人体冠状动脉三维可视化模型在经胸实时三维超声心动图诊断冠心病中的应用

目的：将人体冠状动脉三维可视化模型应用于经胸实时三维超声心动图（RT-3DE-TTE）诊断冠心病中,探讨人体冠状动脉三维可视化模型在RT-3DE-TTE定位诊断病变冠脉中的应用价值.方法：选择西南医院心内科收治的心脏病患者182例,均有明确冠心病史或临床疑诊为冠心病.应用实时三维超声心动图技术对该182例冠心病患者进行检测,使用Qlab 3DQA软件得出182例患者的左室17节段时间-容积曲线和牛眼图,同时应用人体冠状动脉三维可视化模型分析病变节段所对应的病变冠脉.所有患者均于超声心动图检查后行冠脉造影术,将造影结果与实时三维超声心动图作对比研究.结果：182例临床疑诊冠心病患者经冠脉造影证实158例为冠心病.与冠脉造影结果对照,实时三维超声心动图的17节段时间-容积曲线和牛眼图均可直接显示冠心病患者运动异常的心肌节段,包括狭窄程度〈90%的患者.同时冠状动脉三维可视化模型能清晰显示冠状动脉及其分支的二维和三维立体结构,并显示RT-3DE-TTE左室立体17节段与冠状动脉及其三级分支供血关系.二者结合诊断单支病变的灵敏性〉80%,特异性〉90%,多支病变灵敏性〉87%,特异性〉70%.结论：人体冠状动脉三维可视化模型能明确冠脉分支与节段心肌的供血关系,有利于经胸实时三维超声心动图技术准确定位诊断病变冠脉.

Value of Coronary Artery Three-dimensional (3D) Visible Models in Diagnosing Coronary Heart Disease Using Real-time Three-dimensional Transthoracic Echocardiography

Objective： To discuss the value of real-time three-dimensional transthoracic echocardiography （RT-3DE-TTE） in diagnosis of coronary heart disease （ CHD ） using coronary artery three-dimensional （3D） visible models. Methods： RT-3DE-TTE was used to examine 182 patients who had definite history of CHD or were diagnosed as suspensive CHD. Then Qiab 3DQA was used to educe their 17-segment time-volume curves and illustration of the Bull Eye （IBE）. At the same time, pathological coronary arteries related abnormal segments were analyzed using coronary artery threedimensional visible models. All patients were then examined by coronary angiography （ CAG ） , and the results of CAG were compared with RT-3DE-TTE. Results： One hundred and fifty-eight patients were diagnosed as CHD by CAG. 17-segment time-volume curves and IBE of RT-3DE-TTE could show abnormally moving segments of left ventricular directly even the stenosis degree of coronary artery was less than 90%. Coronary artery three-dimensional visible models could clearly display the two and three-dimensional structures of coronary arteries and its branches, and the blood-supply relations of the coronary arteries and its third grade branches to the left ventricular 17 segments of RT-3DE-TTE. So according to the relationship of coronary arteries and left ventricular, the abnormal arteries can be deduced. Compared with CAG, when only a single coronary artery branch had stenosed, the sensitivities and specificities of RT-3DE were more than 80% and 90%. When two or three coronary artery branches had stenosed, the sensitivity and specificity of RT-3DE were more than 87% and 70%. Conclusion Coronary artery three-dimensional visible models could identify the blood-supply relations of the coronary arteries and its branches to the myocardium of left ventricular segments. It could be helpful for accurate diagnosis of the pathological coronary arteries using RT-3DETTE.