all less than 0.01; infarction group vs. non-infarction group: t values were 5.30, 5.50, 4.66, 4.32, 4.66, 7.66 and 10.11, respectively, P values were all less than 0.01); 3DLSe of middle anterior segment, middle anterior septal segment, apical anterior segment, apical septal segment and apex of heart within LAD blood-supplied region were lower in non-infarction group than those of control group, and the differences were statistically significant (t values were 3.56, 3.23, 3.02, 3.25 and 4.36, respectively, P values were all less than 0.01), but 3DLSe of basal anterior segment and basal anterior septal segment had no statistically significant difference. 3DLSe of basal inferior septal segment within LAD adjacent region had no statistically significant difference in all 3 groups. 3DLSe of basal lateral segment, middle inferior septal segment, middle lateral segment, apical inferior segment and apical lateral segment within LAD adjacent region were lower in infarction group than those of non-infarction group and control group, and the differences were statistically significant (infarction group vs. control group: t values were 4.15, 4.79, 4.58, 9.24 and 12.07, respectively, P values were all less than 0.01; infarction group vs. non-infarction group: t values were 2.66, 3.59, 4.29, 7.74 and 10.33, respectively, P values were all less than 0.01); but 3DLSe of basal lateral segment, middle inferior septal segment, middle lateral segment, apical inferior segment and apical lateral segment within LAD adjacent region had no statistically significant difference between non-infarction group and control group. 3DLSe of all 4 segments within remote region had no statistically significant difference. Bland-Altman drawing analysis method showed the mean inter-observer and intra-observer difference of 3DLSe of left ventricular myocardium were -0.3% and -0.2%, the 95% confidence interval (CI) were in the range of (-5.6%, 5.0%) and (-8.2%, 7.7%), respectively. It was demonstrated that 3DLSe of left ventricular myocardium had good inter-observer and intra-observer consistency. Conclusions3DLSe of left ventricular myocardium can detect the subtle changes in myocardial systolic function and is more sensitive than the conventional echocardiography. It can localization and analyze quantitatively the range of myocardial ischemia or infarction and has good consistency.