三维斑点追踪技术评价冠心病早期患者左室局部收缩功能

目的应用三维斑点追踪技术(3D-STE)观察冠状动脉粥样硬化性心脏病(冠心病)早期患者左心室各节段面积应变峰值及达峰时间,评价其左室局部收缩功能。方法选取2017年7月至2018年6月就诊于青岛市市立医院拟诊断为冠心病患者118例,根据冠脉造影检查选出病例组35例和对照组30例,其中病例组分为三组,左前降狭窄组(LAD)15例,左回旋狭窄组(LCX)11例,右冠脉狭窄组(RCA)9例。经胸采集心尖四腔心切面的左室全容积三维动态图像存储,应用3DT分析软件进行脱机分析,得出左心室16节段的面积应变峰值(PAS)及整体面积应变峰值(PAS-glo),左心室16节段面积应变达峰时间(TAS)及整体面积应变达峰时间(TAS-glo)。比较冠心病患者与正常对照组上述指标之间的差异。结果病例组与正常对照组的面积应变曲线的形态和走形趋势基本一致。与正常组比较,病例组狭窄冠脉所对应支配的节段面积应变峰值明显降低,达峰时间延长,差异有统计学意义(P均<0.05)。LAD组前间隔基底段、前间隔中间段、室间隔中间段的PAS降低,前壁基底段、前间隔基底段、前壁中间段、前间隔中间段、室间隔中间段的TAS延长;LCX组后壁基底段、侧壁基底段、后壁中间段的PAS降低,后壁基底段、下壁基底段、后壁中间段、侧壁中间段的TAS延长;RCA组室间隔基底段、下壁中间段的PAS降低,室间隔基底段、下壁基底段、下壁中间段TAS延长。整体面积应变与正常组相比无明显降低,差异无统计学意义(P>0.05)。结论三维斑点追踪技术可以准确评价冠心病早期患者的左室局部应变的异常,从而评价其左室局部收缩功能。

Evaluation of left ventricular regional systolic function using three-dimensional speckle tracking in early patients with coronary heart disease

Objective To observe the peak strain of the left ventricle and the peak time of each segment of the left ventricle in patients with early coronary heart disease by using three-dimensional speckle tracking technology(3D-STE)to evaluate the left ventricular local contraction function.Methods From July 2017 to June 2018,118 cases of patients diagnosed with coronary heart disease who were diagnosed in Qingdao Municipal Hospital were selected.35 cases and 30 cases of the control group were selected based on coronary angiography.The cases were divided into three groups.There were 15 cases in the left anterior descending stenosis group(LAD),11 cases in the left circumflex stenosis group(LCX),and 9 cases in the right coronary stenosis group(RCA).The left ventricle fullvolume three-dimensional dynamic image storage of the apical four-chamber view was acquired through the chest,and the 3DT analysis software was used for offline analysis to obtain the 16-segment area strain peak(PAS)and overall area strain peak(PAS-glo),16-segment area strain peak time(TAS)and overall area strain peak time(TASglo)of the left ventricle.The differences between the above indicators of patients with coronary heart disease and the normal control group were compared.Results The shape and shape of the area strain curve of the case group and the normal control group were basically consistent.Compared with the normal group,the peak strain of the dominated segmental area corresponding to the narrow coronary artery in the case group was significantly reduced,and the peak time was prolonged,and the difference was statistically significant(all P<0.05).In the LAD group,PAS decreased in the anterior septal basal segment,anterior septal intermediate segment,and middle ventricular septal segment,and the TAS of the anterior wall basal segment,anterior septal basal segment,anterior wall intermediate segment,anterior septal middle segment,and interventricular septal segment prolonged.In the LCX group,the PAS of the posterior wall basal segment,lateral wall basal segment,and posterior middle wall segment decreased,and the posterior wall basal segment,lower wall basal segment,posterior wall intermediate segment,and posterior wall intermediate segment TAS prolonged.In the RCA group,the PAS of the interventricular septal basal segment and the lower inferior wall segment decreased,and the TAS of the interventricular septal basal segment,inferior wall basal segment,and inferior middle wall prolonged.Compared with the normal group,the overall area strain was not significantly reduced,and the difference was not statistically significant(P>0.05).Conclusion The three-dimensional speckle tracking technique can accurately evaluate the abnormalities of local left ventricular strain in patients with early coronary heart disease,and thus evaluate their local left ventricular systolic function.